Pneumonia – Paeds

CAP is far less common than URTI’s, however, it needs to be considered within your differentials. Depending on severity there is a guide to investigation and treatment.

Clinical Features Typically

  • Cough
  • Fever
  • Breathing difficulties
  • Tachypnoea

Uncommon

  • Wheeze
  • Chest pain
  • Abdo pain
  • Vomit
  • Headache

Mycoplasma

  • Cough
  • Wheeze
  • Chest pain/Arthralgia
  • Symptoms worse than signs

Severity

mild-moderate

  • Infant: Temp <38.5, RR <50, Mild recession, Taking full feeds
  • Child: Temp<38.5,  RR <50,  Mild breathless,  No vomiting

severe

  • Infant: Temp >38.5, RR >70, Mod-Severe recession, Nasal flaring, Cyanosis, Apnoea, Grunting, Not feeding, Tachycardia, CRT >2 seconds
  • Child: Temp >38.5, RR >50, Severe Resp. distress, Nasal flaring, cyanosis, Grunting, Signs of dehydration, Tachycardia, CRT >2 seconds

Management

mild-moderate – Investigations are not normally required

  • Amoxicillin or Azithromycin
  • Arrange open access with paediatrics
  • Advice
    • Return if deteriorating
    • No improvement at 48Hours
      • GP review
      • Add Azithromycin for 3 days

Under 2

  • Not normally bacterial
  • If has pneumococcal vaccine treat for viral.
  • Arrange contact with community nursing team [via Paeds.]

severe – Admit child to paediatrics

Investigations

  • Chest X-Ray
  • FBC/U&E/CRP
  • Blood Culture

Management

  • Oxygen [maintain SaO >92%]
  • IV Fluids as required
  • Analgesic/Antipyretic
  • Antibiotics
    • Oral Amoxicillin or Azithromycin [Prefered]
    • IV therapy if; Septic or oral not tolerated o Consider adding Azithromycin if mycoplasma suspected
    • If History of Influenza prior, Co-Amoxiclav [Staphylococcus cover]

Antibiotic Guidance

 

PDF:cap pead

Leave a Reply

Your email address will not be published. Required fields are marked *

5 + seven =

This site uses Akismet to reduce spam. Learn how your comment data is processed.