PHARMACOLOGY CONFERENCE

GUIANG, Ada; GUEVARRA, Biancarita; GERONIMO, Cherry; GERONIMO, Maria Angelica;

GERONIMO, Ralph

• History and PE – Ada– General Data, History, PE and Salient Features

• Approach to the diagnosis - Bianca, Cherry– Presenting Manifestations– Working Impression– Differential DX (?) - brief lang– Brief Disc of the Final Diagnosis

• Confirmation of the Working Dx - Ange and Ralph– Work-ups– Pharma

CONFIRMATION OF THE WORKING DIAGNOSIS

Diagnosis• Chest x-ray is considered the gold standard for

the diagnosis of pneumonia• Confluent lobar consolidation is typically seen

with pneumococcal pneumonia • Indicates complications PCAP such as a pleural

effusion or empyema• CXR alone is not diagnostic and other clinical

features must be considered• Repeat CXR are not required for proof of cure for

patients with uncomplicated pneumonia

Diagnosis• Pulse oximetry is recommended in any child with

signs of tachypnea or clinical hypoxemia• CBC

• Culture of sputum is of little value in the diagnosis of pneumonia in young children

• Blood cultures are positive in only 10% of children with pneumococcal pneumonia

Bacterial Viral

WBC 15,000 – 40,000 WBC < 20,000

Granulocytes Lymphocytes

In our patient...

• CBC & platelet• Chest X ray• PDD test

CBC

CXR

• Infiltrates both parahilar and left lower lobe and retrocardiac

• Air bronchogram• Nodular densities with confluence at paratracheal and

peribronchial region

PDD Test

Need for Hospitalization of PCAP• Age <6 mo • Sickle cell anemia with acute chest syndrome• Multiple lobe involvement• Immunocompromised state• Toxic appearance• Severe respiratory distress • Requirement for supplemental oxygen • Dehydration • Vomiting • No response to appropriate oral antibiotic therapy • Noncompliant parents

Nelson Textbook of Pediatrics, 18th ed.

Antibiotic Management• Choice of antibiotics – Age – Clinical presentation – Local resistance patterns of predominant bacterial

pathogens• Oral antibiotic therapy provides adequate

coverage for most patients with pneumonia treated as out-patients

• Parenteral therapy is typically reserved for neonates and patients with pneumonia severe enough to warrant admission to hospital

PPS Clinical Practice Guideline for PCAP 2004

PPS Clinical Practice Guideline for PCAP 2004

PPS Clinical Practice Guideline for PCAP 2004

Empirical Antibiotic of Choice

• Suspected bacterial pneumonia in a hospitalized child

• Mainstay - Parenteral cefuroxime (150 mg/kg/24 hr), cefotaxime, or ceftriaxone

Empiric Antibiotic

Empiric Antibiotic

Empiric Antibiotic

Management

• No cough preparations needed

Supportive Care/ Ancillary Treatment

• Among inpatients, oxygen and hydration may be given if needed

• No routine chest physiotherapy• Nebulization with normal saline solution• Bronchodilators

Philippine Pediatric Society (PPS). Clinical Practice Guideline in the Evaluation and Management of Pediatric Community Acquired Pneumonia (Immunocompetent Filipino

Children Aged 3 months to 19 years). 2004.

In our patient...• Cefuroxime 500mg/slow IV infusion initially 15-30minutes

then every 8 hours• Salbutamol nebulization every 6 hours• Paracetamol 250/5mL, 3mL every 4 hours for temperature

≥38.5˚C• IVF D5 0.3 NaCl 500mL 11-12 gtts/min• 0.65% NaCl drops, 3 drops/nostril every 6 hours then

suction of secretions • Preventive plans• Watch out for cyanosis, retraction, persistent tachypnea

Monitoring Response • Improvement in clinical symptoms (fever, cough, tachypnea, chest pain) within 48–

96 hr of initiation of antibiotics• Radiographic evidence of improvement substantially lags behind clinical

improvement• No follow-up laboratory required • When a patient does not improve on appropriate antibiotic therapy (slowly resolving

pneumonia)• Complications• Bacterial resistance• Nonbacterial etiologies such as viruses and aspiration of foreign bodies or

food• Bronchial obstruction from endobronchial lesions, foreign body, or mucous

plugs• Pre-existing diseases such as immunodeficiencies, ciliary dyskinesia, cystic

fibrosis, pulmonary sequestration, or cystic adenomatoid malformation****A repeat chest x-ray is the 1st step in determining the reason for delay in

response to treatment.

Streamlining of Antibiotic

• In selected patients, switch to oral therapy when signs of infection are resolving after 2-3 days

• Patients with symptom resolution, ability to feed and absence of complications

Philippine Pediatric Society (PPS). Clinical Practice Guideline in the Evaluation and Management of Pediatric Community Acquired Pneumonia (Immunocompetent Filipino

Children Aged 3 months to 19 years). 2004.

THANK YOU!!!!