Treatment of pneumonia in children

Indications for consultation with other specialists

Consultations with other specialists are not indicated. The exception is the development of pulmonary complications (a surgeon's consultation is required).

Indications for hospitalization

Indications for hospitalization for pneumonia in children and adolescents: severe course of the disease, as well as the presence of risk factors for an unfavorable course of the disease (modifying risk factors).

Pneumonia is considered severe if:

• the child is under 3 months old (regardless of the severity and prevalence of the process);
• age of a child under 3 years with lobar pneumonia:
• 2 or more lobes of the lungs are affected (regardless of age);
• there is pleural effusion (regardless of age);
• there is a suspicion of lung abscess.

Risk factors for an unfavorable course of pneumonia include the following conditions in children:

• severe encephalopathy;
• age up to one year and the presence of intrauterine infection;
• hypotrophy grade II-III;
• congenital malformations, especially defects of the heart and large vessels;
• chronic lung diseases, including bronchopulmonary dysplasia, bronchial asthma, cardiovascular diseases, kidney diseases (nephritis), oncohematological diseases;
• immunodeficiency states.

In addition, risk factors include the inability to provide adequate care and follow all medical prescriptions at home - socially disadvantaged families, poor social and living conditions (dormitories, refugee settlements, internally displaced persons, etc.), religious beliefs of parents, modifying social factors.

The indication for hospitalization in the intensive care unit, regardless of whether the child has risk factors, is suspicion of pneumonia in the presence of the following symptoms:

• dyspnea over 80 per minute for children in the first year of life and over 60 per minute for children over one year old;
• retraction of the jugular fossa during the child's breathing;
• moaning breathing, disturbance of breathing rhythm (apnea, gasps);
• signs of acute cardiovascular failure;
• uncontrollable hyperthermia or progressive hypothermia;
• impaired consciousness, convulsions.

Indication for hospitalization in a surgical department or in a department with the possibility of providing adequate surgical care is the development of pulmonary complications (metapneumonic pleurisy, pleural empyema, lung destruction, etc.).

Non-drug treatment of pneumonia in children

The child is prescribed bed rest for the duration of the fever, and a normal diet.

In hospital-acquired and severe community-acquired pneumonia, special attention is paid to the effectiveness of the respiratory function, in particular, pulse oximetry readings. It has been shown that the level of oxygen saturation (S _a 0 ₂ ), equal to or less than 92 mm Hg, is a predictor of an unfavorable outcome of the disease. In this regard, a decrease in S _a 0 ₂ less than 92 mm Hg is an indication for oxygen therapy by any method. For example, placing the child in an oxygen tent, using an oxygen mask or nasal catheters, or performing artificial ventilation of the lungs, in particular, under increased pressure. The main thing is to achieve an increase in oxygen saturation and stabilize the patient's condition.

Drug treatment of pneumonia in children

The main method of treating pneumonia is immediate (if pneumonia is diagnosed or suspected in a child's serious condition) antibacterial therapy, which is prescribed empirically. That is why the doctor needs knowledge about the etiology of pneumonia in different age groups in community-acquired and hospital pneumonia, in various immunodeficiency states.

Indication for changing the antibiotic/antibiotics - absence of clinical effect within 36-72 hours, as well as development of side effects from the prescribed drug/drugs. Criteria for absence of effect: body temperature persistence above 38 °C and/or deterioration of the child's condition, and/or increasing changes in the lungs or pleural cavity; in chlamydial and pneumocystis pneumonia - increasing dyspnea and hypoxemia.

It is important to remember that in the presence of risk factors for an unfavorable prognosis in patients with community-acquired or hospital pneumonia, as well as in patients with immunodeficiency, a fulminant course of pneumonia is typical, and infectious-toxic shock, DIC syndrome and death often develop. Therefore, the prescription of antibacterial drugs is carried out according to the de-escalation principle, i.e. they start with antibiotics with the broadest possible spectrum of action, followed by a transition to antibacterial drugs of a narrower spectrum.

Antibiotic therapy for community-acquired pneumonia

Taking into account the specific etiology of pneumonia in children of the first 6 months of life, the drugs of choice even for mild pneumonia are inhibitor-protected amoxicillin (amoxicillin + clavulanic acid) or second-generation cephalosporin (cefuroxime or cefazolin). In pneumonia occurring with normal or subfebrile temperature, especially in the presence of obstructive syndrome and indications of vaginal chlamydia in the mother, one can think about pneumonia caused by C. trachomatis. In these cases, it is advisable to immediately prescribe an antibiotic from the macrolide group (azithromycin, roxithromycin or spiramycin) orally. One should remember about the possibility of developing pneumonia in premature babies caused by Pneumocystis carinii. If pneumocystosis is suspected, children are prescribed co-trimoxazole along with antibiotics, then if the pneumocystic etiology of pneumonia is confirmed, they switch to co-trimoxazole only, which the child receives for at least 3 weeks.

The drugs of choice for severe pneumonia, pneumonia complicated by the presence of modifying factors or with a high risk of unfavorable outcome are inhibitor-protected amoxicillin in combination with aminoglycosides or cephalosporins of the third or fourth generation (ceftriaxone, cefotaxime, cefepime) in monotherapy or in combination with aminoglycosides depending on the severity of the disease, carbapenems (imipenem from the first month of life, imipenem and meropenem from the second month of life). If staphylococcal etiology of the disease is suspected or confirmed, linezolid or vancomycin is indicated (depending on the severity of the disease) separately or in combination with aminoglycosides.

Alternative drugs, especially in cases of destructive processes in the lungs, may include linezolid, vancomycin and carbapenems.

Choice of antibacterial drugs in children of the first six months of life with community-acquired pneumonia

Form of pneumonia	Drugs of choice	Alternative therapy
Mild typical pneumonia	Amoxicillin + clavulanic acid or second generation cephalosporins	Cephalosporins II and III generation as monotherapy
Severe typical pneumonia	Amoxicillin + clavulanic acid + aminoglycoside or cephalosporins of the third or fourth generation as monotherapy or in combination with aminoglycosides Linezolid or vancomycin as monotherapy or in combination with aminoglycosides Carbapenems	Linezolid Vancomycin Carbapenems
Atypical pneumonia	An antibiotic from the macrolide group	-
Atypical pneumonia in a premature baby	Co-trimoxazole	-

At the age from 6-7 months to 6-7 years, when choosing initial antibacterial therapy, 3 groups of patients are distinguished:

• patients with mild pneumonia who do not have modifying factors or who have modifying factors of a social nature;
• patients with severe pneumonia and patients with modifying factors that worsen the prognosis of the disease;
• patients with severe pneumonia at high risk of adverse outcome.

For patients of the first group (with mild pneumonia and no modifiable factors), it is most advisable to prescribe oral antibacterial drugs. Amoxicillin, amoxicillin + clavulanic acid, or second-generation cephalosporin - cefuroxime (axetine) can be used. But in some cases (lack of confidence in following the instructions, a fairly severe condition of the child with the parents' refusal of hospitalization, and other similar situations), a stepwise method of therapy is justified, when parenteral treatment is administered during the first 2-3 days, and then, when the patient's condition improves or stabilizes, the same antibiotic is prescribed orally. Amoxicillin + clavulanic acid can be prescribed, but it is administered intravenously, which is difficult at home. Therefore, cefuroxime is more often used intramuscularly and cefuroxime (axetine) orally.

In addition to beta-lactams, treatment can be carried out using macrolides. However, given the etiological significance of Haemophilus influenzae (up to 7-10%) in children of this age group, the drug of choice for initial empirical therapy is azithromycin, which acts on H. influenzae. Other macrolides can be alternative drugs for this group of patients in case of intolerance to beta-lactam antibiotics or their ineffectiveness in the case of pneumonia caused by atypical pathogens - M. pneumoniae, C. pneumoniae (which is quite rare at this age). In addition, if the drugs of choice are ineffective, third-generation cephalosporins are used as an alternative.

Patients of the second group (with severe pneumonia and pneumonia with modifying factors, with the exception of social ones) are shown parenteral administration of antibiotics or the use of a stepwise method of administration. The drugs of choice (depending on the severity and prevalence of the process, the nature of the modifiable factors) are amoxicillin + clavulanic acid, cefuroxime or ceftriaxone, cefotaxime. Alternative drugs if the initial therapy is ineffective are cephalosporins of the third or fourth generation, carbapenems. Macrolides are rarely used in this group of patients, since the overwhelming majority of pneumonias caused by atypical pathogens are not severe.

Patients with a high risk of an unfavorable outcome, severe purulent-destructive complications are indicated for the appointment of antibacterial therapy according to the de-escalation principle, which involves the use of linezolid as a starting drug alone or in combination with an aminoglycoside or a combination of a glycopeptide with aminoglycosides, or a cephalosporin of the third or fourth generation with an aminoglycoside. Alternative therapy - carbapenems, ticarcillin + clavulanic acid.

Selection of antibacterial drugs for the treatment of pneumonia in children from 6-7 months to 6-7 years of age

Form of pneumonia	Drug of choice	Alternative therapy
Mild pneumonia	Amoxicillin Amoxicillin + clavulanic acid Cefuroxime Azithromycin	Cephalosporins II generation Macrolides
Severe pneumonia and pneumonia in the presence of modifying factors	Amoxicillin + clavulanic acid Cefuroxime or ceftriaxone Cefotaxime	Cephalosporins of the third or fourth generation, alone or in combination with an aminoglycoside Carbapenems
Severe pneumonia with a high risk of poor outcome	Linezolid alone or in combination with an aminoglycoside Vancomycin alone or in combination with an aminoglycoside Cefepime alone or in combination with an aminoglycoside	Carbapenems Ticarcillin + clavulanic acid

When choosing antibacterial drugs for pneumonia in children over 6-7 years old and adolescents, 2 groups of patients are distinguished:

• with mild pneumonia;
• with severe pneumonia requiring hospitalization, or with pneumonia in a child or adolescent with modifying factors.

The antibiotics of choice for the first group of patients (with mild pneumonia) are amoxicillin and amoxicillin + clavulanic acid (orally) or macrolides. Alternative antibiotics are cefuroxime (axetine), or doxycycline (orally), or macrolides if amoxicillin or amoxicillin + clavulanic acid was previously prescribed.

Antibiotics of choice for patients of the second group (with severe pneumonia requiring hospitalization, or with pneumonia in children and adolescents with modifying factors) are amoxicillin + clavulanic acid or cephalosporins of the first generation. Alternative antibiotics are cephalosporins of the third or fourth generation. Macrolides should be preferred in case of intolerance to beta-lactam antibiotics and in pneumonia presumably caused by M. pneumoniae and C. pneumoniae.

Choice of antibacterial drugs for the treatment of pneumonia in children and adolescents (age 7-18 years)

Form of pneumonia	Drug of choice	Alternative therapy
Mild pneumonia	Amoxicillin Amoxicillin + clavulanic acid Macrolides	Macrolides Cefuroxime Doxycycline
Severe pneumonia, pneumonia in children and adolescents with modifying factors	Amoxicillin + clavulanic acid Cephalosporins of the second generation	Cephalosporins III or IV generation

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ]

Antibacterial therapy for hospital pneumonia

The choice of antibacterial therapy for hospital-acquired pneumonia is significantly influenced by the fact that this disease is characterized by a lightning-fast course with frequent fatal outcomes. Therefore, in severe hospital-acquired pneumonia and VAP, the de-escalation principle of drug selection is absolutely justified. In mild and relatively severe hospital-acquired pneumonia, treatment begins with drugs that are most suitable in terms of spectrum of action.

Thus, a child with mild or relatively severe hospital pneumonia in the therapeutic department can be prescribed amoxicillin + clavulanic acid orally, if the patient's condition allows, or intravenously. In case of severe pneumonia, it is indicated to prescribe cephalosporins of the third (cefotaxime, ceftriaxone) or fourth generation (cefepime), or ticarcillin + clavulanic acid (timentin). All these antibiotics act well on S. aureus et epidermidis, K. pneumoniae, S. pneumoniae, i.e. on the most common pathogens of hospital pneumonia in the therapeutic department. If there is a suspicion of mild staphylococcal hospital pneumonia, then oxacillin can be prescribed as monotherapy or in combination with aminoglycosides. But if severe staphylococcal pneumonia is suspected, especially destructive, or such a diagnosis has already been made, then linezolid or vancomycin is prescribed as monotherapy or in combination with aminoglycosides.

Premature infants in the second stage of nursing who have developed hospital-acquired pneumonia, with suspected Pneumocystis pneumonia (which is characterized by a subacute course, bilateral lung damage, small-focal nature of infiltrative changes in the lungs, severe hypoxemia), are prescribed co-trimoxazole in parallel with antibiotics. If the diagnosis of Pneumocystis hospital-acquired pneumonia is established, treatment is carried out with co-trimoxazole alone for at least 3 weeks.

Oncohematological patients (in cases where the disease begins acutely, with a rise in temperature and the appearance of shortness of breath and often cough) are prescribed third-generation cephalosporins with antipseudomonal action. Alternative therapy - carbapenems (tienam, meropenem) or ticarcillin + clavulanic acid. If staphylococcal hospital pneumonia is suspected, in particular in the absence of cough, in the presence of shortness of breath, the threat of lung destruction with the formation of bullae and / or pleural empyema, linezolid or vancomycin is prescribed either in monotherapy or in combination with aminoglycosides, depending on the severity of the condition.

Fungal hospital pneumonia in oncohematological patients is usually caused by Aspergillus spp. That is why oncohematological patients with dyspnea, in addition to chest X-ray, are shown CT of the lungs. When diagnosing hospital pneumonia caused by Aspergillus spp., amphotericin B is prescribed in increasing doses. The course duration is at least 3 weeks, but, as a rule, the therapy is longer.

In patients in surgical departments or burn departments, hospital pneumonia is most often caused by Ps. aeruginosa, in second place in frequency - K. pneumoniae and E. coli, Acenetobacter spp. and others. S. aureus et epidermidis are rarely detected, sometimes anaerobes are also detected, which are more often associated with Ps. aeruginosa, K. pneumoniae and E. coli. Therefore, the choice of antibiotics is approximately the same as in oncohematological patients with hospital pneumonia. Third-generation cephalosporins with antipseudomonal action (ceftazidime) and fourth-generation (cefepime) in combination with aminoglycosides are prescribed. Alternative therapy is carbapenem therapy (taenam, meropenem) or ticarcillin + clavulanic acid either in monotherapy or in combination with aminoglycosides, depending on the severity of the process. If staphylococcal hospital pneumonia is suspected, linezolid or vancomycin is prescribed either in monotherapy or in combination with aminoglycosides, depending on the severity of the process. Metronidazole is indicated for anaerobic pneumonia.

The development of hospital pneumonia in patients in the intensive care unit requires the same spectrum of antibiotics as in surgical and burn patients. At the same time, in late VAP, the etiology of hospital pneumonia is exactly the same. Therefore, antibacterial therapy should be the same as in patients in surgical and burn units. The leading etiologic factor is Ps. aeruginosa.

In early VAP, the etiology of hospital-acquired pneumonia and, accordingly, the spectrum of antibacterial therapy depend on the age of the child and repeat the spectrum for community-acquired pneumonia.

Doses of the most common antibiotics, their routes and frequency of administration

Antibiotic

Doses

Routes of administration

Frequency of administration

Penicillin and its derivatives

Benzylpenicillin	Children under 12 years old 100,000-150,000 U/(kg x day) For children over 12 years old 2-3 g/day 3-4 times a day	I/m, IV	3-4 times a day
Ampicillin	Children under 12 years old 50-100 mg/kg/day) For children over 12 years old 2-4 g every 6 hours	I/m, IV	3-4 times a day
Amoxicillin	Children under 12 years old 25-50 mg/(kg x day) For children over 12 years old, 0.25-0.5 g every 8 hours.	Inside	3 times a day
Amoxicillin + clavulanic acid	Children under 12 years of age 20-40 mg/(kg x day) (for amoxicillin) For children over 12 years of age with mild pneumonia, 0.625 g every 8 hours or 1 g every 12 hours	Inside	2-3 times a day
Amoxicillin + clavulanic acid	Children under 12 years of age 30 mg/(kg x day) (for amoxicillin) For children over 12 years old 1.2 g every 8 or 6 hours	I/V	2-3 times a day
Oxacillin	Children under 12 years 40 mg/(kg x day) 4-12 g/day	I/V, I/M	4 times a day
Ticarcillin + clavulanic acid	100 mg/(kgxday)	I/V	3 times a day

Cephalosporins I and II generation

Cefazolin	Children under 12 years old 60 mg/(kg x day) For children over 12 years old 1-2 g every 8 hours	I/m, IV	3 times a day
Cefuroxime (cefuroxime sodium)	Children under 12 years old 50-100 mg/(kg x day) For children over 12 years old, 0.75-1.5 g every 8 hours	I/m, IV	3 times a day
Cefuroxime (Axetine)	Children under 12 years old 20-30 mg/(kg x day) For children over 12 years old, 0.25-0.5 g every 12 hours.	Inside	2 times a day

Cephalosporins of the third generation

Cefotaxime	Children under 12 years old 50-100 mg/(kg x day) For children over 12 years old, 2 g every 8 hours	I/m, IV	3 times a day
Ceftriaxone	Children under 12 years old 50-75 mg/(kg x day) For children over 12 years old 1-2 g once a day	I/m, IV	1 time per day
Cefoperazone + sulbactam	Children under 12 years old 75-100 mg/(kg x day) For children over 12 years old 1-2 g every 8 hours	I/V, I/M	One zraz per day
Ceftazidime	Children under 12 years old 50-100 mg/(kg x day) For children over 12 years old, 2 g every 8 hours	I/m, IV	2-3 times a day

Cephalosporins (5th generation)

Cefepime

Children under 12 years old 100-150 mg/(kg x day) For children over 12 years old 1-2 g every 12 hours

I/V

3 times a day

Carbapenems

Imipenem	Children under 12 years old 30-60 mg/(kg x day) For children over 12 years old 0.5 g every 6 hours	V/m I/V	4 times a day
Meropenem	Children under 12 years old 30-60 mg/(kg x day) For children over 12 years old 1 g every 8 hours	I/m, IV	3 times a day

Glycopeptides

Vancomycin

Children under 12 years of age 40 mg/(kg x day) For children over 12 years old 1 g every 12 hours

I/m, IV

3-4 times a day

Oxazolidinones

Linezolid

Children under 12 years old 10 mg/(kg x day) For children over 12 years old 10 mg/(kg x day) 2 times a day

I/m, IV

3 times a day

Aminoglycosides

Gentamicin	5 mg/(kgxday)	I/m, IV	2 times a day
Amikacin	15-30 mg/(kg x day)	I/m, IV	2 times a day
Netilmicin	5 mg/(kgxday)	I/m, IV	2 times a day

Macrolides

Erythromycin	Children under 12 years old 40-50 mg/(kg x day) For children over 12 years old 0.25-0.5 g every 6 hours	Inside	4 times a day
Spiramycin	Children under 12 years old 15,000 units/(kg x day) For children over 12 years old 500,000 IU every 12 hours	Inside	2 times a day
Roxithromycin	Children under 12 years old 5-8 mg/(kg x day) For children over 12 years old 0.25-0.5 g every 12 hours	Inside	2 times a day
Azithromycin	Children under 12 years of age 10 mg/(kg x day) on the 1st day, then 5 mg/(kg x day) for 3-5 days For children over 12 years old, 0.5 g once a day (daily)	Inside	1 time per day
Clarithromycin	Children under 12 years of age 7.5-15 mg/(kg x day) For children over 12 years old 0.5 g every 12 hours	Inside	2 times a day

Tetracyclines

Doxycycline	Children 8-12 years old 5 mg/(kg x day) For children over 12 years old 0.5-1 g every 8-12 hours	Inside	2 times a day
Doxycycline	Children 8-12 years old 2.5 mg/(kg x day) For children over 12 years old 0.25-0.5 g every 12 hours	I/V	2 times a day

Antibacterial drugs of different groups

Co-trimoxazole (trimethoprim + sulfamethoxazole)	20 mg/(kg/day) (according to trimethoprim)	Inside	4 times a day
Metronidazole	Children under 12 years 7.5 mg/(kg x day) Children over 12 years 0.5 g every 8 hours	IV, orally	3-4 times a day
Amphotericin B	Start with 100,000-150,000 IU, gradually increase by 50,000 IU per administration once every 3 days up to 500,000-1,000,000 IU	I/V	1 time in 3-4 days
Fluconazole	6-12 mg/(kg x day)	IV, orally	1 time per day

Tetracyclines are used only in children over 8 years of age.

[ 6 ], [ 7 ], [ 8 ], [ 9 ], [ 10 ]

Antibacterial therapy in patients with immunodeficiency

In patients with immunodeficiency, empirical therapy for pneumonia begins with third- or fourth-generation cephalosporins or vancomycin in combination with aminoglycosides. Subsequently, as the etiology of the disease is clarified, the therapy is either continued, for example, if pneumonia is caused by Enterobacteriaceae (K. pneumoniae, E. coli, etc.), S. aureus, or Streptococcus pneumoniae, or co-trimoxazole (20 mg/kg of trimethoprim) is prescribed if pneumocystosis is detected, or fluconazole is prescribed for candidiasis or amphotericin B for other mycoses. If pneumonia is caused by Mycobacterium tuberculosis, the antibiotic rifampicin and other anti-tuberculosis drugs are prescribed. If pneumonia is caused by viruses, such as cytomegalovirus, ganciclovir is prescribed; If it is the herpes virus, then acyclovir is prescribed, etc.

Choice of antibacterial drugs for pneumonia in immunocompromised patients

Nature of immunodeficiency	Etiology of pneumonia	Drugs for therapy
Primary cellular immunodeficiency	Pneumocystis carinii Fungi of the genus Candida	Co-trimoxazole 20 mg/kg as trimethoprim Fluconazole 10-12 mg/kg or Amphotericin B in 8 increasing doses, starting with 150 U/kg and up to 500 or 1000 U/kg
Primary humoral immunodeficiency	Enterobacteria (K. pneumoniae, E. coli, etc.) Staphylococci (S. aureus, epidermidis, etc.) Pneumococci	Cephalosporins of the III or IV generation as monotherapy or in combination with aminoglycosides Linezolid or vancomycin as monotherapy or in combination with aminoglycosides Amoxicillin + clavulanic acid as monotherapy or in combination with aminoglycosides
Acquired immunodeficiency (HIV-infected, AIDS patients)	Pneumocystis Cytomegaloviruses Herlesviruses Mycobacterium tuberculosis Candida fungi	Co-trimoxazole 20 mg/kg according to trimethoprim Ganciclovir Acyclovir Rifampicin and other anti-tuberculosis drugs Fluconazole 10-12 mg/kg or Amphotericin B in increasing doses
Neutropenia	Gram-negative enterobacteria Fungi of the genus Candida, Aspergillus, Fusahum	Cephalosporins of the third or fourth generation as monotherapy or in combination with aminoglycosides Amphotericin B in increasing doses

The duration of the antibiotic course depends on their effectiveness, the severity of the process, complications of pneumonia and the child's premorbid background. The usual duration of the course for community-acquired pneumonia is 6-10 days and continues for 2-3 days after a stable effect is achieved. Complicated and severe pneumonia usually requires a 2-3-week course of antibiotic therapy.

The duration of antibacterial therapy for hospital pneumonia is at least 3 weeks. Indication for discontinuing antibacterial therapy is the absence of clinical manifestations of the disease with mandatory X-ray monitoring.

In patients with immunodeficiency, the course of treatment with antibacterial drugs is at least 3 weeks, but may be longer.

[ 11 ], [ 12 ], [ 13 ]

Immunocorrective therapy

Recommendations for the administration of immunocorrective drugs in the treatment of community-acquired pneumonia are still under development. The issue of indications for the administration of fresh frozen plasma and immunoglobulin for intravenous administration has been studied the most. They are indicated in the following cases:

• children under 3 months of age;
• the presence of modifying factors, with the exception of social ones, in severe pneumonia;
• high risk of adverse outcome of pneumonia:
• complicated pneumonia, especially destructive.

Fresh frozen plasma at a dose of 20-30 ml/kg is administered intravenously by drip at least 3 times or daily or every other day depending on the severity of the disease. Standard immunoglobulins for intravenous administration (imbioglobulinintraglobin, octagam, etc.) are prescribed as early as possible, on the 1st-2nd day of therapy; administered in usual therapeutic doses (500-800 mg/kg), at least 2-3 times, daily or every other day. In this case, it is desirable to achieve an increase in the IgG level in the patient's blood of more than 800 mg%, in the blood of newborns - more than 600 mg%. In destructive pneumonia, the administration of immunoglobulin preparations for intravenous administration containing IgG and IgM (pentaglobin) is indicated.

Hospital pneumonia by its very existence indicates that children who have fallen ill with it have secondary or, less frequently, primary immunodeficiency. Therefore, the indication for immunocorrective therapy is the very fact of hospital pneumonia. That is why replacement immunotherapy with fresh frozen plasma and immunoglobulins for intravenous administration is a mandatory method of treating hospital pneumonia (along with antibacterial therapy). Fresh frozen plasma is administered intravenously once a day every day or once every 2-3 days (a total of 3-5 times depending on the severity of the condition). Immunoglobulins for intravenous administration are prescribed as early as possible, on the 1st-3rd day of therapy. In hospital pneumonia, especially severe ones, the administration of immunoglobulin preparations containing IgG and IgM (pentaglobin) is indicated.

Syndrome therapy

Rehydration in pneumonia should be complete. It should be remembered that hyperhydration in pneumonia, especially with parenteral administration of fluid, occurs easily due to increased release of antidiuretic hormone (ADH). Therefore, in mild and uncomplicated pneumonia, oral rehydration is used in the form of drinking juices, tea, mineral water and rehydron.

Indications for infusion therapy: exicosis, collapse, microcirculatory disorders, DIC syndrome. The volume of administered fluid is 30-100 ml/kg (in case of exicosis 100-120 ml/kg). For infusion therapy, use a 10% glucose solution with the addition of Ringer's solution, as well as a rheopolyglucin solution at a rate of 20-30 ml/kg.

Antitussive therapy is one of the main directions of symptomatic therapy and plays a major role in the treatment of pneumonia. Of the antitussive drugs, the drugs of choice are mucolytics, which thin bronchial secretions well by changing the structure of mucus. Mucolytics are used internally and by inhalation for 3-10 days. Ambroxol (ambrohexal, ambrobene, etc.), acetylcysteine (ACC), bromhexine, carbocysteine are used.

Lazolvan (ambroxol) - solution for oral administration and inhalation.

Mucolytic drug. Has a secretomotor, secretolytic and expectorant effect. Lazolvan liquefies sputum by stimulating serous cells of the glands of the bronchial mucosa, normalizes the disturbed ratio of serous and mucous components of sputum, stimulates the formation of surfactant in the alveoli and bronchi. Activating hydrolyzing enzymes and increasing the release of lysosomes from Clara cells, reduces the viscosity of sputum and its adhesive properties. Increases the motor activity of the cilia of the ciliated epithelium, increases the mucociliary transport of sputum. Increases the penetration of amoxicillin, cefuroxicam, erythromycin, doxycycline into bronchial secretions.

Indications for use: acute and chronic respiratory diseases with the release of viscous sputum: acute and chronic bronchitis, pneumonia, chronic obstructive pulmonary disease, bronchial asthma with difficulty in expectorating sputum, bronchiectasis.

Method of administration and dosage: 2 ml of solution contains 15 mg of ambroxol hydrochloride (1 ml = 25 drops). For inhalation: children under 6 years old - 1-2 inhalations of 2 ml daily. Adults and children over 6 years old: 1-2 inhalations of 2-3 ml of solution daily. For oral administration: children under 2 years old: 1 ml (25 drops) 2 times a day, from 2 to 6 years old: 1 ml (25 drops) 3 times a day, over 6 years: 2 ml (50 drops) 2-3 times a day. Adults and children over 12 years old: at the beginning of treatment, 4 ml 3 times a day.

Another direction of symptomatic therapy is antipyretic therapy, which is prescribed for fever above 39.5 °C, febrile seizures and metapneumonic pleurisy, often complicated by severe fever. Currently, the list of antipyretic drugs used in children is limited to paracetamol and ibuprofen. They are prescribed separately or in combination with first-generation antihistamines (promethazine, chloropyramine).

Paracetamol is prescribed orally or rectally at a rate of 10-15 mg / (kg x day) in 3-4 doses. Ibuprofen is also prescribed orally at a rate of 5-10 mg / (kg x day) in 3-4 doses. Promethazine (pipolfen) is prescribed orally to children under 3 years old at 0.005 g once a day, children under 5 years old - 0.01 g once a day, children over 5 years old - 0.03-0.05 g once a day; or chloropyramine (suprastin) is prescribed orally in the same doses (children under 3 years old at 0.005 g, children under 5 years old - 0.01 g, children over 5 years old - 0.03-0.05 g once a day).

At temperatures above 40 C, a lytic mixture is used, which includes chlorpromazine (aminazine) in a dose of 0.5-1.0 ml of a 2.5% solution, promethazine (pipolfen) in a solution of 0.5-1.0 ml. The lytic mixture is administered intramuscularly or intravenously, once. In severe cases, metamizole sodium (analgin) is added to the mixture in the form of a 10% solution at the rate of 0.2 ml per 10 kg of body weight.

Surgical treatment of pneumonia in children

Puncture is performed in cases of lung abscess, synpneumonic pleurisy, pyopneumothorax, and pleural empyema.

Prognosis for pneumonia

The vast majority of pneumonias pass without a trace, although the process of resorption of the infiltrate takes up to 1-2 months.

If pneumonia is not treated correctly or in a timely manner (mainly in children with chronic lung diseases such as cystic fibrosis, developmental defects, and others), segmental or lobar pneumosclerosis and bronchial deformations in the affected area may develop.

With a favorable outcome, pneumonia suffered in early childhood manifests itself as persistent pulmonary dysfunction and the formation of chronic pulmonary pathology in adults.