Recurrent Pneumonia
Description Diagnostic criteria General and supportive management Medicine treatment Referral ICD-10 code: J18.9 DESCRIPTION Recurrence of parenchymal and bronchial airways infection clinically and radiologically after a similar episode had completely resolved during that year. Must be distinguished from persistent pneumonia where there is clinical non-recovery of parenchymal ± bronchial in
Description
Diagnostic criteria
General and supportive management
Medicine treatment
Referral
ICD-10 code: J18.9
DESCRIPTION
Recurrence of parenchymal and bronchial airways infection clinically and radiologically after a similar episode had completely resolved during that year. Must be distinguished from persistent pneumonia where there is clinical non-recovery of parenchymal ± bronchial infection after a period of 10 days.
Common aetiologies of recurrent pneumonia include immunosuppression from corticosteroid use, inappropriate antibiotic use, primary and secondary immune-suppression, congenital and structural lung abnormalities, e.g. congenital cystic adenomatous malformation, bronchiectasis, lymphoid interstitial pneumonitis etc.
Common pathogens are community acquired and include Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, respiratory syncytial virus (RSV), influenza, candida. Nosocomial pathogens are uncommon, even in HIV-infected patients.
DIAGNOSTIC CRITERIA
- Confirmation of the presence and resolution of the previous pneumonia radiologically.
- Confirmation of the current pneumonia clinically, on chest radiograph ± microbiologically see: Pneumonia.
GENERAL AND SUPPORTIVE MANAGEMENT
- Identify the underlying cause and exclude HIV and TB.
- Oxygen if saturation <93%.
- Fluid and feeds according to severity of illness.
- Blood transfusion if haemoglobin < 7 g/dL.
MEDICINE TREATMENT
- Amoxicillin/clavulanate, IV, 25 mg/kg/dose of amoxicillin component 8 hourly (do not exceed 10 mg/kg/day of clavulanate component).
Adjust antibiotics according to cultures and sensitivity.
If non-responsive: exclude foreign body and mycobacterium tuberculosis.
REFERRAL
- Underlying systematic chronic disease for consideration of prophylaxis.
- Deterioration
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 15: Respiratory System, 15.1 Cough With Predominant Fever And Tachypnoea, 15.1.1 Pneumonia, 15.1.1.5 Recurrent Pneumonia