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1、Case#1An8-year-oldboyisseeninFebruarybecauseoffever,headache,sorethroat,andmalaise.He’shadnorhinorrhea,cough,orhoarseness.Physicalexaminationrevealsatemperatureof103.5,exudativepharyngitis,andtendercervicaladenopathy.Howwillyoutreathim?Ispenicillinstillthedrugofchoicefortreatmentofstreptococcalphary
2、gitis?AAPrecommendsoralpenicillinV2-3timesdailyfor10days,asingledoseofbenzathinepenicillin,oramoxicillin250mg/kgtidfor10daysLargerdosesofpenicillinoncedailyresultinmorerelapses**Breese,1965,Gerber,1989Oncedailydosing?RecommendedbytheFDA:azithromycin(Zithromax)cefixime(Suprax)cefdinir(Omnicef)cefadro
3、xil(Ultracef,Duracef)ceftibutin(Cedax)Amoxicillin(750mgoncedaily)**Feder,Pediatrics,1999Shortercourses?ApprovedbytheFDAfor5-dayregimen:cefpodoxime(Vantin)cefdinir(Omnicef)azithromycin(Zithromax)Whataboutthepenicillin-allergicchild?Erythromycinestolate(20-40mg/kg/ddividedbid)orethylsuccinate(40mg/kg/
4、ddividedbid)Azithromycin(12mg/kg/dx5d),clarithromycin(15mg/kg/ddivq12hrs),clindamycin(20mg/kg/ddivq6-8hrs)Whypenicillinmight“fail”Non-adherancetoprescribedtherapyfailuretorecognizecarriers?beta-lactamaseproductionbyotherpharyngealfloranewstreptococcalinfectionCase#2A13-year-oldboyhashadfeverandsoret
5、hroatfortwodays.Henowpresentswithacough.Onexaminationhehasatemperatureof104,RR22,O2saturationof98%,retractions,andcracklesovertheposteriorleftlowerlung.Chestx-rayconfirmsaleftlowerlobepneumonia.Whatdoyouthinkiscausinghispneumonia?Howwillyoutreathim?CommonCausesofCommunity-AcquiredPneumoniainOtherwis
6、eHealthyChildrenVirusesRespiratorysyncytialvirusInfluenzaAandBParainfluenza1,2,and3AdenovirusRhinovirusesMeaslesvirusMycoplasmaMycoplasmapneumoniaeChlamydiaChlamydiapneumoniaeChlamydiatrachomatisBacteriaStreptococcuspneumoniaeMycobacteriumtuberculosisStaphylococcusaureusHaemophilusinfluenzaetypebnon
7、-typableH.influenzaeMcIntosh,K:NEJM2002;346:429Likelihoodthatthepneumoniaisbacterialisgreaterif:Feveris>39degreesCThepatient“lookssick”Therearealveolarinfiltratesonchestx-rayWBCis>15,000NB:Bloodcultur
