Penicillin Allergy in Community Acquired Childhood Pneumonia

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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.

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