Treatment of pneumonia in children

Indications for consultation of other specialists

Consultations of other specialists are not shown. An exception is the development of pulmonary complications (a surgeon's consultation is necessary).

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 adverse disease (modifying risk factors).

Pneumonia is considered severe if:

• the child's age is less than 3 months (regardless of the severity and extent of the process);
• age of the child up to 3 years with lobar pneumonia:
• 2 lobes of lungs and more are affected (regardless of age);
• there is a pleural effusion (regardless of age);
• there is a suspicion of abscessing of the lungs.

To the risk factors for the adverse course of pneumonia include the following conditions of children:

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

In addition, the risk factors include the inability to adequately care for and fulfill all medical prescriptions at home - socially disadvantaged families, poor social and living conditions (hostels, settlements of refugees, internally displaced persons, etc.), religious beliefs of parents, modifying factors social plan.

Indication for admission to the intensive care unit, regardless of whether the child has risk factors, is a suspected pneumonia in the presence of the following symptoms:

• shortness of breath over 80 per minute for children of the first year of life and more than 60 per minute for children over the year;
• retraction of the fossa in the breathing of the child;
• moaning breathing, violation of the rhythm of breathing (apnea, guspsy);
• signs of acute cardiovascular insufficiency;
• non-curable hyperthermia or progressive hypothermia;
• impaired consciousness, convulsions.

Indications for hospitalization in the surgical department or in a department with the possibility of providing adequate surgical care are the development of lung complications (metapneumonic pleurisy, empyema of the pleura, destruction of the lungs, etc.).

Non-drug treatment of pneumonia in children

A child is assigned a bed rest for a fever period, a normal diet.

In hospital and severe community-acquired pneumonia, special attention is paid to the effectiveness of respiratory function, in particular, pulse oximetry. It is shown that the level of oxygen saturation (S _a 0 ₂ ), equal to or less than 92 mm Hg. Is the predictor of an unfavorable outcome of the disease. In this connection, the decrease in S _a 0 _{2 is} less than 92 mm Hg. Art. - Indication for oxygen therapy by any method. For example, placing a 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.

Medical treatment of pneumonia in children

The main method of treatment of pneumonia - immediately started (with the diagnosis of pneumonia or with suspicion of it in the severe condition of the child) antibiotic therapy, which is prescribed empirically. That is why the doctor needs knowledge about the etiology of pneumonia in different age groups with community-acquired and hospital pneumonia, with various immunodeficiency conditions.

Indication for the replacement of antibiotic / antibiotics - the lack of clinical effect for 36-72 hours, as well as the development of side effects from the prescribed drug / drugs. Criteria for lack of effect: preservation of body temperature over 38 ° C and / or deterioration of the child's condition, and / or an increase in changes in the lungs or in the pleural cavity; with Chlamydia and Pneumocystis pneumonia - an increase in dyspnea and hypoxemia.

It is important to remember that in the presence of risk factors for unfavorable prognosis in patients with community-acquired or hospital pneumonia, as well as in patients with immunodeficiency, a lightning-fast course of pneumonia is typical, and infectious-toxic shock, DIC-syndrome and lethal outcome are often developed. Therefore, the appointment of antibacterial drugs is carried out according to the de-escalation principle, i.e. Begin with antibiotics with the widest possible spectrum of action, followed by a transition to antibacterial preparations of a narrower spectrum.

Antibiotic therapy for community-acquired pneumonia

Given the characteristics of the etiology of pneumonia in children of the first 6 months of life, drugs of choice, even with mild pneumonia, are inhibitor-protected amoxicillin (amoxicillin + clavulanic acid) or cephalosporin of the second generation (cefuroxime or cefazolin). When pneumonia occurs with normal or subfebrile temperature, especially in the presence of obstructive syndrome and indications of vaginal chlamydia in the mother, one can think of pneumonia caused by C. trachomatis. In these cases, it is expedient to immediately prescribe an antibiotic from the macrolide group (azithromycin, roxithromycin or spiramycin). One should remember the possibility of developing pneumonia in preterm infants caused by Pneumocystis carinii. If there is a suspicion of pneumocystosis, children are prescribed co-trimoxazole together with antibiotics, then with confirmation of pneumocystis etiology, pneumonia only go to co-trimoxazole, which the child receives at least 3 weeks.

Drugs of choice for severe pneumonia, pneumonia, aggravated by the presence of modifying factors or with a high risk of adverse outcome, - inhibitor-protected amoxicillin in combination with aminoglycosides or cephalosporins of III or IV generation (ceftriaxone cefotaxime, cefepime) in monotherapy or in combination with aminoglycosides depending on severity of the disease, carbapenems (imipenem from the first month of life, imipenem and meropin from the second month of life). If suspected of a staphylococcal etiology of the disease or when it is confirmed, the appointment of a linezolid or vancomycin (depending on the severity of the disease) alone or in combination with aminoglycosides is indicated.

Alternative drugs, especially in cases of development of destructive processes in the lungs, can be linezolid, vancomycin and carbapenems.

The choice of antibacterial drugs in children in the first six months of life in community-acquired pneumonia

Form of pneumonia	Drugs of choice	Alternative Therapy
Moderate, severe pneumonia	Amoxicillin + clavulanic acid or cephalosporins of the second generation	Cephalosporins II and III generations in the form of monotherapy
Severe typical pneumonia	Amoxicillin + clavulanic acid + aminoglycoside or cephalosporins of III or IV generation in the form of monotherapy or in combination with aminoglycosides Linezolid or vancomycin in the form of monotherapy or in combination with aminoglycosides Carbapenems	Linezolid Vancomycin Carbapenems
Atypical pneumonia	Antibiotic from the group of macrolides	-
Atypical pneumonia in a premature baby	Co-trimoxazole	-

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

• patients with mild pneumonia, who do not have modifying factors or who have modifying factors in the social plan;
• patients with severe pneumonia and patients with modifying factors, weighting the prognosis of the disease;
• patients with severe pneumonia with a high risk of adverse outcome.

Patients of the first group (with a mild pneumonia and not having any modifiable factors) most appropriately use antibacterial drugs inside. Amoxicillin, amoxicillin + clavulanic acid or cephalosporin of the second generation - cefuroxime (aksetin) can be used. But in some cases (lack of confidence in the performance of appointments, a fairly serious condition of the child in case of parents' refusal from hospitalization and other similar situations), a stepwise method of therapy is justified, when parenteral treatment is performed in the first 2-3 days, and then with improvement or stabilization of the patient's condition the same antibiotic is prescribed inside. Perhaps the appointment of amoxicillin + clavulanic acid, but it is administered intravenously. Which is difficult at home. Therefore, more often use cefuroxime intramuscularly and cefuroxime (aksetin) inside.

In addition to beta-lactams, treatment can be carried out using macrolides. But, given the etiological significance of the hemophilic rod (up to 7-10%) in children of this age group, the drug of choice for starting empirical therapy is azithromycin, which acts on H. Influenzae. Other macrolides may be for this group of patients with alternative drugs with intolerance to beta-lactam antibiotics or if they are ineffective in case of pneumonia caused by atypical pathogens - M. Pneumoniae, S. Pneumoniae (which is rarely observed at this age). In addition, if the drugs of choice are ineffective, cephalosporins of the third generation are used as an alternative.

Patients of the second group (with severe pneumonia and pneumonia with the presence of modifying factors, with the exception of social ones) showed parenteral administration of antibiotics or the use of a stepwise method of administration. Drugs of choice (depending on the severity and extent of the process, the nature of the modifiable factors) - amoxicillin + clavulanic acid, cefuroxime or ceftriaxone, cefotaxime. Alternative drugs with ineffectiveness of starting therapy - cephalosporins III or IV generation, carbapenems. Macrolides in this group of patients are rarely used, since the overwhelming number of pneumonias caused by atypical pathogens is leaking.

Patients with a high risk of adverse outcome, severe purulent-destructive complications, the appointment of antibacterial therapy according to the de-escalation principle, using linezolid as a starting preparation alone or in combination with an aminoglycoside or a combination of a glycopeptide with aminoglycosides, or a cephalosporin III or IV generation with aminoglycoside, is indicated. Alternative therapy - carbapenems, ticarcillin + clavulanic acid.

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

Form of pneumonia	The drug of choice	Alternative Therapy
Severe pneumonia	Amoxicillin Amoxicillin + clavulanic acid Cefuroxime Azithromycin	Second-generation cephalosporins Macrolides
Severe pneumonia and pneumonia with modifying factors	Amoxicillin + clavulanic acid Cefuroxime or ceftriaxone Cefotaxime	Cephalosporins III or IV generation alone or in combination with an aminoglycoside Carbapenems
Severe pneumonia with a high risk of adverse 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

At a choice of antibacterial preparations at a pneumonia at children is more senior 6-7 years and teenagers 2 groups of patients allocate:

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

Antibiotics of choice for the first group of patients (with mild pneumonia) are considered amoxicillin and amoxicillin + clavulanic acid (inside) or macrolides. Alternative antibiotics - cefuroxime (aksetin), or doxycycline (inside), or macrolides, if previously prescribed amoxicillin or amoxicillin + clavulanic acid.

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

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

Form of pneumonia	The drug of choice	Alternative Therapy
Severe 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 of III or IV generation

[1], [2], [3], [4], [5], [6], [7],

Antibiotic therapy in hospital pneumonia

The choice of antibacterial therapy in hospital pneumonia is significantly affected by the fact that this disease is characterized by a lightning course with frequent development of a lethal outcome. Therefore, with severe hospital pneumonia and VAP, the de-escalation principle of drug selection is absolutely justified. With mild and relatively severe hospital pneumonia, treatment begins with drugs that are most suitable for the spectrum of action.

Thus, a child who has contracted a mild or relatively severe hospital pneumonia in the treatment department can be prescribed amoxicillin + clavulanic acid inside if the patient's condition allows, or intravenously. In severe pneumonia, the use of cephalosporins III (cefotaxime ceftriaxone) or IV generation (cefepime) or ticarcillin + clavulanic acid (timentin) is indicated. All these antibiotics work well on S. Aureus et epidermidis, K. Pneumoniae, S. Pneumoniae, i.e. On the most frequent pathogens of hospital pneumonia in the therapeutic department. If there is a suspicion of mild staphylococcal hospital pneumonia, it is possible to administer oxacillin as monotherapy or in combination with aminoglycosides. But if you suspect a severe staphylococcal pneumonia, especially destructive, or if such a diagnosis is already established, then linezolid or vancomycin is prescribed in the form of monotherapy or in combination with aminoglycosides.

Preterm infants who are in the second stage of nursing and who have fallen ill with hospital pneumonia, with suspicion of pneumocystis pneumonia (which is characterized by subacute flow, bilateral lung damage, small-focal character of infiltrative changes in the lungs, severe hypoxemia) are prescribed co-trimoxazole in parallel with antibiotics. With the precise diagnosis of pneumocystis hospital pneumonia, treatment is carried out with one co-trimoxazole for at least 3 weeks.

Oncohematological patients (in cases when the disease begins acutely, with the rise in temperature and the appearance of dyspnoea and often coughing), third-generation cephalosporins with anti-synergic action are prescribed. Alternative therapy - carbapenems (thienam, meropenem) or ticarcillin + clavulanic acid. If suspicion of staphylococcal hospital pneumonia, particularly in the absence of cough, in the presence of dyspnea, the threat of lung destruction with the formation of bullae and / or pleural empyema, appoint linezolid or vancomycin 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 lung radiography, have CT scans of the lungs. When establishing the diagnosis of hospital pneumonia caused by Aspergillus spp., Amphotericin B is prescribed in increasing doses. The duration of the course is not less than 3 weeks, but, as a rule, the therapy is more prolonged.

In patients who are in surgical departments or departments for burn patients, hospital pneumonia is more often caused by Ps. Aeruginosa, in second place in frequency - K. Pneumoniae and E. Coli, Acenetobacter spp. And others. S. Aureus et epidermidis is rarely detected, and anaerobes are also found, which often form associations with Ps. Aeruginosa, K. Pneumoniae, and E. Coli. Therefore, the choice of antibiotics is approximately the same as in oncohematological patients with hospital pneumonia. Assign cephalosporins of the third generation with anti-synergic action (ceftazidime) and IV generation (cefepime) in combination with aminoglycosides. Alternative therapy is therapy with carbapenems (taenam, meropenem) or ticarcillin + clavulanic acid either in monotherapy or in combination with aminoglycosides depending on the severity of the process. If suspected of staphylococcal hospital pneumonia, appoint linezolid or vancomycin either in monotherapy or in combination with aminoglycosides depending on the severity of the process. Anaerobic etiology of pneumonia shows metronidazole.

Features of the development of hospital pneumonia in patients residing in the intensive care unit require the appointment of the same spectrum of antibiotics as surgical and burn patients. However, with late VAP, the etiology of hospital pneumonia is exactly the same. Therefore, antibiotic therapy should be the same as in patients who are in surgical and burn units. The leading etiologic factor is Ps. Aeruginosa.

With early VAP, the etiology of hospital pneumonia and, accordingly, the spectrum of antibiotic therapy depend on the child's age and repeat the spectrum for community-acquired pneumonia.

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

Antibiotic

Doses

Routes of administration

Multiplicity of the introduction

Penicillin and its derivatives

Benzylpenicillin	Children under 12 years old 100 000-150 000 Unit / (kgsut) For children over 12 years 2-3 g / day 3-4 times a day	V / m, in / in	3-4 times a day
Ampicillin	Children under 12 years of age 50-100 mgDkgsut) For children over 12 years of age, 2-4 g every 6 hours	V / m, in / in	3-4 times a day
Amoxicillin	Children under 12 years 25-50 mg / (kghsut) For children over 12 years of age, 0.25-0.5 g every 8 hours	Inside	3 times a day
Amoxicillin + clavulanic acid	Children under 12 years 20-40 mg / (kghsut) (for amoxicillin) For children older than 12 years 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 30 mg / (kghsut) (for amoxicillin) For children over 12 years of age, 1.2 g every 8 or 6 hours	In / in	2-3 times a day
Oxacillin	Children under 12 years 40 mg / (kghsut) 4-12 g / day	In / in, in / m	4 times a day
Ticarcillin + clavulanic acid	100 mg / (kg x 10)	In / in	3 times a day

Cephalosporins I and II generations

Cefazolin	Children under 12 years 60 mg / (kghsut) For children over 12 years of age, 1-2 g every 8 hours	V / m, in / in	3 times a day
Cefuroxime (cefuroxime sodium)	Children under 12 years of age 50-100 mg / (kilohsut) For children over 12 years of age, 0.75-1.5 g every 8 hours	V / m, in / in	3 times a day
Cefuroxime (aksetin)	Children under 12 years of age 20-30 mg / (kghsut) For children over 12 years of age, 0.25-0.5 g every 12 hours	Inside	2 times a day

Third generation cephalosporins

Cefotaxime	Children under 12 years of age 50-100 mg / (kilohsut) For children over 12 years, 2 g every 8 hours	V / m, in / in	3 times a day
Ceftriaxone	Children under the age of 12 years 50-75 mg / (kghsut) For children over 12 years 1-2 l of 1-2 times a day	V / m, in / in	1 time per day
Cefoperazone + sulbactam	Children under 12 years of age 75-100 mg / (kilohsut) For children over 12 years of age, 1-2 g every 8 hours	In / in, in / m	Zraz per day
Ceftazidime	Children under 12 years of age 50-100 mg / (kilohsut) For children over 12 years, 2 g every 8 hours	V / m, in / in	2-3 times a day

Cephalosporins (V generation)

Cefepim

Children under 12 years of age 100-150 mg / (kghsut) For children over 12 years 1-2 g every 12 hours

In / in

3 times a day

Carbapenems

Imipenem	Children under 12 years 30-60 mg / (kghsut) For children over 12 years, 0.5 g every 6 hours	In / m In / in	4 times a day
Meropenem	Children under 12 years 30-60 mg / (kghsut) For children over 12 years of age, 1 g every 8 hours	V / m, in / in	3 times a day

Glycopeptides

Vancomycin

Children under 12 years 40 mg / (kghsut) For children over 12 years of age, 1 g every 12 hours

V / m, in / in

3-4 times a day

Oxazolidinones

Linezolid

Children under 12 years 10 mg / (kghsut) For children over 12 years 10 mg / (kghsug) 2 times a day

V / m, in / in

3 times a day

Aminoglycosides

Gentamicin	5 mg / (kg x 10)	V / m, in / in	2 times a day
Amikacin	15-30 mg / (kg x 10)	V / m, in / in	2 times a day
Nethylmycin	5 mg / (kg x 10)	V / m, in / in	2 times a day

Macrolides

Erythromycin	Children under 12 years 40-50 mg / (kghsut) For children over 12 years of age, 0.25-0.5 g every 6 hours	Inside	4 times a day
Spiramycin	Children under 12 years 15 000 U / (kghsut) For children over 12 years, 500 000 units every 12 hours	Inside	2 times a day
Roxithromycin	Children under 12 years of age 5-8 mg / (kghsug) For children over 12 years of age, 0.25-0.5 g every 12 hours	Inside	2 times a day
Azithromycin	Children under 12 years 10 mg / (kghsut) in the 1-st day, further 5 mg / (kgHsut) for 3-5 days For children over 12 years, 0.5 grams once a day (daily)	Inside	1 time per day
Clarithromycin	Children up to 12 years of age 7.5-15 mg / (kghsut) For children over 12 years, 0.5 g every 12 hours	Inside	2 times a day

Tetracyclines

Doxycycline	Children 8-12 years 5 mg / (kghsut) For children over 12 years, 0.5-1 g every 8-12 hours	Inside	2 times a day
Doxycycline	Children 8-12 years of age 2.5 mg / (kghsut) For children over 12 years of age, 0.25-0.5 g every 12 hours	In / in	2 times a day

Antibacterial drugs of different groups

Co-trimoxazole (trimethoprim + sulfamethoxazole)	20 mg / (kghsut) (with trimethoprim)	Inside	4 times a day
Metronidazole	Children up to 12 years of age 7.5 mg / kg kg Children over 12 years 0.5 g every 8 hours	In / in, inside	3-4 times a day
Amphotericin B	Begin with 100 000-150 000 units, gradually increase by 50 000 units for 1 introduction 1 every 3 days to 500 000-1 000 000 units	In / in	1 time in 3-4 days
Fluconazole	6-12 mg / (kg x 10)	In / in, inside	1 time per day

Tetracyclines are used only in children older than 8 years.

[8], [9], [10], [11], [12]

Antibiotic therapy in patients with immunodeficiency

In pneumonia in patients with immunodeficiency, empiric therapy is initiated with cephalosporins of the third or fourth generation or with vancomycin in combination with amy-sliccosides. In the future, as the etiology of the disease is refined, or if the therapy is started, for example, if pneumonia is caused by Enterobacteriaceae (K. Pneumoniae, E. Coli, etc.), S. Aureus or Streptococcus pneumoniae, or co-trimoxazole (20 mg / kg by trimethoprim) in the detection of pneumocystosis, or appoint fluconazole in candidiasis or amphotericin B in other mycoses. If pneumonia is caused by mycobacteria tuberculosis, then prescribe antibiotic rifampicin and other anti-tuberculosis drugs. If pneumonia is caused by viruses, for example cytomegalovirus, ganciclovir is prescribed; if a herpes virus, then prescribe acyclovir, etc.

Selection of antibacterial drugs for pneumonia in patients with immunodeficiency

The nature of immunodeficiency	Etiology of pneumonia	Drugs for therapy
Primary cellular immunodeficiency	Pneumocystis carinii Mushrooms of the genus Candida	Co-trimoxazole 20 mg / kg trimethoprim Fluconazole 10-12 mg / kg or Amphotericin In 8 increasing doses, starting at 150 U / kg and up to 500 or 1000 U / kg
Primary humoral immunodeficiency	Enterobacteria (C. pneumoniae, E. Coli, etc.) Staphylococci (S. Aureus, epidermidis, etc.) Pneumococci	Cephalosporins III or IV generation in the form of monotherapy or in combination with aminoglycosides Linezolid or vancomycin in the form of monotherapy or in combination with aminoglycosides Amoxicillin + clavulanic acid in monotherapy or in combination with aminoglycosides
Acquired immunodeficiency (HIV-infected, AIDS patients)	Pneumocysts Cytomegaloviruses Gerlesviruses Mycobacterium tuberculosis Fungi of the genus Candida	Co-trimoxazole 20 mg / kg trimethoprim Ganciclovir Acyclovir Rifampicin and other anti-tuberculosis preparations Fluconazole 10-12 mg / kg or Amphotericin B in increasing doses
Neutropenia	Gram-negative enterobacteria Fungi of the genus Candida, Aspergillus, Fusahum	Cephalosporins III or IV generation in the form of monotherapy or in combination aminoglycosides Amphotericin B in increasing doses

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

The duration of antibiotic therapy for hospital pneumonia is at least 3 weeks. Indication for the abolition of antibiotic therapy is the lack of clinical manifestations of the disease with mandatory radiographic monitoring.

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

[13], [14], [15]

Immunocorrective therapy

Recommendations for the appointment of immunocorrecting drugs in the treatment of community-acquired pneumonia are still under development. The most studied question is the indications for the appointment of fresh-frozen plasma and immunoglobulin for intravenous administration. They are shown in the following cases:

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

Freshly frozen plasma at a dose of 20-30 ml / kg is injected intravenously at least 3 times or daily, or every other day, depending on the severity of the disease. Standard immunoglobulins for intravenous administration (imbioglobulin / intraglobin, octagam, etc.) are prescribed as early as possible, in the 1-2 days of therapy; Enter in usual therapeutic doses (500-800 mg / kg), at least 2-3 times, daily or every other day. It is desirable to achieve an increase in the level of IgG in the blood of the patient 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 already by its very existence indicates that children who have it have a secondary or, more rarely, primary immunodeficiency. Therefore, the indication for carrying out immunocorrective therapy is the very fact of hospital pneumonia. That is why replacement immunotherapy with freshly frozen plasma and immunoglobulins for intravenous administration is an obligatory method of treating hospital pneumonia (along with antibiotic therapy). Freshly frozen plasma is injected intravenously once a day daily or once every 2-3 days (only 3-5 times depending on the severity of the condition). Immunoglobulins for intravenous administration are prescribed as early as possible, in the 1-3 days of therapy. When hospital pneumonia, especially severe, shows the administration of preparations of immunoglobulins containing IgG and IgM (pentaglobin).

Posidrome therapy

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

Indications for infusion therapy: exsicosis, collapse, microcirculatory disorders, DIC syndrome. The volume of the injected fluid is 30-100 ml / kg (with excoxosis 100-120 ml / kg). For infusion therapy, a 10% solution of glucose is used with the addition of Ringer's solution, as well as a solution of rheopolyglucin from the calculation of 20-30 ml / kg.

Anti-tussive therapy - one of the main directions of symptomatic therapy - takes a big place in the treatment of pneumonia. From antitussive medicines, the drugs of choice are mucolytics, which dilute the bronchial secret well by changing the structure of the mucus. Mucolytics are used inside and in inhalations for 3-10 days. Ambroxol (ambrohexal, ambroben, etc.), acetylcysteine (ATSTS) is used. Bromhexine, carbocysteine.

Lazolvan (ambroxol) - solution for ingestion and inhalation.

Mucolytic drug. Has a secretion. Secretionolytic and expectorant action. Lazolvan liquefies phlegm by stimulating the 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. By activating the hydrolysing enzymes and enhancing the release of lysosomes from Clara cells, reduces the viscosity of the sputum and its adhesive properties. Increases the motor activity of cilia of ciliated epithelium, increases mucociliary transport of sputum. Increases the penetration into the bronchial secret of amoxicillin, cefuroxicam, erythromycin, doxycycline.

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

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

Another area 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 by paracetamol and ibuprofen. They are prescribed alone or in combination with antihistamine preparations of the first generation (promethazine, chloropyramine).

Paracetamol is administered orally or rectally from the calculation of 10-15 mg / (kghsut) in 3-4 doses. Ibuprofen is also prescribed internally from the calculation of 5-10 mg / (kghsut) in 3-4 doses. Prometazine (pipolphen) is prescribed to children under 3 years of 0,005 grams once a day, children under 5 years - 0,01 g once a day, children over 5 years - 0,03-0,05 g once a day; or prescribe chloropyramine (suprastin) orally in the same doses (children under 3 years of 0,005 g. Children under 5 years - 0,01 g, children over 5 years - 0,03-0,05 g once a day).

At a temperature above 40 C use a lytic mixture, which includes chlorpromazine (aminazine) in a dose of 0.5-1.0 ml of a 2.5% solution, promethazine (pipolphen) 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 from the calculation of 0.2 ml per 10 kg of body weight.

Surgical treatment of pneumonia in children

Puncture is performed with abscessing of the lungs, synpneumonic pleurisy, pyopneumotorax, pleural empyema.

Prognosis for pneumonia

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

In case of incorrect and untimely treatment of pneumonia (mainly in children with chronic lung diseases, such as cystic fibrosis, malformations and others), it is possible to develop segmental or lobar pneumosclerosis and bronchial deformities in the affected area.

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