What are the medications for pediatric pneumonia?

Pneumonia is a disease that has a very serious impact on the lungs of the human body, pneumonia will bring a lot of symptoms after the occurrence of pneumonia, cough is particularly serious, and it will lead to abnormalities in the lungs for a long time, and there are many drugs for the treatment of pneumonia, but we must choose carefully, let's take a look at what drugs are available to treat pediatric pneumonia.

(1) General care and supportive care

1. Keep warm: keep the skin temperature at about 36.5°C,prematureand those whose body temperature does not rise should be placed in an incubator. The room temperature should be kept at about 20°C and the relative humidity should be 55-65% to prevent respiratory secretions from drying out and not easy to cough up. Prevent cross-infection.

2. Pay attention to nutrition and water supply: those with mild disease should be fed a small amount and many times, should not be overfilled, prevent vomiting and inhalation, and feed severely ill children with nasal feeding. Breastfeeding should be tried as much as possible, if artificial feeding can determine the amount and concentration of milk according to its digestive function and condition, if there is diarrhea to give skim milk, young children or children should be provided with a light, easy to digest, multivitamin-rich diet, convalescent sick children should be given nutritious, high-calorie food. For critically ill infants who cannot eat, intravenous amino acid solution and internal fat and water are required. The amount of fluid rehydration should reach 60~80ml/kg per day.

3. Keep the respiratory tract unobstructed: nasal crusts, nasal secretions and respiratory sputum should be removed in time. Improve ventilation function, increase alveolar ventilation, correct hypoxia, and reduce CO2 retention. If the sputum is thin and thin, it can be repeatedly turned over and positioned for drainage or patting the back to facilitate the discharge of sputum. It can also be used to take oral expectorant drugs and ammonium chloride mixture to promote sputum discharge. If the sputum is viscous and not easy to cough up, it can be suctioned or inhaled with ultrasonic nebulization to promote sputum discharge.

4. Oxygen supply: use nasal cannulas, masks or hoods to give oxygen as appropriate. The oxygen flow of the nasal canal is 0.5L/min, the oxygen flow of the mask is 1~2L/min, and the oxygen flow of the hood is 5~8L/min to maintain the partial pressure of arterial blood oxygen of 8~11kPa or the bruising disappears.If hypoxemia cannot be corrected, continuous positive airway pressure (CPAP) may be used.

5. Blood transfusion: critically ill children can be transfused with blood or plasma in small quantities and many times, 5~10ml/kg each time.

(2) Application of anti-infective drugs

1. Selection of antibiotics: selection of drugs for pathogenic bacteria. Commonly used antibiotics are penicillin, ampicillin, oxypiperazine, and aminoglycosides (eg, amikanuamycin), and cephalosporin antibiotics may be used for severe infections.

(1) Gram-positive coccal infection in the lungs: for pneumococcal pneumoniae pneumonia, penicillin is still the first choice. People who are allergic to penicillin should be given erythromycin.

(2) Gram-negative bacilli infection in the lungs can generally be treated with ampicillin or aminoglycoside antibiotics. Pseudomonas aeruginosa pneumonia can be treated with Fudaxin, bacterium, etc.

(3) Mycoplasma pneumonia: erythromycin is mostly used, and the course of treatment is 2 weeks.

(4) For pneumonia with unclear bacteria, broad-spectrum antibiotics should be selected according to the condition and combined drugs (one of which should be more important than Gram-negative bacteria drugs).

2. Principles of antibiotic use:

(1) Select sensitive drugs according to pathogenic bacteria. Cultures of bacteria such as bronchial secretions, blood, or pleural fluid (including anaerobic cultures) and drug susceptibility testing are given before medication.Then, according to the clinical probability, the corresponding sensitive antibiotics are used, and the results of culture and drug susceptibility tests are used before considering whether to change the drug.

(2) Early treatment is very important. After the animal is infected with Staphylococcus aureus, if the treatment is delayed for 54 hours, a small abscess will form.

(3) Combination of drugs. For example, Staphylococcus aureus and Gram-negative bacillus pneumonia should be used with two sensitive antibiotics at the same time.

(4) Understand the pharmacokinetics of pediatric respiratory antibiotics. Different antibiotics infiltrate the lower respiratory tract at different concentrations, e.g., ampicillin increases penetration only when there is inflammation in the respiratory tract; The concentrations of acetylspiramycin and crosssamycin in the respiratory tract are quite high; Erythromycin can only be administered intravenously to achieve the minimum inhibitory concentration (MIC) required for susceptible bacteria; Concentrations of aminoglycoside antibiotics in the respiratory tract barely reach the MIC.

(5) Sufficient amount and full course of treatment. Severe cases should be given intravenously.

(6) Use a certain antibiotic, observe for at least 3 days, and only consider changing other antibacterial drugs after it is ineffective.

(7) Medication time: It should be continued until 5~7 days after normal body temperature, and 3 days after the clinical symptoms basically disappear. Staphylococcal pneumonia is stubborn and prone to recurrence, so the course of treatment should be long, and the drug should be continued for 2 weeks after the body temperature is normal.

3. Application of virus inhibitory drugs:

(1) Ribavirin has broad-spectrum antiviral activity, including respiratory syncytial virus, adenovirus, parainfluenza virus and influenza virus.

(2) Acyclovir has the characteristics of broad spectrum, potency and fast onset. It is clinically used for herpes virus and varicella virus infection. In particular, it should be used as soon as possible for immunodeficiency or immunosuppressants.

(3) Ganciclovir can inhibit DNA synthesis. It is mainly used for cytomegalovirus infection.

(4) Oseltamivir is a neuraminidase inhibitor, which has a good effect on influenza A and B viruses, and the incidence of drug resistance is low.

(5) Cytarabine has a wide range of antiviral effects. It is mostly used to treat herpesvirus and varicella virus infections in immunocompromised patients.

(6) Amantadine organizes certain viruses to enter human cells and has antipyretic effects. It is clinically used for influenza virus and other infections.

4. Use of hormones:

Adrenocorticosteroids can reduce inflammatory exudation, relieve bronchospasm, improve the permeability of blood vessel walls, reduce intracranial pressure, and improve microcirculation. Although there are many effects, such drugs should also be avoided from abuse, because after the use of drugs, the body's immunity and reactivity can be reduced, and it is easy to mask the nature of the primary disease.

In general, hormonal therapy is not required for pneumonia, but for severe bacterial pneumonia, corticosteroids may be added if the pathogen is sensitive to antibiotics in the following cases:

(1) Severe symptoms of poisoning, such as shock, toxic encephalopathy, ultra-high fever (body temperature above 40 °C persists), etc.

(2) Bronchiolasm is obvious or there is more secretion.

(3) Early pleural effusion, in order to prevent pleural adhesions, it can also be applied topically.

Hydrocortisone 5~8mg/kg·time, or dexamethasone 0.15~0.25mg/kg·time, added to glucose intravenous infusion.

Note that in the case of pediatric pneumonia, corticosteroids should be used for no more than 3 days, of course, under the premise of adequate treatment with effective antimicrobial drugs. For viral pneumonia, it is generally contraindicated. Because hormones can spread the virus and worsen the condition, it can also be used for a short time in critical cases or when bronchiolitis is severe and wheezing.

Based on the above content, we are very clear about the drug treatment of pediatric pneumonia, pneumonia is easy to find children, so we should always pay attention to the child's physical condition, and protect the child's lungs, usually pay attention to the indoor environment, and often disinfect.