Post on 28-Dec-2015
transcript
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!!!!