Cps Statement Pneumonia
Most doctors who care for children and adolescents have experience in treating acute pneumonia. The incidence of pneumonia due to any etiology is lower in developed parts of the world than in less developed areas, as immunization coverage rates may be lower in developing areas.  Pneumococcal conjugate vaccines have been shown to reduce radiologically proven pneumonia absorption rates by an average of 27% in children under five years of age.   A chest x-ray (CXR) should always be the first imaging modality. Ultrasound provides a non-invasive, radiation-free modality to confirm the presence of suspected pleural effusion on CXR. Ultrasound can also estimate the size of the effusion and distinguish between free-flowing and localized effusions. Chest computed tomography is associated with significant radiation exposure and generally does not alter treatment or predict outcomes. therefore, this should not be done systematically. However, chest computed tomography should be considered if another diagnosis, such as a . B a malignant tumor, is suspected. Repeated CXRs are not necessary unless clinical deterioration is evident.
If drainage of the liquid is clinically indicated, the liquid should be sent to the bacterial culture. The yield of pleural fluid cultures is low, since most children have already received antibiotics; However, molecular tests, such as pneumococcal polymerase chain reaction, can increase yield if available . Blood cultures are positive only in a minority of cases (approx. 10%), but they should be collected prior to antibiotic administration to potentially guide the selection of antibiotics for children who are sick enough to be hospitalized for pneumonia . Sputum culture is sometimes useful when available, but it`s usually hard to find. However, molecular diagnostic tests for pleural fluid are generally not available and often confirm S. pneumonia . Children with complicated pneumonia have many symptoms and signs of uncomplicated pneumonia, including tachypnea, fever, cough, and shortness of breath. The patient may have complicated pneumonia or initially uncomplicated pneumonia that responds poorly to antibiotics (persistent fever after 48 to 72 hours of antibiotics without clinical improvement, persistent shortness of breath or worsening and/or hypoxia or new clinical results of pleural effusion). The results of the examination consistent with pleural effusion include a decrease in respiratory sounds, a decrease in chest expansion and dullness up to percussion on the affected side.
Keywords: antimicrobial therapy; Bacterial pneumonia; Viral pneumonia Children with respiratory failure or septic shock associated with pneumonia should receive empirical treatment with third-generation cephalosporin, as it offers wider coverage. Ceftriaxone or cefotaxime offer better coverage than amoxicillin or ampicillin for beta-lactamase-producing H-flu and may be more effective against high-level penicillin-resistant pneumococci – and potentially provide empirical coverage for rare methicillin-prone urea S (a rare cause of pneumonia).  However, when rapidly progressing multilobular disease or pneumatocele is present, the addition of vancomycin is empirically proposed to provide additional coverage for MRSA until culture results are available. If the results of microbiological studies do not show a pathogen in these patients, the transition to ampicillin with subsequent oral amoxicillin makes sense. In Canada, it is still common to treat suspected uncomplicated bacterial pneumonia in children hospitalized for a total of seven to 10 days. In a recent study, five days seemed sufficient for outpatient pneumonia.  Pneumonia complicated by the formation of empyema or abscesses requires a longer duration of treatment, determined by the clinical course (usually two to four weeks). Progressive oral treatment is usually appropriate once patients are improved, brainless, and ready to discharge from the hospital. .