Title: Atypical Antibiotics for Acute Chest Syndrome in Young Children (submitted by Dan Gingold, MD)<br/>Author: Mimi Lu<br/><a href='http://umem.org/profiles/faculty/185/'>[Click to email author]</a><hr/><p dir="ltr" style="font-family: arial, sans-serif; font-size: 12.800000190734863px; line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;">
<span style="font-size: 14.6667px; font-family: Arial; color: rgb(0, 0, 0); vertical-align: baseline; white-space: pre-wrap; background-color: transparent;">Typically, empiric treatment for lobar community acquire pneumonia (CAP) in immunized < 5 year olds (preschool) is amoxicillin (45mg/kg BID or 30 mg/kg TID for resistant <em>S. pneumoniae</em>) for outpatient and ampicillin or ceftriaxone for inpatient. Additional coverage with azithromycin is typically recommended for school age and adolescent patients (>= 5 years), but not necessarily for younger children unless there is a particular clinical suspicion for atypical pneumonia with history, xray findings, or sick contacts.</span></p>
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<span style="font-size: 14.6667px; font-family: Arial; color: rgb(0, 0, 0); vertical-align: baseline; white-space: pre-wrap; background-color: transparent;">However, in sickle cell patient with suspicion for acute chest syndrome, azithromycin is recommended for all ages groups, as atypical bacteria such as </span><span style="font-size: 14.6667px; font-family: Arial; color: rgb(0, 0, 0); font-style: italic; vertical-align: baseline; white-space: pre-wrap; background-color: transparent;">Mycoplasma</span><span style="font-size: 14.6667px; font-family: Arial; color: rgb(0, 0, 0); vertical-align: baseline; white-space: pre-wrap; background-color: transparent;"> are a common cause of acute chest syndrome in patients of all ages with sickle cell disease even young children. In a prospective series of 598 children with acute chest syndrome, 12% of the 112 cases in children less than 5 had positive serologic testing of </span><span style="font-size: 14.6667px; font-family: Arial; color: rgb(0, 0, 0); font-style: italic; vertical-align: baseline; white-space: pre-wrap; background-color: transparent;">M. pneumoniae</span><span style="font-size: 14.6667px; font-family: Arial; color: rgb(0, 0, 0); vertical-align: baseline; white-space: pre-wrap; background-color: transparent;"> (9% of all cases had </span><span style="font-size: 14.6667px; font-family: Arial; color: rgb(0, 0, 0); font-style: italic; vertical-align: baseline; white-space: pre-wrap; background-color: transparent;">M. pneumoniae</span><span style="font-size: 14.6667px; font-family: Arial; color: rgb(0, 0, 0); vertical-align: baseline; white-space: pre-wrap; background-color: transparent;">) (Neumayr et al, 2003).</span></p>
<fieldset><legend>References</legend>
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<span id="m_-2811847942340779061docs-internal-guid-342adcb8-604f-0657-e833-779ee74ef15f" style="font-family: arial, sans-serif; font-size: 12.800000190734863px;"><span style="font-size: 14.6667px; font-family: Arial; color: rgb(0, 0, 0); vertical-align: baseline; white-space: pre-wrap; background-color: transparent;">1) Bradley et al. </span><span style="font-size: 14.6667px; font-family: Arial; color: rgb(0, 0, 0); font-style: italic; vertical-align: baseline; white-space: pre-wrap; background-color: transparent;">The Management of Community-Acquired Pneumonia in infants and children older than 3 months of age: Clinical Practice Guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America</span><span style="font-size: 14.6667px; font-family: Arial; color: rgb(0, 0, 0); vertical-align: baseline; white-space: pre-wrap; background-color: transparent;">. Clin. Infect. Dis. 53:617-630 (2011)</span></span></p>
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2) <span style="font-size: 14.6667px; font-family: Arial; color: rgb(0, 0, 0); vertical-align: baseline; white-space: pre-wrap; background-color: transparent;">Miller, S. </span><span style="font-size: 14.6667px; font-family: Arial; color: rgb(0, 0, 0); font-style: italic; vertical-align: baseline; white-space: pre-wrap; background-color: transparent;">How I treat acute chest syndrome in children with sickle cell disease.</span><span style="font-size: 14.6667px; font-family: Arial; color: rgb(0, 0, 0); vertical-align: baseline; white-space: pre-wrap; background-color: transparent;"> Blood 117:5297-5305 (2011)</span></p>
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3) <span id="m_-2811847942340779061docs-internal-guid-342adcb8-604f-0657-e833-779ee74ef15f" style="font-family: arial, sans-serif; font-size: 12.800000190734863px;"><span style="font-size: 14.6667px; font-family: Arial; color: rgb(0, 0, 0); vertical-align: baseline; white-space: pre-wrap; background-color: transparent;">Neumayr L, et al. </span><span style="font-size: 14.6667px; font-family: Arial; color: rgb(0, 0, 0); font-style: italic; vertical-align: baseline; white-space: pre-wrap; background-color: transparent;">Mycoplasma disease and acute chest syndrome in sickle cell disease. </span><span style="font-size: 14.6667px; font-family: Arial; color: rgb(0, 0, 0); vertical-align: baseline; white-space: pre-wrap; background-color: transparent;">Pediatrics 1212:87-95 (2003)</span></span></p>
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