High Yield Facts — Pediatric Pneumonia
For MBBS / NEXT / FMGE exam preparation.
Must-Know One-Liners
- Most common cause of pneumonia in children 3 months–3 years = S. pneumoniae
- Chief viral cause <6 months = RSV
- Mycoplasma pneumoniae uncommon <4 years
- Pathognomonic of staphylococcal pneumonia = Pneumatoceles
- Empyema <2 years = nearly always Staphylococcal
- Rusty sputum = Pneumococcal pneumonia
- Blood-streaked sputum = Streptococcal / Mycoplasma
- Cold agglutinins elevated in 30–60% = Mycoplasma pneumonia
- X-ray findings >> physical signs = Mycoplasma pneumonia (hallmark discordance)
- Meningismus in apical pneumonia = Pneumococcal (must rule out meningitis)
- Pneumatoceles + empyema = Staphylococcal pneumonia until proven otherwise
- GBS pneumonia common in West, uncommon in India
- Kerosene aspiration — do NOT induce vomiting, no gastric lavage
Fast Breathing Cutoffs — EXAM FAVOURITE
| Age | Fast Breathing Threshold |
|---|---|
| <2 months | ≥60/min |
| 2–12 months | ≥50/min |
| 1–5 years | ≥40/min |
Mnemonic: “60-50-40” for <2m, 2–12m, 1–5y
IMNCI Classification — Quick Recall
| Category | Key Feature | Rx |
|---|---|---|
| No pneumonia | No fast breathing | Home care |
| Pneumonia | Fast breathing | Oral amoxicillin × 5 days |
| Severe pneumonia | Chest indrawing + danger signs | IV ampicillin + gentamicin |
Antibiotic Drug of Choice — Summary Table
| Organism | Drug of Choice |
|---|---|
| S. pneumoniae | Penicillin G / Amoxicillin |
| S. aureus | Cloxacillin / Co-amoxiclav; Vancomycin (MRSA) |
| H. influenzae | Ampicillin / Cefotaxime / Ceftriaxone |
| Mycoplasma / Chlamydia | Macrolide (Azithromycin / Erythromycin) |
| Gram-negatives (E. coli, Klebsiella) | Cefotaxime or Ceftriaxone ± Aminoglycoside |
| Pseudomonas | Ceftazidime |
| Neonatal (community) | Ampicillin + Gentamicin |
| Neonatal (hospital-acquired) | Cephalosporin + Amikacin |
Organism–Complication Pairs — PYQ Favourite
| Organism | Unique Feature / Complication |
|---|---|
| S. pneumoniae | Lobar consolidation; rusty sputum; meningismus (apical) |
| S. aureus | Pneumatoceles; pyopneumothorax; empyema; metastatic abscesses |
| H. influenzae | Bacteremia; meningitis; pericarditis; mimics bronchiolitis |
| Mycoplasma | X-ray >> signs; cold agglutinins; macrolide treatment |
| RSV | Chief viral cause <6 months; bronchiolitis / interstitial pneumonia |
| Streptococcus (Group A) | Serosanguineous empyema; interstitial pneumonia |
| Klebsiella / E. coli | Pneumatoceles; Gram-negative; immunocompromised / <2 months |
| Pseudomonas | Cystic fibrosis; ceftazidime |
CXR Pattern – Organism Associations
| CXR Finding | Organism Think |
|---|---|
| Lobar consolidation | S. pneumoniae, Klebsiella |
| Bronchopneumonia (bilateral patchy) | Staph, H. influenzae, Gram-negatives |
| Interstitial / perihilar | Viral (RSV), Mycoplasma |
| Pneumatoceles | S. aureus (pathognomonic), Gram-negatives |
| Round pneumonia | S. pneumoniae (children) |
| Hilar lymphadenopathy + infiltrates | Mycoplasma, TB |
Mnemonics
Complications of Staphylococcal Pneumonia — “PEPPMA”
- Pneumatoceles (pathognomonic)
- Empyema
- Pyopneumothorax
- Pericarditis (purulent)
- Metastatic abscesses (bone, joint, brain, liver)
- Abscess (lung)
Risk Factors for Pediatric Pneumonia — “BAMBOO”
- Breastfeeding absent
- Air pollution (indoor)
- Malnutrition / low birth weight
- Birth order (advanced) / Birth weight (low)
- Overcrowding
- Other: Vitamin A deficiency, passive smoking, young age
Duration of Antibiotic Therapy
| Organism / Severity | Duration |
|---|---|
| Non-severe CAP (oral amoxicillin) | 5 days |
| Pneumococcal (IV) | 7 days |
| H. influenzae | 10–14 days |
| Staphylococcal | 2–6 weeks |
| Gram-negative | 10–14 days |
| Mycoplasma / Chlamydia | 7–10 days |
WHO ARI Program — Key Numbers
- LRTI: leading cause of mortality in children <5 years
- Bacterial etiology in LMICs: 50–60% of cases
- Bacterial causes sensitive to amoxicillin / cotrimoxazole: H. influenzae, S. pneumoniae, Staphylococci
- Blood culture positive in pneumococcal pneumonia: only 5–10%
Frequently Tested Scenarios
| Scenario | Answer |
|---|---|
| Infant with pneumonia + pneumatoceles | Staphylococcal |
| Child with pneumonia, X-ray worse than signs | Mycoplasma |
| Toddler with H/o choking + localized wheeze | Foreign body aspiration (not pneumonia) |
| Neonate with respiratory distress + positive blood culture | Neonatal sepsis with pneumonia |
| Child with empyema under 2 years | Staphylococcal until proven otherwise |
| Fast breathing in 8-month-old: threshold? | ≥50/min |
| DOC for MRSA pneumonia | Vancomycin |
| DOC for Pseudomonas in CF | Ceftazidime |
| Kerosene ingestion + respiratory symptoms | Do NOT induce vomiting; oxygen; no routine antibiotics |