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PCAP

CLINICAL MANAGEMENT
PGI Eileen Andres
Pediatrics

WHEN IS ANTIBIOTIC
RECOMMENDED?

PCAP A/PCAP B may be considered if patient

Beyond 2 years of age


With high grade fever without wheezing

PCAP C

Should administer if alveolar consolidation on CXR


May be administered if patient has any of the ff:

Elevated serum C-reactive protein


Elevated serum procalcitonin level
Elevated white cell count
High grade fever without wheeze
Beyond 2 years of age

PCAP D should refer to specialist

EMPIRIC TREATMENT IF
BACTERIAL ETIOLOGY?

PCAP A/PCAP B w/o previous antibiotic:

Amoxicillin (40-50 mg/kg/day) TID


Azithromycin (10 mg/kg/day then 5 mg/kg/day) OD or
Clarithromycin (15 mg/kg/day) BID

PCAP C w/o previous antibiotic:

requiring hospitalization and HiB immunization


completed: PCN G IV (100,000 IU/k/d) QID
requiring hospitalization and HiB immunization not
completed or unknown: Ampicillin (100 mg/kg/day)
QID
above15 years of age:
Parenteral non-antipseudomonal -lactam + extended
macrolide
Parenteral non-antipseudomonal -lactam + respiratory
fluoroquinolone

EMPIRIC TREATMENT IF
BACTERIAL ETIOLOGY?

PCAP C w/o a previous antibiotic:

And can tolerate oral feeding and does not


require oxygen support:
Amoxicillin

(40-50 mg/kg/day) TID may give as OPD

PCAP C and severely malnourished or


suspect MRSA or classified as PCAP D refer
to specialist
Patient established to have Mycobacterium
tuberculosis infection or disease, should start
antituberculous drugs

INITIAL TREATMENT IF VIRAL


ETIOLOGY?

Oseltamivir (30 mg for 15 kg body wt,


45 mg for 15-23 kg, 60 mg for 23-40 kg,
75 mg for >40 kg)
Immunomodulators for viral pneumonia
not recommended
Ancillary treatment

IF NO RESPONSE TO CURRENT
ANTIBIOTIC TREATMENT?

If outpatient PCAP A/PCAP B not responding w/in 72


hrs:

If inpatient PCAP C not responding w/in 72 hrs

Change initial antibiotic


Start oral Macrolide
Reevaluate diagnosis
Reevaluate diagnosis
Change initial antibiotic
Start oral Macrolide
May refer to specialist

If inpatient PCAP D not responding w/in 72 hrs, then


immediate consult to a specialist is warranted

WHEN TO SWITCH THERAPY IN


BACTERIAL PNEUMONIA?

PCAP C:

Switch from IV to oral form 3 days if patient:


Responds

to treatment
Tolerance to feeding and without vomiting or
diarrhea
Without any current pulmonary or extrapulmonary
complications
Without oxygen support

Switch from 3 days parenteral ampicillin to:


Amoxicillin

(40-50 mg/kg/day) for 4 days

PCAP D refer to specialist

ANCILLARY TREATMENT

PCAP A/PCAP B

PCAP C

Bronchodilator in presence of wheezing


Oxygen and hydration
Bronchodilator in presence of wheezing
Probiotic

PCAP D refer to specialist

HOW TO PREVENT
PNEUMONIA?

Should be given

Vaccine against

Micronutrient

Elemental zinc for ages 2-59 months for 4-6 months

May be given

Micronutrient

Streptococcus pneumonia (conjugate type)


Influenza
Diphtheria, Pertussis, Rubeola, Varicella, Haemophilus
Influenzae type b

Vitamin D3 supplementation

Should not be given

Vitamin A