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Pneumonia - symptoms in children and first signs. Symptoms of pneumonia in children of different ages

Pneumonia in children is a phenomenon that is best recognized at an early stage. In a child, it begins suddenly and can be dangerous not only for this, but also for a significant number of complications.

Pneumonia in children occurs due to various reasons. Any suspicion of the present pathology and characteristic symptoms in an infant, one month old, a child under one year old, 3 years old and older (for example heat and ESR) - all this indicates that childhood pneumonia is manifesting itself, which must be treated with special care, no matter how much it is required.

Pneumonia can be caused by a virus, bacteria, or fungus. Symptoms will vary depending on the pathogenesis: temperature, ESR, breathing. The main forms of pneumonia in children should be noted:

viral origin - is the mildest and simplest form that does not need to be treated in a hospital, because it goes away on its own, at home, up to 1 or 3 years;
bacterial – manifests itself, as well as due to other diseases, and most often the form of inflammation presented requires antibacterial therapy;
fungal - the rarest and provoked by a high degree of fungal activity.

U infant, as well as older than 1 year and 3 years, the latter of the presented forms most often develops due to incorrect treatment using antibiotic components.

There are varieties, the symptoms of which are most problematic in the context of diagnosis - this is mixed type pneumonia.

It is characterized by various symptoms, for example, temperature, ESR, intermittent breathing, and recovery will be the most difficult.

In a child, pneumonia can be identified as unilateral (if inflammation is identified in only 1 lung) or bilateral (when 2 lungs are affected). Despite the fact that the presented pathology is an infectious disease, very rarely it turns out to be contagious or is able to “move” from an infant to a child of 1 year or 3 years.

Causes

In most cases, a child develops pneumonia as a complication of another, most often respiratory, disease. This could be any form of sore throat, ARVI, bronchitis, as well as other ailments including pharyngitis. and the disease itself when mucus accumulates and begins to thicken in the bronchial region and pulmonary parenchyma, creating obstacles to optimal ventilation at home or in the hospital.

This is also influenced by the fact that in young children (infants and up to one year old), due to the poor development of the respiratory muscles, it is difficult to get rid of mucus in the bronchi. They can't do
This is due to the urge to cough, therefore the ventilation of certain areas of the lungs is destabilized. As a result, inflammation develops, the symptoms and signs of which are more than typical and understandable at home.

Symptoms

Parents should start to worry if, with pneumonia in adolescents, the following symptoms and signs are present:

constant and noticeable cough, the first forms of which appear unexpectedly;
high temperature, ESR and hard breath, which are difficult to knock down and forcefully increase again;
lack of recovery from a “cold” for more than 7 days or after an improvement in health, a new, even stronger deterioration is noted;
the inability to take a deep breath, while each attempt to fill the lung area 100% with air ends with a powerful cough, the temperature rises, as do the ESR indicators in a child of 1 year or 3 years.

Other characteristic signs and symptoms are obvious pallor of the skin. This indicates the formation of bacterial-type pneumonia in a child and is explained by the fact that the degree of bacterial activity provokes vasospasm. A similar process occurs due to poisoning by toxins that bacteria develop.

If all other symptoms that hint at developing inflammation lungs, the child has skin Pink colour, then its pathology is associated with a viral nature. This is evidence that inflammatory process does not pose a danger and will go away on its own in 5-6 days, no matter how old the child is.

The body can heal itself in this way by filling it with useful interferons, which stop the viral effect on the lung area of a 1-year-old or 3-year-old child.

If the child remains pale or blue and exhibits forced breathing, then these are common signs and symptoms of bacterial pneumonia. This is an obvious reason to immediately contact a specialist. Another alarming symptom and a sign indicating bilateral pneumonia or causing suspicion is the demonstration of shortness of breath even at relatively low temperatures at home.

Diagnostics

The presence of all the presented manifestations cannot be considered evidence that pneumonia is occurring. Therefore, an objective and competent diagnosis is needed, which will allow us to determine the causes of the formation of pathology in small children 1 year old, 3 years old and older, as well as in adolescents.

In addition to the conversation and studying the medical history, the therapist or pulmonologist is required to conduct the following examinations:

studying the activity of the lungs, up to listening, by which an experienced specialist will be able to identify and characterize pneumonia;
x-rays (it is optimal to take them simultaneously in 2 projections - front and side - this will make it possible to place more accurate diagnosis, exclude forms such as two-sided);
assessment of the general condition of a child from 1 to 3 years old - both at home and in the hospital;
a comprehensive blood test that will indicate why the inflammatory process is formed and what is triggering it: inflammation, infection or fungus.

Such a diagnosis of pneumonia in children should be carried out at the very beginning of the disease, as well as after the recovery cycle has been completed.

Treatment

Only a specialist can determine the treatment course.

The process is complicated by the fact that for young children - from 1 to 10-12 years old - the use of antibiotics is unacceptable.

In addition, how to treat pneumonia depends on its type: whether it is bilateral or not, whether it has complications. Therefore, the most appropriate first step is to prescribe bed rest. In this case, treatment of pneumonia in children can be started even at home, but consultation with a specialist is required. This will smooth out the symptoms, and the temperature and ESR levels will also improve, no matter how long the disease has lasted.

The next step should be the prescription of medicinal components that constitute symptomatic treatment. Read more about whether the use of antibiotic components is acceptable.

Use of antibiotics

There can be endless debate about whether the use of antibiotics is acceptable or not. Some believe that their use is possible because they eliminate the causes of the disease. Others claim that it is these components that have a positive effect on the spread of microbes throughout the lung area.

The indisputable fact is that if the pathology is bilateral and caused by bacteria or infections, the use of antibiotics can be dangerous. Under their influence, dangerous agents begin to multiply, provoking the formation of mucus and sputum in the pulmonary area. Thus, in order to cure a child at home or in a hospital, it is permissible to use antibiotic components, but not in all cases.

Rehabilitation course

The treatment cycle depends on what types of pathology have developed:

a viral type of pneumonia in a child from 1 to 10-14 years of age is most often formed on the basis of a standard ARVI and goes away on its own without the need for special therapy - this accounts for at least 60% of all cases;
a bacterial species that occurs in 40% of cases and requires a cycle of antibiotics;
a fungal variety, or pneumomycosis, is treated through the use of multi-component antifungal drugs.

In the second case, the medicinal components are selected by the therapist and if there are threatening data within the framework of diagnostic examinations. We are talking about such types as a complete blood test, x-ray, and scrupulous “listening” of the pulmonary area. When trying to treat pneumonia in a child, you can achieve even greater success if you use combinations of medications and methods approved by your therapist. traditional medicine.

Application of traditional medicine

It will not be possible to cure the pathology using only traditional medicine methods, but by combining these methods, it will be possible to achieve a quick and problem-free recovery. The most effective methods should be the preparation of decoctions and tinctures, mixtures for inhalation, as well as other compositions that can strengthen the body at home.

For example, it is useful to use propolis, lemon balm, leaves peppermint, and also prepare teas based on chamomile and coltsfoot leaves.

It is acceptable to use honey if there are no allergic reactions to it or drink milk.

All these measures must be agreed with a specialist, for example, how much and at what time of day it is permissible to use certain recipes. This will help smooth out the first and subsequent causes of the formation of pathology, improve indicators such as elevated temperature, high ESR levels. However, incorrect use of the techniques will affect the formation of complications, so you should be careful with their use - especially at home.

Complications

The types of complications after the inflammatory process in the pulmonary area can be different: from acute respiratory failure to the formation. It may also include processes such as:

sepsis, in which the temperature and ESR indicators increase critically;
abscess - absolute or partial;
bacteremia;
problems with the functioning of the heart, which appear because the enlarged lungs begin to put pressure on it.

Reaction to medications There may be a rash, vomiting and other specific manifestations. Temperature and ESR levels increase for a short period of time.

Prevention

In order for prevention to be 100% effective, you don’t need to do anything special. Thus, it is not recommended to use medications and other drugs. It is advisable to minimize the use folk remedies. The body must begin to recover itself, using its internal resources. Bed rest is not advisable because it will contribute to the accumulation of mucus and phlegm in the pulmonary area.

You should increase the child’s activity level and ventilate the room and apartment or house as often as possible. This will clear the lung parenchyma. It is necessary to drink as much fluid as possible - from water and juices to teas with lemon. Due to this, the temperature and ESR levels are normalized. This will make it possible to make blood and sputum more fluid, speeding up the healing process.

Visits to sanatoriums are encouraged, sea resorts, which will be useful for the child. All these measures will be indicated by a specialist and must be followed by parents unquestioningly, because otherwise pneumonia will childhood may develop into chronic form or develop with complications.

The goal of treatment and prevention is to prevent the accumulation of sputum and other secretions in the pulmonary area. This will be collateral get well soon no relapses. It may take 1-2 months for the body to recover 100%, and not 7 days, as many parents are used to. However, it is recommended to complete the cycle so that the child is completely healthy.

Pneumonia is an acute infectious disease, the causative agent of which is most often bacteria. The disease occurs with focal damage to lung tissue.

In a sick child at 4 years old, the signs of the disease may differ significantly from the manifestations of the disease in an infant. Helps differentiate pneumonia from bronchitis X-ray, in which the darkening of the respiratory part of the respiratory organs is clearly visible.

Among 1 thousand children in the first year of life, pneumonia, or pneumonia, occurs in 15–20 cases, and among preschool children – in 36–40. In school-age children and adolescents, the incidence is much lower and amounts to only 7–10 cases. The highest mortality rates from pneumonia are recorded under the age of 4 years.

The pathogen enters the alveoli of the lungs, where it provokes the development of the inflammatory process. Liquid (exudate) accumulates here, which interferes with physiological air exchange. The amount of oxygen entering the body is sharply reduced, so hypoxia is a sign of pneumonia in a child. Lack of oxygen often causes disruption of the circulatory system. This condition poses a danger not only to health, but also to life, so treatment must begin immediately.

COMMON SIGNS IN CHILDREN

It is quite difficult to identify signs of pneumonia in a child at an early stage. At the first stages, the symptoms of pneumonia are difficult to distinguish from the manifestations of acute bronchitis.

General symptoms:

Increased body temperature. Infection of lung tissue is accompanied by an inflammatory process that causes febrile symptoms. Unlike common viral infectious diseases, the temperature during pneumonia does not decrease on days 2–3, but remains at 37–38 degrees for a long time, despite competent treatment of ARVI.
The cough may vary in nature or be absent altogether. It can be dry, wet, paroxysmal or similar to whooping cough symptoms. It is also likely that its character will change from dry to wet. It is possible to produce mucous or purulent sputum; if traces of blood are detected in it, you must immediately inform your doctor.
Chest pain may occur during coughing or when inhaling. Pain syndrome concentrated on the right or left, and also radiates under the shoulder blade.
Change breath sounds. When listening, the doctor may detect wheezing or harsh breathing.
Lack of oxygen.

External manifestations:

fast fatiguability;
pallor and bluishness of the skin in the area of the nasolabial triangle;
swelling of the wings of the nose;
rapid shallow breathing (more than 40 times per minute in children from 1 to 6 years old);
increased sweating without physical and emotional stress;
decreased appetite due to intoxication.

The described symptoms make it possible to timely identify the first signs of pneumonia in children.

From point of view laboratory diagnostics, valuable information can be obtained from the results clinical analysis blood. It reflects the total amount of inflammatory metabolic products in its liquid fraction.

The presence of pneumonia can be indicated by an increased content of band and segmented leukocytes (more than 15 thousand per 1 cubic mm), as well as a significant increase in the erythrocyte sedimentation rate.

A timely consultation with a pediatrician will help determine which signs actually indicate pneumonia and differentiate them from symptoms of other pulmonary diseases.

SIGNS IN A CHILD IN THE FIRST YEAR OF LIFE

In children under one year of age, pneumonia occurs 10 times more often than in schoolchildren. The highest incidence is observed among children 3-9 months.

The danger of pneumonia in infants is the rapid spread of the pathological process in the lung tissue and disruption of the functions of digestion and urination.

Features of symptoms:

Symptoms of pneumonia in children under one year of age develop gradually. First, there is a general malaise, which manifests itself as weakness, loss of appetite, regurgitation, and sleep disturbances. Next, symptoms similar to a viral infection occur: dry cough, sneezing and nasal congestion.
The disease occurs at a relatively low and stable body temperature. As a rule, it does not exceed 38 degrees or may not rise at all.
Cyanosis of the nasolabial triangle and fingertips intensifies when screaming, during strong crying or breastfeeding.
Retraction of skin between ribs.
During development respiratory failure the two halves of the chest participate in the act of breathing differently.
Later, increased breathing and disruption of its rhythm are noted. The wings of the nose are tense, they become pale and motionless.
Infants under three months may experience foamy discharge from the mouth. Such signs of pneumonia in a child under one year old may be a harbinger of frequent and prolonged respiratory arrest.

Symptoms of pneumonia in children under 6 months of age may be atypical, so if pneumonia is suspected, an x-ray examination is required.

SIGNS IN PRESCHOOL CHILDREN

The symptoms of pneumonia in a 1-year-old child and in older children have some differences. Preschoolers have developed a more stable immune system, so pneumonia manifests itself with clear typical symptoms.

Features of symptoms:

A child aged 2 to 5 years has signs of pneumonia in initial stage There may be general symptoms of a viral infection that overlap with other diseases.
Most often, in children of preschool and school age, pneumonia occurs as a type of bronchopneumonia.
When a 3-year-old child has pneumonia, his breathing rate is more than 50 respiratory movements per minute.
A cough may appear only on the 5th–6th day of illness, but may be absent altogether.
Preparations based on ibuprofen and paracetamol cannot reduce body temperature.
Sputum during coughing occurs only when the surface of the bronchi is inflamed. It may have a greenish or yellowish color.
Extrapulmonary symptoms may also be observed: muscle pain, increased heart rate, confusion, indigestion, skin rashes.

Among adolescents, pneumonia of the community-acquired and hospital-acquired type occurs. In all cases, the main pathogens are: viruses, bacteria, and Candida fungi.

Doctors say that pneumonia in adolescents is usually associated with previous illnesses. It could be measles, simple flu, salmonellosis, scarlet fever, and so on. Chlamydial and ureaplasmosis pneumonia are classified into a separate group. These types of diseases among adolescents are quite common. How does pneumonia start? Symptoms in teenagers are shown below.

Causes

Risk factors that provoke the development of pneumonia in adolescents include:

presence of bad habits;
contact with sick people.

Of course, the children school age suffer from pneumonia not as often as it might have been before. If infection does occur, the main pathogens will be pneumococci and chlamydia. Mycoplasmas and their various atypical forms are also sometimes encountered. It is this age group that suffers most from prolonged pneumonia, which cannot be said about adults or newborn children.

In any case, everything is determined by the state of the immune system, so it is important to take measures to strengthen it.

Symptoms

Drug treatment

The main purpose of treatment is associated with the complete destruction of all pathogens that provoked the development of pneumonia. It is important to remember that traditional medicine cannot give the desired result, so it is best to completely abandon this technique. In most cases, this disease is bacterial. After examinations, doctors prescribe a course of antibiotics (Amoxicillin, Flemoxin, Mezlociollin, Erythromycin, Clarithromycin, Ceftriaxone, etc.). Selection medicines carries out exclusively qualified specialist, since the dosage should correspond to the age of the teenager and the severity of the pneumonia. Sometimes a few days are enough for the patient’s condition to improve. This appointment is only suitable for children adolescence or adults. Adolescents are advised to take appropriate therapy for several weeks.

Antibiotics to the rescue

As already mentioned, thanks to antibiotics, it is possible to relieve the symptoms of the disease in a short period of time, but there is no talk of complete destruction of the infection yet. That is why the attending physician prohibits stopping taking medications, even if the patient feels much better. The course of therapy is completed only after a repeat x-ray of the lungs is performed and the results are obtained laboratory research.

Conditions for successful treatment

the temperature drops to normal levels (below 37 degrees);
Dysbacteriosis and intoxication of the body do not appear;
shortness of breath and increased sweating have completely disappeared;
when coughing, no sputum is produced;
the sense of appetite has normalized;
improved leukocyte formula(neutrophils should not be more than 80%).

Parents of teenagers are not recommended to self-medicate and should immediately seek help at the first sign. qualified help doctors Otherwise, complications may develop and the patient will have to be admitted to the hospital for a longer period. Sometimes deaths occur for this reason.

Hospitalization

Hospitalization for a teenager with pneumonia may be indicated after evaluating certain factors. This is the age of the patient and the severity of the disease itself. If pneumonia occurs in mild form, then the child is sent home for treatment. In some cases, the doctor must take into account the participation of the patient's body systems in the disease process. For example, sometimes against the background of such inflammation the liver may become enlarged or difficulties with respiratory function may begin. The presence of such symptoms always requires emergency hospitalization.

Several options are used to treat pneumonia in adolescents. We are talking about symptomatic and etiological directions. The latter helps to directly destroy the source of infection, which caused the development of the disease. The majority of patients (approximately 70%) suffer from pneumonia, which is associated with staphylococci and streptococci. For symptomatic treatment characteristically alleviates the immediate symptoms of the disease. The main task of doctors is to ensure improved filtration of the lungs, so that the body can be fully saturated with oxygen.

Even if the general condition improves, the patient is advised to remain in bed and ensure a constant supply of cool air inside the room where it is located. It is important to monitor the humidity level so that the air masses are not too dry. As for drinking regime, then it is better to drink only warm liquid, but not boiling water. Don't forget to take extra vitamins.

Traditional treatment

If a teenager light form pneumonia and this is confirmed by specialists, then treatment can be carried out using traditional methods. There are many ways, you just have to choose the one that suits best:

It is best to combine medications and traditional methods to avoid the consequences of pneumonia that occur with insufficient therapy.

Prevention

Every person is not immune from developing pneumonia. It manifests itself after hypothermia of the body, even if it was very slight. Everyone knows the most common signs of this disease. Pathological condition develops even against the background of a common cold, but only if it has not been fully treated. If a person suffers from flu and other diseases on the legs, then in most cases this leads to the development of pneumonia.

Experts identify a whole group of people who are most susceptible to this disease. We are talking about those who smoke a lot and are addicted to alcohol. People who do not smoke but inhale tobacco smoke are also at risk.

If you want to completely protect the body from pneumonia, then it is recommended to lead a healthy lifestyle and actively strengthen the immune system at any time of the year. With the onset of the cold season, it is important to be especially careful about your health. To maintain the immune system, preference should be given to proven traditional medicine recipes.

If the problem persists, then it is important to adhere to all the doctor’s recommendations and follow treatment regimen. Thanks to modern methods Treatments and medications can quickly eliminate the symptoms of the disease and prevent the development of complications of pneumonia that arise from improper treatment. It is worth remembering that the disease can lead to complications such as pleurisy, pulmonary edema or abscess, acute cardiopulmonary failure, myocarditis, endocarditis, meningoencephalitis, meningitis, sepsis, infectious-toxic shock, etc.

According to statistics, 1% of minor children suffer from pneumonia at least once in their lives. This can be explained by a decrease in immunity due to intensive growth of the body. The provoking factors of the disease are infections, poor nutrition, violation of hygiene. Clinical signs of pneumonia appear within 3 days after the onset of general malaise.

In adolescents, pneumonia becomes a consequence of age-related changes in the endocrine and immune systems. Children have a fragile body, and encountering any new infection comes with complications if left untreated. Pneumonia is dangerous at the age of 11-16 years, when the child is growing rapidly. Lack of vitamins and microelements important for growth undermines defenses.

Bacteria constantly surround humans. They are in the air, rising along with the dust. Within normal limits, streptococci are not capable of harming a teenager, but even a small concentration of them in the larynx is enough for the development of diseases of the respiratory system during the period of a common cold, flu, or injury. Intensive development of pneumonia begins after the appearance of sore throat, bronchitis, and sinusitis.

The causative agents of pneumonia in adolescents are pneumococci and streptococci. Less commonly, the respiratory tract is affected by Haemophilus influenzae, Mycoplasma or Klebsiella. The bacterial environment always manifests itself in different ways. But before the formation of inflammation, the patient always feels a deterioration in health. This symptom is a sign of the onset of pathogenic microorganism activity.

Based on the type of infection acquired, a distinction is made between hospital-acquired and community-acquired pneumonia. In adolescents, the first type of pneumonia occurs as a result of acute respiratory infections. The second case occurs in a clinical setting after contact with a sick person or artificial ventilation. According to the scale of inflammation in respiratory organ There are focal, lobar, segmental pneumonia.

Consequences of untreated inflammation

Pneumonia is dangerous because complications arise after it varying degrees gravity:

Pleurisy.
Broncho-obstructive syndrome.
Pneumothorax.
Infectious-toxic shock can result in damage to the brain and parts of the heart. Sepsis requires urgent measures to thin the blood and destroy the bacterial environment.
Lung abscess.
Swelling of tissues that makes it difficult for a person to breathe.
Tuberculosis, lung cancer.
Acute lung destruction.
Acute failure of the heart and blood vessels.
Death.
Postpneumonic pneumosclerosis.
The occurrence of mediastinitis.

The listed complications require urgent resuscitation of the patient. The result of a serious condition may be the formation of fibrous tissue in the lung, which will have to be removed surgically.

How does inflammation manifest?

Pneumonia does not occur suddenly; people often do not pay attention to the first signs of pneumonia. The painful process begins with a rise in body temperature to values above 38 degrees. The teenager’s activity decreases, lethargy and lack of desire to do physical work are observed.

The child may feel discomfort when breathing, which manifests itself in conditions ranging from small tingling sensations with a long breath to acute pain in the sternum. This symptom is accompanied by a cough, first dry and infrequent, then prolonged with sputum. The discharged liquid becomes yellow-green in color, this shade is due to pus.

Gradually, the teenager’s breathing becomes shallow and therefore rapid. Due to pain in the sternum, the patient has no desire to breathe deeply. Sweating increases, heart rate increases. In acute stages, headaches often occur and digestion is disturbed. At the moment when the bacterial environment enters the blood, conditions close to critical are formed.

Severe cough and lack of air lead to clouded consciousness, primarily the heart suffers. With prolonged infection, meningitis can form in the body. Brain damage is one of the severe consequences of pneumonia.

How to determine the type of inflammation?

Interviewing the patient and parents helps narrow down the search for the cause of the disease. If there are similar cases in a school group, then the extent of the spread of pneumonia is assessed. It can be transmitted by airborne droplets. Provoking factors in adolescents are taken into account:

Smoking, nutrition, physical condition.
State of the environment. Place of residence.
Diseases of the respiratory system: bronchitis, sinusitis, rhinitis, tonsillitis. Dental problems.
Decreased immunity for another reason: diseases of internal organs, poisoning, injury, surgery.
It takes into account whether artificial ventilation lungs on the eve of illness.
Stressful conditions, taking potent drugs.
Visit public places: camps, sporting events, trips to swampy areas with high humidity.

To assess the condition of a teenager, the following methods are used:

Serological studies.
Images of the sternum: x-ray, ultrasound, MRI.
Microbiological research.
Differential diagnosis.

From the images you can clearly see large lesions of the lungs the size of a penny coin. The croupous type of pneumonia is difficult to see in the photograph. It passes with the formation of small infectious points. Which are very blurred, it is impossible to draw clear conclusions about the cause of the disease. Additional methods for analyzing a person’s condition are blood and urine indicators. Elevated leukocytes in the blood indicate the onset of inflammation in the body, but the exact cause can only be determined after identifying the type of pathogen in the sputum released with a cough.

To assess the condition of the lungs, the method of auscultation and bronchophony is used. Installed characteristic of the disease sounds during tapping of the sternum. A shortening of the percussion tone indicates the onset of inflammation. Pathological phenomena are: wheezing, bursts during breathing are formed due to the accumulation of fluid in the respiratory organ.

However atypical pneumonia requires a more thorough analysis of the symptoms present. They are less pronounced and comparable to ordinary acute respiratory infections. There is a deterioration in health, an increase in temperature, and slight discomfort in the larynx and lungs. Often patients begin to self-medicate and trigger the ongoing inflammation.

Anti-inflammatory therapies

In adolescents, based on test results, treatment is carried out using antibiotics: amoxycyclines, cephalosporins, doxycyclines, macrolides. They continue to take the drugs even after the clinical symptoms disappear. Often the duration of therapy lasts more than 10 days, depending on the severity of complications.

Positive treatment results are accompanied by the following conditions:

Significant decrease in body temperature.
Normalization of digestion.
Signs of intoxication disappear.
Breathing is normalized. The patient does not feel pain or discomfort in the sternum.
There are no febrile manifestations.
Cough and phlegm disappear.
Blood and urine test results are normal.

Treatment of pneumonia is carried out in a hospital setting. At any moment, your health may deteriorate and you will need urgent help to reduce intoxication in the body. Therapy can be carried out at home as prescribed by a doctor only in mild cases of inflammation.

The type of drug is selected based on the results of an analysis of the bacterial environment for sensitivity to active substance. This approach allows you to choose the most effective drug from those available for sale. Let's look at the main types of medications prescribed for pneumonia:

Benzylpenicillin is effective against staphylococcal pneumonia, pneumococci or Haemophilus influenzae.
For mycoplasma and legionella, choose doxycycline or erythromycin.
When the source of inflammation is pneumococcus with gram-negative flora, treatment is started with second or third generation cephalosporins.
When it is necessary to replace penicillin-based drugs, nitorfuran or macrolide agents are chosen.

In some cases, it is advisable to choose a method of drug administration. This becomes important in moments of critical conditions. This way, a dropper can remove intoxication within 10 minutes, make the patient feel better, and also restore the water balance in the body. Infections are diagnosed when there are complications in the digestive system. Excluded Negative influence medications for the stomach and intestines.

The dose of drugs is selected individually and is often overestimated. This is done to avoid developing antibiotic-resistant bacteria. Additional help oxygen therapy is used; when tissues are saturated with its molecules, internal metabolic processes. This measure significantly reduces the duration of treatment.

Not really

Doctor of Medical Sciences, Prof. Samsygina G.A., head. Department of Childhood Diseases No. 1, Faculty of Pediatrics, Russian State Medical University named after. N.I. Pirogova, Honored Doctor of Russia

Pneumonia - acute infection, predominantly of a bacterial nature, is an old, long-known and eternally new, or rather renewing, disease. Pneumonia is characterized by focal damage to the respiratory parts of the lungs, the presence of respiratory disorders and intra-alveolar exudation, as well as infiltrative changes on radiographs of the lungs.

Currently, pneumonia is usually divided depending on the conditions of its occurrence into community-acquired (home-acquired) and hospital-acquired (hospital-acquired, nosocomial). Community-acquired pneumonia, which, by the way, predominates, is understood as an acute infectious disease of the lung parenchyma that developed in normal conditions existence of a child or adolescent. This article is devoted to the problems community-acquired pneumonia or, as they are commonly called, simply pneumonia, in children.

Pneumonia occurs at different age periods of childhood with varying frequencies. There are two peaks for diagnosing pneumonia. The first and highest peak occurs in early childhood and preschool age, when pneumonia is diagnosed in approximately 40 out of 1000 children. The second, lower level, is determined in high school and adolescence. The diagnosis of pneumonia is established in approximately 10 cases per 1000 children /1, 2/. This morbidity dynamics is not accidental. It reflects the critical period of development of the pulmonary system (begins from the age of 18 months of the child and occurs at the age of 2-3 years /3/), the expansion of the child’s contacts with the outside world, which contributes to infection and, in high school and adolescence, coincides with the endocrinological and immunological restructuring of the adolescent’s body.

Mortality from pneumonia (together with influenza) in Russian Federation the average is 13.1 per 100 thousand population. Moreover highest mortality rate is observed in the first four years of children’s lives (30.4 per 100 thousand population), the smallest (0.8 per 100 thousand population) is registered at the age of 10-14 years. During the period of the second rise in incidence, i.e. at the age of 15-19 years, there is a slight increase in mortality from pneumonia (up to 2.3 per 100 thousand population) /4/.

According to clinical and radiological data, pneumonia can affect a lobe (lobar), segment or segments (segmental or polysegmental), alveoli or groups of alveoli (focal pneumonia), incl. adjacent to the bronchi (bronchopneumonia) or interstitial tissue (interstitial pneumonia). Mainly, these differences are revealed during X-ray examination of patients /5, 6, 7/.

Based on the severity of the course, the severity of lung damage, manifestations of toxicosis and complications, mild and severe pneumonia, uncomplicated and complicated are distinguished. Complications of pneumonia can be infectious-toxic shock with the development of multiple organ failure, destruction of the pulmonary parenchyma (bullas, abscesses), involvement in infectious process pleura with the development of pleurisy, empyema, pneumothorax, the occurrence of mediastenitis, etc.

Most common pathogens pneumonia in children and adolescents are Streptococcus pneumoniae(in 20-60% of cases); Mycoplasma pneumoniae(in 5-50% of cases); Chlamydia pneumoniae(in 5-15% of cases); Chlamydia trachomatis(in 3-10% of cases); Haemophilus influenzae(in 3-10% of cases); Enterobacteriaceae (Klebsiella pneumoniae, Escherichia coli etc.) (in 3-10% of cases); Staphylococcus aureus(in 3-10% of cases); Streptococcus pyogenes, Chlamydia psittaci, Coxiella burneti etc. (rarely). It should be noted that the etiology of pneumonia in children and adolescents is closely related to the age of the child /7-10/.

In the first six months of life, the etiological role of pneumococcus and Haemophilus influenzae is insignificant, because antibodies to these pathogens are transmitted from the mother in utero. In this age E. coli, K. pneumoniae And S. aureus play a leading role as a cause of pneumonia. They cause the most severe forms of the disease in children, complicated by the development of infectious-toxic shock and lung destruction. Another group of pneumonia at this age is pneumonia caused by atypical pathogens, mainly C. trachomatis, infection of which occurs from the mother either intranatally/antenatally (rarely), or in the first days of life. Infection is also possible P. carinii, especially premature babies.

Starting from 6 months of age and up to 6-7 years inclusive, pneumonia is mainly caused by S. pneumoniae which accounts for up to 60% of all cases of pneumonia. Often, non-capsular hemophilus influenzae is also sown. H. influenzae type b is detected less frequently, in 7-10% of cases, and usually causes severe pneumonia, complicated by lung destruction and pleurisy.

Diseases caused by S. aureus And S. pyogenis usually complicated by severe viral infections, such as influenza, chicken pox, measles, herpes infection, and do not exceed 2-3% in frequency. Pneumonia caused by atypical pathogens in children of this age is mainly due to M. pneumoniae And C. pneumoniae. It should be noted that the role M. pneumoniae as causes of pneumonia in children last years is clearly increasing. Basically, mycoplasma infection begins to be diagnosed in the second or third year of life. C. pneumoniae as a cause of pneumonia, it is detected mainly after five years.

Viruses can be like independent cause diseases and create viral-bacterial associations. The most important is the respiratory syncytial (RS) virus, which occurs in approximately half of cases of viral and viral-bacterial disease; in a quarter of cases, the cause of the disease is parainfluenza viruses types 3 and 1. Influenza A and B viruses and adenoviruses play a minor role. Rhinoviruses, enteroviruses, and coronaviruses are rarely detected. Pneumonia caused by measles, rubella, chickenpox. It should be emphasized that in addition to its independent etiological significance, respiratory viral infection occurs in children of early and preschool age an almost obligatory background for the development of bacterial inflammation.

The etiology of pneumonia in children over seven years of age is practically no different from that in adults. The most common cause of pneumonia is S. pneumoniae(up to 35-40% of cases), M. pneumoniae(23-44% of all cases), C. pneumoniae(15-30% of cases). H. influenzae type b and pathogens such as and etc.). S. aureus are practically not detected.

Particularly worth mentioning is pneumonia in immunocompromised patients /12/. In children with primary cellular immunodeficiencies, HIV-infected patients and children with AIDS, pneumonia is more often caused P. carinii and mushrooms of the genus Candida, and M. avium-intracellare and cytomegalovirus. In case of humoral immunodeficiencies, pneumonia is more often caused S. pneumoniae as well as staphylococci and enterobacteria, and in case of neutropenia - gram-negative enterobacteria and fungi (Table 1).

Table 1

Etiology of pneumonia in immunocompromised patients

In the development of pneumonia in children and adolescents, two main routes of infection are important: aspiration of oropharyngeal secretions and inhalation of an aerosol containing microorganisms. Microaspiration of oropharyngeal secretions in children is of greatest importance. Greater value has obstruction in microaspiration mechanisms respiratory tract, especially in the presence of broncho-obstructive syndrome, which is so common in children of early and preschool age. Aspiration large quantity contents of the upper respiratory tract and/or stomach is typical for newborns and children in the first months of life and occurs during feeding and/or vomiting and regurgitation.

When microaspiration/aspiration or inhalation of an aerosol containing microorganisms occurs against the background of a violation of the mechanisms of nonspecific resistance of the child’s body, for example during ARVI, the most favorable conditions for the development of pneumonia.

Clinical manifestations of pneumonia include: shortness of breath, cough, fever, weakness, impairment of the child’s general condition and symptoms of intoxication. Thus, the diagnosis of pneumonia should be assumed if a child develops a cough and/or shortness of breath with a number of respiratory movements of more than 60 per minute for children under three months, more than 50 per minute for children under one year, more than 40 per minute for children under five years of age, especially in combination with retraction of the compliant areas of the chest and fever of more than 38 °C for three days or more /12/.

During the physical examination, special attention is paid to identifying the following signs:

●shortening (dullness) of percussion sound over the affected area of the lung;

●local bronchial breathing, sonorous fine rales or inspiratory crepitus during auscultation;

Percussion and auscultation changes in the lungs, namely shortening of the percussion sound, weakening or, conversely, the appearance bronchial breathing, crepitus or fine rales in the lungs are detected in 50-70% of cases /8, 12, 13/. However, it should be remembered that in early childhood, especially in children in the first months of life, these manifestations are typical for almost any acute respiratory infection, and physical changes in the lungs with pneumonia in most cases (with the exception of lobar pneumonia) are practically indistinguishable from physical changes in bronchiolitis and bronchitis. In most cases, the severity of clinical symptoms depends on many factors, including the severity of the disease, the extent of the process, the age of the child, the presence concomitant diseases etc. It should be noted that approximately 15-25% of sick children may have no physical symptoms or cough.

The gold standard for diagnosing pneumonia is chest x-ray. The following criteria are assessed, which also indicate the severity of the disease and help in choosing antibacterial therapy:

●the size of lung infiltration and its prevalence;

●presence or absence of pleural effusion;

●presence or absence of destruction of the pulmonary parenchyma.

Subsequently, with clear positive dynamics clinical manifestations pneumonia, there is no need for control radiography both upon discharge from the hospital and during treatment at home. It is advisable to carry out control radiography no earlier than 4-5 weeks from the onset of the disease. X-ray study in dynamics in acute period disease is carried out only if there is progression of symptoms of lung damage or if signs of destruction and/or involvement of the pleura in the inflammatory process appear. In cases of complicated pneumonia, mandatory X-ray monitoring is also carried out before the patient is discharged from the hospital.

A peripheral blood test should be performed in all patients with suspected pneumonia. Leukocytosis >10-12·10 9 /l and band shift >10% indicate high probability bacterial infection, and leukopenia<3·10 9 /л или лейкоцитоз >25·10 9 /l are unfavorable prognostic signs of the course of pneumonia.

Thus, radiological and clinical laboratory criteria for diagnosing pneumonia are the presence of infiltrative changes on the radiograph in combination with at least two of the following clinical and laboratory signs:

●acute febrile onset of the disease (body temperature >38 °C);

●cough;

●auscultatory signs of pneumonia;

●leukocytosis >10-12·10 9 /l and/or band shift >10%.

A biochemical blood test is the standard method for examining children and adolescents with severe pneumonia who require hospitalization. The activity of liver enzymes, the level of creatinine and urea, and electrolytes in the blood are determined. The acid-base status of the blood is also a standard method of examining children and adolescents with severe pneumonia. In young children, pulse oximetry is performed.

The etiological diagnosis is established mainly when severe pneumonia. A blood culture is performed, which gives positive result in 10-40% of cases /14/. Microbiological examination of sputum in pediatrics does not have wide application due to technical difficulties in collecting sputum in the first 7-10 years of life. In cases of bronchoscopy, aspirates from the nasopharynx, tracheostomy and endotracheal tube are subjected to microbiological examination. It is also possible to culture punctate pleural contents.

To clarify the etiology of the disease, serological research methods are also used. An increase in titers of specific antibodies in paired sera taken during the acute period and during convalescence may indicate a mycoplasma or chlamydial etiology of pneumonia. Reliable methods for identifying antigens are latex agglutination, counter immunoelectrophoresis, ELISA, PCR, etc. All these methods, however, do not affect the choice of treatment tactics and have only epidemiological significance.

●the diagnosis of “pneumonia” should be assumed when a child or adolescent develops an acute cough and/or shortness of breath, especially in combination with fever and/or corresponding auscultatory changes in the lungs and symptoms of intoxication;

●the diagnosis criterion is the presence of characteristic changes of an infiltrative nature in the lungs on radiographs of the chest organs;

●the assumption of a diagnosis of pneumonia, and even more so its clinical and radiological substantiation, is an indication for the immediate administration of the first dose of an antibiotic and determining the place of treatment for the patient;

●Only after starting antibacterial therapy and determining the site of treatment should efforts be focused on etiological diagnosis.

The need for a differential diagnosis for pneumonia arises only in difficult cases. Then they use computed tomography, which has twice the sensitivity in identifying foci of infiltration in the lower and upper lobes of the lungs, fibrobronchoscopy and other instrumental techniques.

The differential diagnosis of pneumonia in children and adolescents is closely related to the age of the child, because determined by the characteristics and character pulmonary pathology at different age periods. For example, in infancy the need for a differential diagnosis arises in diseases that are difficult to treat standard treatment. In these cases, it should be remembered that, firstly, pneumonia can complicate another pathology. Secondly, the clinical picture of respiratory failure can be caused by conditions such as aspiration, a foreign body in the bronchi, previously undiagnosed tracheoesophageal fistula, gastroesophageal reflux, malformations of the lung (lobar emphysema, coloboma), heart and large vessels, cystic fibrosis and α-antitrypsin deficiency .

In children of the second or third years of life and older, with pneumonia that is difficult to treat, Kartagener syndrome, pulmonary hemosiderosis, nonspecific alveolitis, and selective IgA immunodeficiency should be excluded. Differential diagnosis at this age is based on the use of endoscopic examination of the trachea and bronchi, lung scintigraphy, angiography, sweat and other tests for cystic fibrosis, determination of the concentration of α 1 -antitrypsin, etc.

In all age groups, it is necessary to exclude the diagnosis of pulmonary tuberculosis.

In patients with severe immune defects, when shortness of breath and focal infiltrative changes appear on a chest x-ray, it is necessary to exclude the involvement of the lungs in the main pathological process(for example, in systemic connective tissue diseases), as well as the consequences of the therapy (drug-induced lung damage, radiation pneumonitis, etc.).

Treatment of pneumonia begins with determining the place of treatment and prescribing antibacterial therapy to the patient, incl. if pneumonia is suspected.

Indications for hospitalization for pneumonia in children and adolescents are the severity of the disease and the presence of risk factors for an unfavorable course of the disease (modifying risk factors). Indicators of disease severity include:

●child’s age is less than two months, regardless of the severity and extent of the process;

●child's age up to three years with lobar lung damage;

●damage to two or more lobes of the lungs (regardless of age);

●presence of pleural effusion (regardless of age).

Modifying risk factors include:

●severe encephalopathy;

●intrauterine infection in children of the first year of life;

●hypotrophy 2-3 degrees;

● birth defects development, especially congenital heart defects and large vessels;

●chronic diseases of the lungs (including bronchopulmonary dysplasia, bronchial asthma), cardiovascular system, kidneys (nephritis), oncohematological diseases;

●immunocompromised patients;

●impossibility of adequate care and fulfillment of all medical prescriptions at home (socially disadvantaged families, poor social and living conditions, including hostels, settlements of refugees, internally displaced persons, etc., religious views of parents, etc. ) and other modifying social factors.

Indications for hospitalization in the intensive care unit and intensive care(ICU), regardless of the presence or absence of modifying risk factors in the child, pneumonia is suspected if the following symptoms are present:

●shortness of breath over 80 breaths per minute for children of the first year of life and over 60 breaths per minute for children over one year of age;

●retraction of the jugular fossa when the child breathes;

●moaning breathing, irregular breathing rhythm (apnea, gasps);

●signs of acute cardiovascular failure;

●intractable hyperthermia or progressive hypothermia;

●impaired consciousness, convulsions.

Indications for hospitalization in surgery department or to a department with the possibility of providing adequate surgical care is the development of pulmonary complications (sypneumonic pleurisy, metapneumonic pleurisy, pleural empyema, lung destruction, etc.). It should be emphasized that the nature of pulmonary complications is in a certain relationship with the etiology of the process. Thus, metapneumonic pleurisy is more typical for pneumococcal etiology of the disease, and pleural empyema is more typical for staphylococcal and klebsiella etiology; destruction of the pulmonary parenchyma without the formation of bullae is for hemophilus influenzae infection, and the formation of bullae is for staphylococcal infection (however, there is no direct correlation between the clinical and radiological picture and the etiological factor).

Empirical antibacterial therapy, immediately started when pneumonia is diagnosed or suspected in a child’s serious condition, is the main method of treating pneumonia /5, 7, 8, 12/. The empirical prescription of antibacterial agents makes it important for the physician to know about the etiology of pneumonia at different ages.

The indication for replacing the antibiotic/antibiotics is the lack of clinical effect within 36-72 hours, as well as the development of side effects. The criteria for lack of effect are the following symptoms: persistence of body temperature above 38 °C and/or deterioration of the child’s condition, and/or increasing changes in the lungs or pleural cavity; with chlamydial and Pneumocystis pneumonia - an increase in shortness of breath and hypoxemia.

If there are risk factors for an unfavorable prognosis, treatment of pneumonia is carried out according to the de-escalation principle, i.e. begins with antibiotics with potentially the broadest spectrum of action, followed by a transition to antibacterial drugs with a narrower spectrum.

Features of the etiology of pneumonia in children in the first six months of life make inhibitor-protected amoxicillin (amoxicillin + clavulanate) or cephalosporin the drugs of choice for mild pneumonia I-II generations(cefuroxime or cefazolin), for severe pneumonia - III-IV generation cephalosporins (ceftriaxone, cefotaxime, etc.) in monotherapy or in combination with aminoglycosides.

For pneumonia occurring in a child up to six months with normal or low-grade fever, especially in the presence of obstructive syndrome and indications of vaginal chlamydia in the mother, we can assume pneumonia caused by C. trachomatis. In these cases, it is advisable to immediately prescribe the child a macrolide antibiotic (azithromycin, roxithromycin or spiramycin) orally.

In premature babies, be aware of the possibility of pneumonia caused by P. carinii. If pneumocystis is suspected, children are prescribed co-trimoxazole along with antibiotics, and if the etiology of pneumonia is confirmed, only co-trimoxazole is left, which the child receives for at least three weeks.

For pneumonia aggravated by the presence of modifying risk factors or with a high risk of an unfavorable outcome, the drugs of choice are the inhibitor-protected amoxicillin in combination with aminoglycosides or cephalosporins of the III-IV generation - ceftriaxone, cefotaxime, cefepime in monotherapy or in combination with aminoglycosides, depending on the severity diseases; carbapenems (imipenem from the first month of life, imipenem and meropinem from the second month of life). If a staphylococcal etiology of the disease is suspected or diagnosed, the administration of linezolid or vancomycin is indicated, depending on the severity of the disease, alone or in combination with aminoglycosides.

Alternative drugs, especially in cases of development destructive processes in the lungs, are linezolid, vancomycin, carbapenems (Table 2).

table 2

Choice antibacterial drugs in children in the first six months of life with pneumonia

Form of pneumonia	Drugs of choice	Alternative therapy
Mild typical pneumonia	Amoxicillin + clavulanate or 2nd generation cephalosporins	Cephalosporins II and III generation in monotherapy
Severe typical pneumonia	Amoxicillin + clavulanate in combination with an aminoglycoside or Linezolid or vancomycin alone or in combination with aminoglycosides Carbapenems	Carbapenems Vancomycin Linezolid
Atypical pneumonia	Macrolide antibiotic Co-trimoxazole	-

At the age of 6-7 months to 6-7 years, when choosing initial antibiotic therapy, 3 groups of patients are distinguished:

●patients with non-severe pneumonia who do not have modifying risk factors or have modifying social risk factors;

●patients with severe pneumonia and patients with modifying risk factors that worsen the prognosis of the disease;

●patients with severe pneumonia with a high risk of unfavorable outcome.

For patients in the first group—with mild pneumonia and no modifying risk factors—it is most advisable to prescribe oral antibacterial drugs. For this purpose, amoxicillin, amoxicillin + clavulanate or the second generation cephalosporin cefuroxime axetil can be used. But in some cases (lack of confidence in fulfilling prescriptions, a rather serious condition of the child when the parents refuse hospitalization and other similar situations), a stepwise method of therapy is justified, when in the first 2-3 days the treatment is carried out parenterally, and then when the patient’s condition improves or stabilizes the same antibiotic is prescribed orally. For this purpose, amoxicillin + clavulanate can be used, but it is administered intravenously, which is difficult at home. Therefore, cefuroxime intramuscularly and cefuroxime axetil orally are more often used.

In addition to beta-lactams, treatment can be carried out with macrolides. But, given the etiological significance of Haemophilus influenzae (up to 7-10%) in children of this age group, from wide range macrolide antibiotics, the drug of choice for initial empirical therapy is only azithromycin, which has an effect on H. influenzae. Other macrolide drugs are alternative drugs in case of intolerance to beta-lactam antibiotics or their ineffectiveness in case of pneumonia caused by atypical pathogens - M. pneumoniae, C. pneumoniae, which is quite rare at this age. In addition, if the drugs of choice are ineffective, third generation cephalosporins are used as an alternative.

For patients in the second group - severe pneumonia and pneumonia with the presence of modifying risk factors (except for social ones) - parenteral administration of antibiotics or the use of a step-by-step method of administration is indicated. The drugs of choice, depending on the severity and extent of the process and the nature of the modifying factor, are amoxicillin + clavulanate, cefuroxime or ceftriaxone, cefotaxime. Alternative drugs if initial therapy is ineffective are third or fourth generation cephalosporins, incl. in combination with aminoglycosides; carbapenems. Macrolides are rarely used in this group.

Patients with a high risk of an unfavorable outcome, severe purulent-destructive complications, are prescribed antibacterial therapy according to the de-escalation principle, which involves the use of linezolid alone or in combination with an aminoglycoside or a combination of a glycopeptide with an aminoglycoside, or a fourth generation cephalosporin with an aminoglycoside as a starting drug. An alternative therapy is the administration of carbapenems (Table 3).

Table 3

The choice of antibacterial drugs for the treatment of pneumonia in children (age from 6-7 months to 6-7 years)

Form of pneumonia	Drug of choice	Alternative therapy
Non-severe pneumonia	Amoxicillin Amoxicillin + clavulanate Cefuroxime axetil Azithromycin	III generation cephalosporins Macrolides other than azithromycin
Severe pneumonia and pneumonia in the presence of modifying risk factors	Amoxicillin + clavulanate Cefuroxime or ceftriaxone, cefotaxime	III or IV generation cephalosporins alone or in combination with an aminoglycoside Carbapenems
Severe pneumonia with a high risk of poor outcome	Linezolid alone or in combination with an aminoglycoside Vancomycin alone or in combination with an aminoglycoside Cefepime alone or in combination with an aminoglycoside	Carbapenems

When choosing antibacterial drugs for pneumonia in children over 6-7 years of age and adolescents, 2 groups of patients are distinguished:

●with mild pneumonia;

●with severe pneumonia requiring hospitalization, or with pneumonia in a child or adolescent with modifying risk factors.

The antibiotics of choice for the first group of patients (with mild pneumonia) are amoxicillin and amoxicillin + clavulanate or macrolides. Alternative antibiotics are cefuroxime axetil or doxycycline, or macrolides if amoxicillin or amoxicillin + clavulanate was previously prescribed. The antibiotics of choice for patients of the second group with severe pneumonia requiring hospitalization, or with pneumonia in children and adolescents with modifying risk factors, are amoxicillin + clavulanate or second generation cephalosporins. Alternative antibiotics are third or fourth generation cephalosporins. Macrolides should be preferred in cases of intolerance to beta-lactam antibiotics and in cases of pneumonia presumably caused by M. pneumoniae And C. pneumoniae(Table 4).

Table 4

The choice of antibacterial drugs for the treatment of pneumonia in children and adolescents (age from 6-7 to 18 years)

For pneumonia in immunocompromised patients empirical therapy start with III-IV generation cephalosporins or vancomycin in combination with an aminoglycoside, or linezolid in combination with an aminoglycoside. Then, as the etiology of the disease is clarified, or the started therapy is continued, for example, if pneumonia is caused Enterobacteriaceae (K. pneumoniae, E. coli and etc.), S. aureus or S. pneumoniae or prescribe co-trimoxazole (20 mg per 1 kg of body weight according to trimethoprim) if pneumocystis is detected, or fluconazole for candidiasis or amphotericin B for other mycoses. If pneumonia is caused by viral agents, such as cytomegalovirus, ganciclovir is prescribed, if it is caused by a herpes virus, then acyclovir, etc. (Table 5).

Table 5

The choice of antibacterial drugs for pneumonia in immunocompromised patients

Nature of immunodeficiency	Etiology of pneumonia	Drugs for therapy
Primary cellular immunodeficiency	P. carinii Mushrooms of the genus Candida	Co-trimoxazole 20 mg/kg body weight according to trimethoprim
Primary humoral immunodeficiency	Enterobacteriaceae ( K. pneumoniae, E. coli and etc.) Staphylococcus ( S. aureus, epidermidis and etc.) Pneumococci	III or IV generation cephalosporins in monotherapy or in combination with aminoglycosides Linezolid or vancomycin alone or in combination with aminoglycosides Amoxicillin + clavulanate in monotherapy or in combination with aminoglycosides
Acquired immunodeficiency (HIV-infected, AIDS patients)	Pneumocysts Cytomegaloviruses Mycobacterium tuberculosis Herpesviruses Mushrooms of the genus Candida	Co-trimoxazole 20 mg/kg over trimethoprim Ganciclovir Rifampicin and other anti-tuberculosis treatments Acyclovir Fluconazole 10-12 mg/kg or amphotericin B in increasing doses, starting from 150 units/kg and up to 500 or 1000 units/kg
Neutropenia	Gram-negative enterobacteriaceae Mushrooms of the genus Candida, Aspergillus, Fusarium	III or IV generation cephalosporins in monotherapy or in combination with aminoglycosides Amphotericin B in increasing doses, starting from 150 U/kg and up to 500 or 1000 U/kg

Table 6 shows the most commonly used antibiotics for pneumonia, their doses, routes and frequency of administration.

Table 6

Doses of the most commonly used antibiotics, routes and frequency of their administration

Antibiotic	Dose	Route of administration	Frequency of administration
Penicillin and its derivatives
Benzylpenicillin	100-150 thousand units/kg	V/m, i.v.	3-4 times a day
Ampicillin	50-100 mg/kg. Children over 12 years old: 2-4 g every 6 hours	V/m, i.v.	3-4 times a day
Amoxicillin	25-50 mg/kg. Children over 12 years old 0.25-0.5 g every 8 hours	Inside	3 times a day
Amoxicillin+clavulanate	20-40 mg/kg (for amoxicillin). For children over 12 years of age with mild pneumonia, 0.5 g every 8 hours or 1 g (amoxicillin) every 12 hours	Inside	2-3 times a day
Amoxicillin+clavulanate	30 mg/kg body weight (for amoxicillin). Children over 12 years of age: 1 g (amoxicillin) every 8 or 6 hours	IV	2-3 times a day
II generation cephalosporins
Cefazolin	60 mg/kg. Children over 12 years old: 1-2 g every 8 hours	V/m, i.v.	3 times a day
Cefuroxime sodium	50-100 mg/kg. Children over 12 years old 0.75-1.5 g every 8 hours	V/m, i.v.	3 times a day
Cefuroxime axetil	20-30 mg/kg. Children over 12 years old 0.25-0.5 g every 12 hours	Inside	2 times a day
III generation cephalosporins
Cefotaxime		V/m, i.v.	3 times a day
Ceftriaxone	50-75 mg/kg. Children over 12 years old: 1-2 g 1 time per day	V/m, i.v.	1 time per day
Ceftazidime	50-100 mg/kg. Children over 12 years old 2 g every 8 hours	V/m, i.v.	2-3 times a day
IV generation cephalosporins
Cefepime	100-150 mg/kg. Children over 12 years old: 1-2 g every 12 hours	IV	3 times a day
Carbapenems
Imipenem	30-60 mg/kg. Children over 12 years old 0.5 g every 6 hours	V/m, i.v.	4 times a day
Meropenem	30-60 mg/kg. Children over 12 years old 1 g every 8 hours	V/m, i.v.	3 times a day
Glycopeptides
Vancomycin	40 mg/kg. Children over 12 years old 1 g every 12 hours	V/m, i.v.	3-4 times a day
Oxazolidinones
Linezolid	10 mg/kg	V/m, i.v.	3 times a day
Aminoglycosides
Gentamicin	5 mg/kg	V/m, i.v.	2 times a day
Amikacin	15-30 mg/kg	V/m, i.v.	2 times a day
Netilmicin	5 mg/kg	V/m, i.v.	2 times a day
Macrolides
Erythromycin	40-50 mg/kg. Children over 12 years old 0.25-0.5 g every 6 hours	Inside	4 times a day
Spiramycin	15 thousand units/kg. Children over 12 years old 500 thousand units every 12 hours	Inside	2 times a day
Roxithromycin	5-8 mg/kg. Children over 12 years old 0.25-0.5 g every 12 hours	Inside	2 times a day
Azithromycin	10 mg/kg on the first day, then 5 mg/kg per day for 3-5 days. Children over 12 years old: 0.5 g 1 time per day, every day	Inside	1 time per day
Tetracyclines[Tetracyclines are only used in children over 8 years of age]
Doxycycline	5 mg/kg. Children over 12 years old 0.5-1 g every 8-12 hours	Inside	2 times a day
Doxycycline	2.5 mg/kg. Children over 12 years old 0.25-0.5 g every 12 hours	IV	2 times a day

The duration of the course of antibiotics depends on their effectiveness, the severity of the process, the presence of complications of pneumonia and the premorbid background of the child. The usual course duration is 6-10 days and lasts 2-3 days after obtaining a lasting effect. Complicated and severe pneumonia usually require a 2-3 week course of antibiotic therapy. In immunodeficient patients, the course of antibacterial drugs is at least three weeks, but may be longer.

Recommendations for the use of immunocorrective drugs in the treatment of pneumonia are still under discussion. The most studied indications for the use of fresh frozen plasma and immunoglobulin for intravenous administration. They are indicated in the following cases:

●children up to two months old;

●presence of modifying risk factors, with the exception of social ones;

●high risk of unfavorable outcome of pneumonia;

●complicated pneumonia, especially destructive ones.

Immunoglobulins for intravenous administration are prescribed as early as possible, on days 1-2 of therapy. Entered in regular therapeutic doses(from 500 to 800 mg/kg), at least 2-3 times, daily or every other day. In this case, it is desirable to achieve an increase in the level of IgG in the patient’s blood of more than 800 mg%. For destructive pneumonia, administration of immunoglobulin preparations containing IgG and IgM is indicated.

Adequate hydration is essential when treating pneumonia. But it should be remembered that especially with parenteral administration of fluid, overhydration easily occurs due to increased release of antidiuretic hormone. Therefore, for mild and uncomplicated pneumonia, oral hydration in the form of drinking juices, tea, mineral water and taking rehydrants is preferable.

Indications for infusion therapy are the presence of exicosis, collapse, and microcirculatory disorders. The infusion volume should not exceed 20-30 ml/kg, except for exicosis, in which it can reach 100-120 ml/kg, depending on the severity of exicosis.

Antitussive therapy occupies an important place in the treatment of pneumonia, being one of the main directions of symptomatic therapy. Among the antitussive drugs, the drugs of choice are mucolytics, which dilute bronchial secretions well by changing the structure of mucus. Mucolytics are used orally and inhaled for 3-7-10 days. These are ambroxol, acetylcysteine, bromhexine, carbocysteine.

Another direction of symptomatic therapy is antipyretic, which is prescribed for febrile convulsions and metapneumonic pleurisy, often complicated by severe fever. Currently, the list of antipyretic drugs for children is limited to paracetamol and ibuprofen. At temperatures above 40 °C, use a lytic mixture, which includes a 2.5% solution of aminazine 0.5-1.0 ml and a solution of pipolfen 0.5-1.0 ml, the mixture is administered intramuscularly or intravenously. In severe cases, a 10% analgin solution is included in the mixture - 0.2 ml per 10 kg of body weight.

It has been established that stimulating, restorative and antihistamine therapy does not affect the outcome and duration of treatment for pneumonia.

In the absence of positive dynamics of the process within 3-5 (maximum - 7) days of therapy, protracted course, resistance to therapy, it is necessary to expand the range of examination both in terms of identifying unusual pathogens (C. psittaci, Ps. aerugenozae, Leptospira, Coxiella burneti), and in terms of identifying other lung diseases.

If incorrect and untimely treatment pneumonia is extremely rare and mainly in children with chronic lung diseases, such as cystic fibrosis or developmental defects, the formation of segmental or lobar pneumosclerosis and bronchial deformations in the affected area is possible.

With an unfavorable outcome, as recently shown by cooperative studies, pneumonia suffered in early childhood is manifested by persistent pulmonary dysfunction and the formation of chronic pulmonary pathology in adulthood /16/. The vast majority of pneumonia in childhood is completely cured, although this process takes up to 1-2 months.

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