Pneumonia in older children

Pneumonia is an inflammation at the level of the respiratory bronchioles, alveolar spaces, and/or interstitium.

 For more information see Pneumonia.

Etiology of pneumonia in older children

• The most common agents in children over 5 years of age:
  • bacteria: Streptococcus pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumoniae
• rare agents:
  • respiratory viruses: adenoviruses, influenza, parainfluenza, rhinovirus, RSV
  • bacteria: Haemophilus influenzae, Mycobacterium tuberculosis, vzácně Staphylococcus aureus, Legionella pneumophila.

Clinical picture

 For more information see Bacterial pneumonia, Atypical pneumonia.

Therapy

• Empirical antibiotic treatment of community-acquired pneumonia in older children:
  • mild pneumonia - amoxicillin p.o. (50-90 mg / kg / day in 3 doses),
  • severe pneumonia - penicillin G i.v. (100-200,000 IU / kg / day or more in 4-6 doses), in case of allergy, cephalosporin III. generation i.v can be used instead.
• symptomatic treatment:
  • expectorants, mucolytics, antitussives for irritating dry cough
  • antipyretics
  • oxygen therapy for respiratory insufficiency
  • nebulization therapy
• regime measures:
  • adequate supply of fluids, calories, vitamins
  • respiratory rehabilitation
• Functional lung examination is indicated 6 weeks after the pneumonia has subsided.

Comparison table for typical and atypical pneumonia

PARAMETER	TYPICAL PNEUMONIA	ATYPICAL PNEUMONIA
Basic characteristics	significant physical findings	poor physical findings
Agens	(extracellular) Streptococcus pneumoniae, Haemophilus influenzae Haemophilus parainfluenzae, Staphylococcus aureus, Klebsiella pneumoniae, Escherichia coli a Pseudomonas aeruginosa	(intra / paracellular) Mycoplasma pneumoniae, Chlamydophila pneumoniae, Chlamydophila psittaci, Legionella pneumophila Coxiella burnetii, viruses - RSV, influenza, Pneumocystis carinii
Boarding	sudden	slow
Extrapulmonary symptoms	infrequent	common - headache and muscle pain, vomiting, diarrhea
Fever	febrile	subfebrile
Cough	productive	dry, irritating
Heart rate	possibly tachycardia	normal
The patient looks	sick	calm, unaffected
Physically	crepitus, tubular respiration	isolated rales
X-ray	segmental/lobar opacities (alveolar involvement)	Reticulonodulation (interstitial involvement)
Sedimentation	high	slightly increased
Inflammatory parameters	high	slightly increased
Blood count	leukocytosis	lymphocytosis
Therapy	penicillins	macrolides

Related articles

• Pneumonia (pediatrics) • Infant pneumonia • Pneumonia
• Bacterial pneumonia • Atypical pneumonia • Abscessive pneumonia • Aspiration pneumonia
• X-ray examination in lower respiratory tract inflammation • Clinical evaluation of the severity of pneumonia