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.