penicillin allergy in community acquired childhood pneumonia
TRANSCRIPT
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Penicillin Allergy in Community
Acquired Childhood Pneumonia
David Feng
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Case
Ms. E 14 y.o student
Presented to ED 7/5/2010 Headache 4/7
Throbbing
R sided initially progressing tobilateral Not associated with aura
Photophobia
Not associated with any neck stiffness
Fever 1/7
Cough 1/52 Productive with green sputum
Patientsmother was also in ED with similarrespiratory symptoms.
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Allergies, Past and Family History
Allergies Penicillin anaphylactic reaction
PHx Appendectomy
Bowel Obstruction Vaginal Haematoma
?Dysmenorrhoea
FHx Heart Disease
?EtOH related
Maternal Migraine
DM II
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Symptoms of Pneumonia
Acute infective pneumonia Fever
Dyspnoea
Malaise
Cough Dry vs.moist
Not always present
Pleuritic Chest pain
Neck stiffness if apices involved Shouldertip/abdominal pain if diaphragmatic pleural
surfaces involved.
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Symptoms of Pneumonia
Acute infective pneumonia Fever
Dyspnoea
Malaise Cough
Dry vs.moist
Not always present
Pleuritic Chest pain
Neck stiffness if apices involved Shouldertip/abdominal pain if diaphragmatic pleural
surfaces involved.
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On Examination
Patient looked notunwell
OBS BP 97/61
Sats
97% RA
HR 67
Afebrile 36.8o C
43kg
Not in any respiratory distress
Left-sided basal crepitations Inflammed throat
Abdomen SNT
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SignsofPneumonia
Tachypnoea
Respiratory Distress
On aus
cu
lta
tio
n Crackles
Bronchial breathing
Signsof additional pleural effusion
Trachea/mediastinal shift
Dullnessto percussion
Reduced/absentbreathing sounds
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SignsofPneumonia
Tachypnoea
Respiratory Distress
On aus
cu
lta
tio
n Crackles
Bronchial breathing
Signsof additional pleural effusion
Trachea/mediastinal shift
Dullnessto percussion
Reduced/absentbreathing sounds
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Pneumonia Severity Index
Ms. E is considered a Class I on the pneumonia
severity index.
Ms. Esmotherscored a on the PSI and isconsidered Class II
Both Ms. E and hermother were therefore
eligible toundergotreatment in the
outpatientsetting.
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Investigations
Ms. Esmother had an x-ray ordered, showing
consolidation of her lungs.
The diagnosisof lobar pneumonia wasmade.
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Management
Ms. Esmother was given a course of
Ms. E herself was initially prescribed a course ofAugmentin and Roxithromycin totake home. Atthis point, Ms Es penicillin allergy wasbroughtup with
the treating team.
Therapeutic guidelines for adultssuggestmoxifloxacin,however quinolones are contraindicated in age
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Children Therapeutic Guidelines
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Adult Therapeutic Guidelines
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Pneumonia andthe Penicillin Sensitive
hild
No information intherapeutic/R H guidelines
is given.
For adults, moxifloxacin isrecommended intherapeutic guidelines.
Quinolones CI in age < 18 years
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Pneumonia andthe Penicillin Sensitive
Child (continued)
RCH specialist advisedroxithromycin to be
sufficient
Macrolide usually usedto cover atypical
organisms
Hopstaken, R.M., et al trialled amoxycillin vs.
roxithromycin interms oftherapeutic benefits,
with outcomesbeing similar.