Outpatient Treatment of Community-AcquiredPneumonia in Children

Yıl 2016, Cilt: 8 Sayı: 3, 17 - 24, 05.05.2016

Uzm. Dr. Melda Çelik

Öz

Abstract

Community-acquired pneumonia (CAP) is a public health problem all over theworld, that is a significant cause of respiratory morbidity and mortality especiallyin children under age 5 living in developing countries. CAP is the leading cause of death worldwide in children younger than 5 years old.Clinical findings of the patients are important in the diagnosis of CAP in children. Common symptoms include fever, tachypnea, increased respiratory effort, rhonchi, crackles and wheezing. Hydration status, activity level and oxygen saturation ofthe patient are also important and may indicate the need for hospitalization.The outpatient administration of empirical oral antimicrobial treatment is oftenplanned in order to provide an effective treatment against the bacterial pathogens thatare the most common causes of lower respiratory tract infection and especially against S. pneumoniae, a bacterial pathogen, which if untreated or inadequately treated, can cause severe sequels. In this article, the most common pathogens, diagnostic criteria and empirical and agentspecific outpatient treatment options for pediatric patientsdiagnosed with community-acquired pneumonia with noindication of hospitalization have been described.

Anahtar Kelimeler

Antimicrobial, community-acquired pneumonia, outpati-ent, pediatric

Çocukluk Çağında Toplum KökenliPnömoninin Ayaktan Tedavisi

Öz

Öz

Toplum kökenli pnömoni (TKP) tüm dünyada özellikle gelişmekte olan ülkelerde yaşayan 5 yaşın altındaki çocuklarda önemli düzeyde solunumsal morbidite vemortalite nedeni olan bir halk sağlığı sorunudur. TKP dünya çapında 5 yaşından küçük çocuklarda önde gelen ölüm nedenidir. Çocuklarda TKP tanısında hastaların klinik bulguları önemlidir. Sık rastlanan bulgular arasında ateş, takipne, artmış solunum çabası, ronkuslar, raller ve vizing yeralır. Hidrasyon durumu, aktivite düzeyi ve oksijen satürasyonu da önemlidir ve hastaneye yatma ihtiyacını gösterebilir.Ayaktan verilen ampirik oral antimikrobiyal tedavi alt solunum yolu enfeksiyonlarının en sık nedeni olan bakteriyel patojenlere ve özellikle de tedavi edilmediğinde veya yetersiz tedavide ağır sekele yol açabilecek bir bakteriyel patojen olan S. pneumoniae’ya karşı etkili bir tedavi sağlamaya yönelik olarak planlanmaktadır. Bu yazıda toplum kökenli pnömoni tanısı konulan ancak hastaneye yatış endikasyonu ol-mayan çocuk hastalarda en sık rastlanan etkenler, tanı kriterleri ve ampirik ve etkene yönelik ayaktan tedavi seçenekleri anlatılmıştır.

Anahtar Kelimeler

Antimikrobiyal, ayaktan, çocuk, toplum kökenli pnömoni

Kaynakça

• Kaynaklar 1.Schauner S, Erickson C, Fadare K, Stephens K. Community-ac-quired pneumonia in children: a look at the IDSA guidelines. JFam Pract 2013; 62 (1): 9-15. 2.Black RE, Cousens S, Johnson HL, et al.; Child Health Epide-miology Reference Group of WHO and UNICEF. Global, regio-nal, and national causes of child mortality in 2008: a systema-tic analysis. Lancet 2010; 375 (9730): 1969-87. 3.Jadavji T, Law B, Lebel MH, Kennedy WA, Gold R, Wang EE.A practical guide for the diagnosis and treatment of pediatric pneu-monia. CMAJ 1997; 156 (5): S703-S711. 4.Kumar S, Wang L, Fan J, et al. Detection of 11 common viral andbacterial pathogens causing community-acquired pneumonia orsepsis in asymptomatic patients by using a multiplex reverse trans-cription-PCR assay with manual (enzyme hybridization) or au-tomated (electronic microarray) detection. J Clin Microbiol 2008;46 (9): 3063-72. 5.Michelow IC, Olsen K, Lozano J, et al. Epidemiology and clini-cal characteristics of community-acquired pneumonia in hospi-talized children. Pediatrics 2004; 113 (4): 701-707. 6.Williams JV, Harris PA, Tollefson SJ, et al. Human metapneu-movirus and lower respiratory tract disease in otherwise healthyinfants and children. N Engl J Med 2004; 350 (5): 443-50. 7.Cincinnati Children’s Hospital Medical Center. Evidence-basedcare guideline. Community acquired pneumonia in children 60days through 17 years of age. http://www.cincinnatichildrens.org/service/j/ anderson-center/ evidence-based-care/ community-acquired-pneumonia. Accessed February 14, 2012. 8.Black S, Shinefield H, Baxter R, et al. Postlicensure surveillan-ce for pneumococcal invasive disease after use of heptavalent pneu-mococcal conjugate vaccine in Northern California Kaiser Per-manente. Pediatr Infect Dis J 2004; 23 (6): 485-89. 9.Kallen AJ, Reed C, Patton M, Arnold KE, Finelli L, Hageman J.Staphylococcus aureus community-onset pneumonia in patientsadmitted to children’s hospitals during autumn and winter of 2006-2007. Epidemiol Infect 2010; 138 (5): 666-72. 10.Stankovic C, Mahajan PV, Asmar BI. Methicillin-resistantStaphylococcus aureus as a cause of community-acquired pneu-monia. Curr Infect Dis Rep 2007; 9 (3): 223-27. 11.Finelli L, Fiore A, Dhara R, et al. Influenza-associated pediat-ric mortality in the United States: increase of Staphylococcus au-reus coinfection. Pediatrics 2008; 122 (4): 805-11. 12.Hageman JC, Uyeki TM, Francis JS, et al. Severe community-acquired pneumonia due to Staphylococcus aureus, 2003-04 in-fluenza season. Emerg Infect Dis 2006; 12 (6): 894-99. 13.Taylor JA, Del Beccaro M, Done S, Winters W. Establishing clini-cally relevant standards for tachypnea in febrile children youngerthan 2 years. Arch Pediatr Adolesc Med 1995; 149 (3): 283-87. 14.Margolis P, Gadomski A. The rational clinical examination. Doesthis infant have pneumonia? JAMA 1998; 279 (4): 308-13. 15.Swingler GH, Hussey GD, Zwarenstein M. Randomised control-led trial of clinical outcome after chest radiograph in ambula-tory acute lower-respiratory infection in children. Lancet 1998;351 (9100): 404-408. 16.World Health Organization. The Management of Acute Respira-tory Infections in Children: Practical Guidelines for OutpatientCare. Geneva, Switzerland: World Health Organization; 1995. 17.Harper SA, Bradley JS, Englund JA, et al. Seasonal influenza inadults and children—diagnosis, treatment, chemoprophylaxis, andinstitutional outbreak management: clinical practice guidelinesof the Infectious Diseases Society of America. Clin Infect Dis 2009;48 (8): 1003-32. 18.American Academy of Pediatrics Subcommittee on Diagnosis andManagement of Bronchiolitis. Diagnosis and management ofbronchiolitis. Pediatrics 2006; 118 (4): 1774-93. 19.Virkki R, Juven T, Rikalainen H, Svedström E, Mertsola J, Ru-uskanen O. Differentiation of bacterial and viral pneumonia inchildren. Thorax 2002; 57 (5): 438-41. 20.Hickey RW, Bowman MJ, Smith GA. Utility of blood cultures in pediatric patients found to have pneumonia in the emergency de-partment. Ann Emerg Med 1996; 27 (6): 721-25. 21.Alberta Clinical Practice Guidelines Steering Committee. Gui-deline for the diagnosis and management of community acqui-red pneumonia: pediatric. 2008 update. http://www.topalberta-doctors.org/cpgs. php?sid=15&cpg_cats=61. Accessed January10, 2012. 22.Devitt M. PIDS and IDSA issue management guidelines for com-munity-acquired pneumonia in infants and young children. AmFam Physician. 2012; 86 (2): 196-202. 23.Bradley JS, Byington CL, Shah SS, et al. Executive Summary: TheManagement of Community-Acquired Pneumonia in Infantsand Children Older Than 3 Months of Age: Clinical Practice Gui-delines by the Pediatric Infectious Diseases Society and the In-fectious Diseases Society of America. Clin Infect Dis 2011; 53(7): 617–30. doi: 10.1093/cid/cir625. 24.Bradley JS, Garonzik SM, Forrest A, et al. Pharmacokinetics, phar-macodynamics, and Monte Carlo simulation: selecting the bestantimicrobial dose to treat an infection. Pediatr Infect Dis J 2010;29: 1043–46. 25.Harrison CJ, Woods C, Stout G, et al. Susceptibilities of Haemop-hilus influenzae, Streptococcus pneumoniae, includingserotype19A, and Moraxella catarrhalis paediatric isolatesfrom 2005 to 2007 to commonly used antibiotics. J AntimicrobChemother 2009; 63: 511–19. 26.Sader HS, Jacobs MR, Fritsche TR. Review of the spectrum andpotency of orally administered cephalosporins and amoxicillin/clavulanate. Diagn Microbiol Infect Dis 2007; 57: 5S–12S. 27.Mulholland S, Gavranich JB, Chang AB. Antibiotics for commu-nity acquired lower respiratory tract infections secondary toMycoplasma pneumoniae in children. Cochrane Database SystRev 2010; 7:CD004875. 28.Matsubara K,Morozumi M, Okada T, et al. A comparative cli-nical study of macrolide-sensitive and macrolide-resistantMycoplasma pneumoniae infections in pediatric patients. J In-fect Chemother 2009; 15: 380–83. 29.Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Disea-ses Society of America/American Thoracic Society consensus gui-delines on the management of community-acquired pneumoniain adults. Clin Infect Dis 2007; 44 (Suppl 2): S27–72. 30.Plouffe JF. Importance of atypical pathogens of community-ac-quired pneumonia. Clin Infect Dis 2000; 31 (Suppl 2): S35–39. 31.Bradley JS, Arguedas A, Blumer JL, et al. Comparative study oflevofloxacin in the treatment of children with community-acqui-red pneumonia. Pediatr Infect Dis J 2007; 26: 868–78. 32.Burillo A, Bouza E. Chlamydophila pneumoniae. Infect Dis ClinNorth Am 2010; 24: 61–71. 33.McGeer A, Green KA, Plevneshi A, et al. Antiviral therapy andoutcomes of influenza requiring hospitalization in Ontario, Ca-nada. Clin Infect Dis 2007; 45: 1568–75.