Pediatric Coughs: Pneumonia
Valeria Wu, MD
Presentation: cough, fever, tachypnea, and respiratory distress
Diagnosis: Clinical, look out for fine crackles, tachypnea, decreased breath sounds, desaturation, chest indrawing, lethargy, fever / radiograph can help support but not gold standard
Treatment: Supportive. Antipyretics, hydration. If bacterial, consider the following:
< 1 month: ampicillin + gentamicin/3rd gen cephalosporin (NOT ceftriaxone)
1 -3 month: erythromycin or clarithromycin (NOT azithromycin)
3 mo - 5 yr: high dose amoxicillin or 3rd gen cephalosporin
5 + : macrolide (add beta lactam or 3rd gen cephalosporin if resistance is high)
General recommendations - escalate for more sick kids and consider local resistance!
Take note: Young infants can have concurrent UTI. Full sepsis work up for neonates! Well appearing kids may just have viral pneumonia.
Overmann KM, Florin TA. Pneumonia in Infants and Children. In: Tintinalli JE, Ma O, Yealy DM, Meckler GD, Stapczynski J, Cline DM, Thomas SH. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 9e. McGraw-Hill; Accessed October 29, 2020.
Photo: Case courtesy of Dr Jeremy Jones, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/27245">rID: 27245</a>