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1、Franois Boucher MD, FRCPCCommunity acquired pneumonia (CAP): Why is this still a problem?ObjectivesAfter this presentation, participants will be able to: Determine appropriate agents, routes and duration of treatment.Recognize how local epidemiology influences treatment choices.Manage complications
2、of CAP.Emergent problems in pediatric community-acquired pneumoniaSevere pneumonia Pulmonary abscess formation: GAS Pulmonary necrosis 53:e25Incidence in Canadian children41,000 children 7 years oldIDSA Pediatric Community Pneumonia Guidelines. CID 2011;53:e25Management of CAP: Antibiotic therapy In
3、patient (All ages)Presumed bacterial pneumonia Ampicillin or penicillin G; alternatives: ceftriaxone or cefotaxime; addition of vancomycin or clindamycin for suspected CA-MRSAIDSA Pediatric Community Pneumonia Guidelines. CID 2011;53:e25Management of CAP: Antibiotic therapy Inpatient (All ages)Presu
4、med atypical pneumonia Azithromycin (in addition to -lactam, if diagnosis of atypical pneumonia is in doubt); alternatives: clarithromycin or erythromycin; doxycycline for children 7 years old; levofloxacin for children who have reached growth maturity, or who cannot tolerate macrolidesIDSA Pediatri
5、c Community Pneumonia Guidelines. CID 2011;53:e25Management of CAP: Antibiotic therapy Not completely immunizedPresumed bacterial pneumonia: Ceftriaxone or cefotaxime; addition of vancomycin or clindamycin for suspected CA- MRSA; alternative: levofloxacin; addition of vancomycin or clindamycin for s
6、uspected CA- MRSAIDSA Pediatric Community Pneumonia Guidelines. CID 2011;53:e25Management of CAP: Antibiotic therapy Not completely immunizedPresumed atypical pneumonia Azithromycin (in addition to -lactam, if diagnosis in doubt); alternatives: clarithromycin or erythromycin; doxycycline for childre
7、n 7 years old; levofloxacin for children who have reached growth maturity or who cannot tolerate macrolidesIDSA Pediatric Community Pneumonia Guidelines. CID 2011;53:e25Management of CAP: Antibiotic therapy Mild case or step-down therapyPreferred: amoxicillin (90 mg/kg/day in 2 doses or 45 mg/kg/day
8、 in 3 doses);Alternatives: second- or third-generation cephalosporin (cefpodoxime, cefuroxime, cefprozil); oral levofloxacin, if susceptible (16 20 mg/kg/day in 2 doses for children 6 months to 5 years old and 810 mg/kg/day once daily for children 5 to 16 years old; maximum daily dose, 750 mg) or or
9、al linezolid (30 mg/kg/day in 3 doses for children 2 weeks: neuropathy, lactic acidosis, mitochondrial toxicityManagement of CAP: Antibiotic therapy Group A Streptococcus Parenteral therapyPreferred: intravenous penicillin (100 000250 000 U/kg/day every 46 hours) or ampicillin (200 mg/kg/day every 6
10、 hours);Alternatives: ceftriaxone (50100 mg/kg/day every 1224 hours) or cefotaxime (150 mg/kg/day every 8 hours);may also be effective: clindamycin, if susceptible (40 mg/kg/day every 68 hours) or vancomycin (4060 mg/kg/day every 68 hours)IDSA Pediatric Community Pneumonia Guidelines. CID 2011;53:e2
11、5Management of CAP: Antibiotic therapy Group A Streptococcus Oral therapyPreferred: amoxicillin (5075 mg/kg/day in 2 doses), or penicillin V (5075 mg/kg/day in 3 or 4 doses);Alternative: oral clindamycin (40 mg/kg/day in 3 doses)IDSA Pediatric Community Pneumonia Guidelines. CID 2011;53:e25Managemen
12、t of CAP: Antibiotic therapy Mycoplasma pneumoniae Parenteral therapyPreferred: intravenous azithromycin (10 mg/kg on days 1 and 2 of therapy; transition to oral therapy if possible); Alternatives: intravenous erythromycin lactobionate (20 mg/kg/day every 6 hours) or levofloxacin (16-20 mg/kg/day ev
13、ery 12 hours; maximum daily dose, 750 mg)IDSA Pediatric Community Pneumonia Guidelines. CID 2011;53:e25Management of CAP: Antibiotic therapy Mycoplasma pneumoniae Oral therapyPreferred: azithromycin (10 mg/kg on day 1, followed by 5 mg/kg/day once daily on days 25);Alternatives: clarithromycin (15 m
14、g/kg/day in 2 doses) or oral erythromycin (40 mg/kg/day in 4 doses);for children 7 years old, doxycycline (24 mg/kg/day in 2 doses;for adolescents with skeletal maturity, levofloxacin (500 mg once daily) or moxifloxacin (400 mg once daily)IDSA Pediatric Community Pneumonia Guidelines. CID 2011;53:e2
15、5Franois Boucher MD, FRCPCPneumonia caused by MRSACA-MRSA: Antibiotic susceptibilityUnlike HA-MRSA, usually susceptible to antibiotics other than vancomycinTypically also susceptible to Clindamycin (!inducible resistance!)TMP/SMXGentamicinErythromycinFluoroquinolonesBarton M et al. Can J Infect Dis
16、Med Microbiol 2006; 17(Suppl C): 1B-24BCA-MRSA risk factorsChildren less than 2 years old Minority populations: Native or Aboriginal African-American Athletes (mainly contact-sport participants) Injection drug users Men who have sex with men Military personnel Inmates of correctional facilities Veterinarians, pet owners and pig farmersBarton M et al. Can J Infect Dis Med Mic
