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2 . R e s p ir a to r y d is e a s e s
S ta p h y lo c o c c a l p n e u m o n ia
P ne u m onia d u e to S ta p h y lo c o c c u s a u r e u s a ffe c ting y ou ng c hild re n, ofte n those in a
p oor g e ne ra l 2
c ond ition (m a lnu trition, sk in le sions, e tc .). S ta p hy loc oc c a l p ne u m onia is a c la ssic
c om p lic a tion
of m e a sle s.
C lin ic a l fe a t u r e s
– G e ne ra l sig ns: c ha ng e in ove ra ll c ond ition, pa llor, hig h fe ve r or hy pothe rm ia , fre qu e ntly
sig ns of
shoc k ; pre se nc e of sk in le sions (point of ba c te ria l e ntry ), how e ve r, sk in le sions m a y be
a bse nt.
– G a strointe stina l sig ns: na u se a , vom iting , d ia rrhoe a , p a infu l a bd om ina l d iste ntion.
– R e sp ira tory sig ns: d ry c ou g h, ta c hy p noe a , sig ns of d istre ss (na sa l fla ring , c he st
ind ra w ing ).
P u lm ona ry a u sc u lta tion is ofte n norm a l; som e tim e s d u llne ss ind ic a ting p le u ra l
e ffu sion.
If p ossible , ta k e a c he st X -ra y : the p re se nc e of bu lla e c onfirm s the d ia g nosis. P le u ra l
e ffu sion,
ofte n u nila te ra l, m a y a lso be se e n.
c e ftria x o n e IM or slow IV (a t le a st 3 m inu te s): 5 0 m g / k g onc e d a ily
T re a tm e n t
T rAe aftetmr celinnticisaulrigmepnrtoaves mp aetinetn, t3s dd eatye rsiowra itteh nqou ifcekvelyr,:ahonsdp ditaralisien .re m ova l if a ny , sw itc h to th
– A ntibiotic tre a tm e nt: if sta p hy loc oc c a l a e tiolog y c a nnot be c onfirm e d or w hile w a iting
for
1c 0on0firm ga t/iokng, a/ dbraoay dins2p edcivtriud me dadntoibsieotsic(ifthuesriangp yforismreuclaotmionms ine nadrea dtio: of 8 :1 or 7 :1 )
1
+ c lo x a c illin IV : 1 0 0 m g / k g / d a y in 4 d ivid e d d ose s
T he se d ose s a re d ou ble d in c hild re n w ith H IV -infe c tion or m a lnu trition or m e a sle s.
2
route w ith a m o x ic illin /c la v u la n ic a c id P O to c om ple te 1 0 to 1 4 d a y s:
T he d ose is e x pre sse d in a m ox ic illin:
3
N ote : the d ose of c la vu la nic a c id shou ld not e x c e e d 1 2 .5 m g / k g / d a y or 3 7 5
m g / day.
In the e ve nt of la rg e e m p y e m a : sa m e tre a tm e nt bu t sw itc h to the ora l rou te a fte r 7
d a y s w ith
no fe ve r a nd tre a t for 3 w e e k s.
C lin d a m y c in IV m a y be a n a lte rna tive to c lox a c illin: 3 0 m g / k g / d a y in 3 d ivid e d
inje c tions the n
sw itc h to c lind a m y c in P O a t the sa m e d ose , a c c ord ing to the c rite ria a bove .
– F e ve r: p a ra c e ta m ol P O (se e p a g e 2 6 ).
– H y d ra tion by ora l rou te or infu sion or na sog a stric tu be d e p e nd ing on c linic a l c ond ition
(se e
p a g e 6 9 ).
– O x y g e n a t the flow ra te re qu ire d to m a in ta in S p O 2 ≥ 9 0 % or, if p u lse
ox y m e te r is n ot
a va ila ble , m inim u m 1 litre / m inu te .
– L oc a l d isinfe c tion of sk in le sions.
– I f the re is sig nific a nt p le u ra l e ffu sion: p le u ra l ta p w ith d ra ina g e ( for p y op ne u m othora x ;
inse rt 2 d ra ins, one a nte rior a nd one p oste rior) or w ithou t d ra ina g e (for su p p u ra tive
p le u risy ,
m a k e re p e titive ta p s w ith a n IV c a the te r).
C lin ic a l e v o lu t io n
– T he re is a se riou s risk of d e c om p e nsa tion from p ne u m othora x or su p p u ra tive p le u risy
S ta p h y lo c o c c a l p n e u m o n ia
P ne u m onia d u e to S ta p h y lo c o c c u s a u r e u s a ffe c ting y ou ng c hild re n, ofte n those in a
p oor g e ne ra l 2
c ond ition (m a lnu trition, sk in le sions, e tc .). S ta p hy loc oc c a l p ne u m onia is a c la ssic
c om p lic a tion
of m e a sle s.
C lin ic a l fe a t u r e s
– G e ne ra l sig ns: c ha ng e in ove ra ll c ond ition, pa llor, hig h fe ve r or hy pothe rm ia , fre qu e ntly
sig ns of
shoc k ; pre se nc e of sk in le sions (point of ba c te ria l e ntry ), how e ve r, sk in le sions m a y be
a bse nt.
– G a strointe stina l sig ns: na u se a , vom iting , d ia rrhoe a , p a infu l a bd om ina l d iste ntion.
– R e sp ira tory sig ns: d ry c ou g h, ta c hy p noe a , sig ns of d istre ss (na sa l fla ring , c he st
ind ra w ing ).
P u lm ona ry a u sc u lta tion is ofte n norm a l; som e tim e s d u llne ss ind ic a ting p le u ra l
e ffu sion.
If p ossible , ta k e a c he st X -ra y : the p re se nc e of bu lla e c onfirm s the d ia g nosis. P le u ra l
e ffu sion,
ofte n u nila te ra l, m a y a lso be se e n.
c e ftria x o n e IM or slow IV (a t le a st 3 m inu te s): 5 0 m g / k g onc e d a ily
T re a tm e n t
T rAe aftetmr celinnticisaulrigmepnrtoaves mp aetinetn, t3s dd eatye rsiowra itteh nqou ifcekvelyr,:ahonsdp ditaralisien .re m ova l if a ny , sw itc h to th
– A ntibiotic tre a tm e nt: if sta p hy loc oc c a l a e tiolog y c a nnot be c onfirm e d or w hile w a iting
for
1c 0on0firm ga t/iokng, a/ dbraoay dins2p edcivtriud me dadntoibsieotsic(ifthuesriangp yforismreuclaotmionms ine nadrea dtio: of 8 :1 or 7 :1 )
1
+ c lo x a c illin IV : 1 0 0 m g / k g / d a y in 4 d ivid e d d ose s
T he se d ose s a re d ou ble d in c hild re n w ith H IV -infe c tion or m a lnu trition or m e a sle s.
2
route w ith a m o x ic illin /c la v u la n ic a c id P O to c om ple te 1 0 to 1 4 d a y s:
T he d ose is e x pre sse d in a m ox ic illin:
3
N ote : the d ose of c la vu la nic a c id shou ld not e x c e e d 1 2 .5 m g / k g / d a y or 3 7 5
m g / day.
In the e ve nt of la rg e e m p y e m a : sa m e tre a tm e nt bu t sw itc h to the ora l rou te a fte r 7
d a y s w ith
no fe ve r a nd tre a t for 3 w e e k s.
C lin d a m y c in IV m a y be a n a lte rna tive to c lox a c illin: 3 0 m g / k g / d a y in 3 d ivid e d
inje c tions the n
sw itc h to c lind a m y c in P O a t the sa m e d ose , a c c ord ing to the c rite ria a bove .
– F e ve r: p a ra c e ta m ol P O (se e p a g e 2 6 ).
– H y d ra tion by ora l rou te or infu sion or na sog a stric tu be d e p e nd ing on c linic a l c ond ition
(se e
p a g e 6 9 ).
– O x y g e n a t the flow ra te re qu ire d to m a in ta in S p O 2 ≥ 9 0 % or, if p u lse
ox y m e te r is n ot
a va ila ble , m inim u m 1 litre / m inu te .
– L oc a l d isinfe c tion of sk in le sions.
– I f the re is sig nific a nt p le u ra l e ffu sion: p le u ra l ta p w ith d ra ina g e ( for p y op ne u m othora x ;
inse rt 2 d ra ins, one a nte rior a nd one p oste rior) or w ithou t d ra ina g e (for su p p u ra tive
p le u risy ,
m a k e re p e titive ta p s w ith a n IV c a the te r).
C lin ic a l e v o lu t io n
– T he re is a se riou s risk of d e c om p e nsa tion from p ne u m othora x or su p p u ra tive p le u risy
