Pneumonia   

Diet :PO ( if tachypnic : NPO )

V/S: routine

[ Admission :< 6 month , respiratory distress , dehydration , O2 dependent , toxic , vomiting , resistant to PO medications , immunocompromised ]

1. CBC diff

2. Electrolyte

3. BUN & Creatinine

4. ESR .CRP

5. U/A.U/C

6. CXR

7. (    if   in distress ) : pulse oximetry

8.O2 ( if O2 sat < 90% )

9. ABG

10 . ( if septic ) : BC ( Bacteck )

11. IV maintainance  

12. ( if wheeze or in distress ): vintoline 0.15mg / kg ( 2.5 mg ) with nebulizer q 20 min , then q 2h – 4h – 6h

13. ( if severe wheeze & tachypnea ) : + Hydrocortisone : 5 mg / kg / dose IV stat then 2 mg / kg / dose IV QID

14. ( IF cough ) : SYR ketotifen ( SYR 1mg / 5ml & Tab 1 mg ) : 2.5- 5 cc PO BID

15. SYR Bromhexine ( 4mg / 5 ml & Tab 8 mg ) : 5 cc or 1 Tab BID-QID

16. ( if fever  ) : Acetaminophen 15 mg / kg / dose PO   q 4-6 h

17. Nasal drop Nacl : 2-4 drops q  4 h + Nasal suction

18. chest physiotherapy

19. Antibiotics

Inpatient :

Ceftriaxone :75mg / kg / day IV in 2 div doses   10-14 days

Or cefolaxime : 50 mg / kg / dose TDS-QID   10-14 days

-( if severe ): + clindamycin : 10 mg / kg / dose IV QID

Outpatient

5 months – 5 years & typical :

Amoxicillin : 30 mg / kg / dose TDS ( high dose )   10-14 days

Or: coamoxiclav ( SYE 156 , 315 & Tab 375 , 625 ) or : farmentine ( 228/5 ml & 457 /5 ml ) : 40 mg / kg / dose BID   10-14 days

Older than 5 years ( school aged ) & atypical : Azithromycin ( SYR 100/5 ml & 200/5 ml & cap 250,500 ) : 10mg / kg  PO  on first day , then 5 mg / kg / d  4 days

Clarithromycin ( SYR  125/ 5 ml & 250/5 ml ) 7.5 mg / kg / dose  BID

Erythromycin ( SYR 200/5 ml & Tab 200,400 ) : 10mg / kg / dose QID

Adolescent : respiratory quinolones : levofioxocin ( Tab 250& 500 ) : 500 mg QD

(20) . intubation & transfer to ICU  [ if in severe distress : ( 1) PO2 or O2 sat doesn’t improve with O2

100% ,

OR PO2 < 50   : (2) PCO2 > 60 :    (3) PH<7.2

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