Antibiotic Stewardship in a Pediatric Patient with Pneumonia

 

 


Explore appropriate antibiotic selection, dosing, and resistance concerns in pediatric care.

Patient Profile:

Age: 6
Gender: Female
Weight: 44 lbs (20 kg)
Medical History: Recurrent ear infections, no known drug allergies
Current Medications: None
Diagnosis: Community-Acquired Pneumonia (CAP)
Instructions for Students:

Identify the most likely pathogens causing pneumonia in this age group and discuss antibiotic options.
Select an appropriate antibiotic regimen, including dosing, route, and frequency, based on guidelines for pediatric CAP.
Evaluate the risk of antibiotic resistance and the importance of antibiotic stewardship in this case.
Monitor: Define what clinical signs/symptoms and laboratory findings should be monitored to ensure the therapy is effective.
Adjust: Outline any considerations if the patient fails to respond to first-line therapy or develops adverse effects.
Counsel: Provide key teaching points for parents on the correct use of antibiotics, potential side effects, and the importance of completing the prescribed course.
 

Sample Answer

 

 

 

 

 

 

 

Appropriate Antibiotic Selection, Dosing, and Resistance Concerns in Pediatric CAP

1. Likely Pathogens and Antibiotic Options

Most Likely Pathogens in a 6-Year-Old:

  • Bacterial: Streptococcus pneumoniae (most common), Haemophilus influenzae, Moraxella catarrhalis.
  • Atypical: Mycoplasma pneumoniae (increasingly common in school-aged children).
  • Viral: RSV, influenza, adenovirus (do not require antibiotics).

Antibiotic Options:

  • First-line: Amoxicillin (high-dose) for pneumococcal coverage.
  • Alternatives:
    • Macrolides (e.g., azithromycin) for atypical coverage or penicillin allergy.
    • Amoxicillin-clavulanate if beta-lactamase producers (e.g., H. influenzae) are suspected.

2. Selected Antibiotic Regimen

  • Drug: Amoxicillin
  • Dose: 90 mg/kg/day (high-dose for pneumococcal resistance)
    • Calculation: 90 mg/kg × 20 kg = 1,800 mg/day
  • Frequency: Divided every 12 hours (900 mg/dose)

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