PCAP Guideline Flashcards by Sam James

The most common cause of PCAP

bacterial vs viral

bacterial

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bacterial etiologies of PCAP

Step. Pneumonia > H. Influenzae > Mycoplasma > Chlamydia

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PCAP A Management

OPD

follow up at the end of treatment

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PCAP B

OPD

Follow up after 3 days

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PCAP C Management

Admit to wards

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PCAP D

Admit to ICU

Refer to specialist

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PCAP A

minimal

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PCAP B

Low

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PCAP C

Moderate

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PCAP D

High

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Compliant caregiver

PCAP A +
PCAP B +
PCAP C -
PCAP D -

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Ability to follow up

PCAP A +
PCAP B +
PCAP C None
PCAP D None

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Dehydration

PCAP A None
PCAP B Mild
PCAP C Moderate
PCAP D Severe

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Feeding

PCAP A Yes
PCAP B Yes
PCAP C No
PCAP D No

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Age

PCAP A >11 months
PCAP B > 11 months
PCAP C <11 months
PCAP D < 11 months

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PCAP A

2-12 mos >/= 50
1-5 yrs >/=40
> 5 yrs >/=30

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PCAP B

2-12 mos >50
1-5 yrs >40
>5 yrs >30

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PCAP C

2-12 mos >60
1-5 yrs >50
>5 yrs >35

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PCAP D

2-12 mos >70
1-5 yrs >50
>5 yrs >35

PCAP

Retractions

PCAP C - intercostal/ subcostal

PCAP D - supraclavicular

Head bobbing

PCAP A -
PCAP B -
PCAP C +
PCAP D +

Cyanosis

PCAP A
PCAP B
PCAP C +
PCAP D +

Grunting

PCAP A
PCAP B
PCAP C
PCAP D +

Apnea

PCAP A
PCAP B
PCAP C
PCAP D +

Sensorium

PCAP A - Awake PCAP B - Awake PCAP C -Irritable PCAP D - Lethargic/ stuporous/ Comatose

Complications

PCAP A PCAP B PCAP C + PCAP D +

Diagnostic aids

PCAP A/ B - none, managed on outpatient basis Routine exam for PCAP C/ D - CXR PAL - WBC count - Culture and sensitivity: blood (PCAP D), pleural fluid, ETA upon intubation - Blood gas/ O2 sat Sputum CS - older children ESR CRP - not routinely requested

BPS score in hospitalized patients 1 month - 5 years

BPS >/= 4

Increase agge =

higher chance of bacterial pathogen, inc frequency of atypical organism

predictors of bacterial pathogen

hospitalized patients 1 month – 5 years increase age decreased breath sounds

Antibiotics recommended in

1. PCAP A/B - beyong 2 yrs of age, high grade fever without wheeze 2. PCAP C- beyond 2 yrs of age, high grade fever without wheeze, having alveolar consolidation in chest xray, WBC count > 15000 3. PCAP D

Empiric treatment | PCAP A or B w/o previous antibiotic

Amoxicillin 45 mg/kg/day in 3 divided doses x 3 days (minimum) if hypersensitive to amoxicillin - macrolide Other regimens: cotrimoxazole, azithromycin, erythromycin, co-amoxiclav, clarithromycin

PCAP C w/o previous antibiotic | complete immunization against Hib

Pen G 100, 000 u/kg/day oral amox- can tolerate feeding ( comparable to parenteral penicillin)

PCAP w/o Hib immunization

IV Ampicillin 100 mg/kg/day in 4 divided doses -monotherapy/ combination + chloramphenicol in patients who cannot tolerate feeding other regiments: amoxicillin / sulbactam, cefuroxime, chloramphenicol

PCAP D

consult a specialist

CA- MRSA suspected

refer to specialist

Clinical management of MRSA

follow antibiotic susceptibility based on culture studies Vancomycn - 1st line CA MRSA- synergisticaly inhibited y vancomycin + gentamicin

initial treatment viral

ancillary tx | oseltamivir 2 mg/kg/dose BID x 5 days

response to antibiotics

improved RR < age specific range | - without chest indrawing, or any danger signs (central cynosis, inability to drink, abnormally sleepy, convulsions_

treatment failure

same RR > age specific range without chest indrawing or any danger signs worse- developed chest indrawing or any danger signs

PCAP A/ B not responding to antibiotics within 72 hours consider

change initial antibiotic start oral macrolide re-evaluate diagnosis

causes of tx failure

coinfection with RSV | nonadherence to tx

PCAP C not responding

penicillin resistant strep presence of pulmonary or extrapulmonary complications or other diagnosis

causes tx failuure PCAP C

antibiotic resistance clincal sepsis progressive pneumonia mixed infection

if PCAP D not responding to antibiotiics

immediate reconsultation with a specialist