The correct answers are:

a) Order a respiratory PCR panel (Biofire)

b) Treat with Augmentin

c) Treat with Azithromycin

d) Treat with Levofloxacin

e) Treat with Amoxicillin and Azithromycin

f) Order a Pneumococcal urine antigen

Here’s how respondents answered:

Q2 graph

ID Attending Discussion:

Options for diagnosis include:

–  Respiratory PCR Panel (Biofire) should be considered to help determine if viral

  • If viral testing is positive, serious consideration should be given to watchful waiting
  • If Chlamydophila pneumoniae or Mycoplasma pneumoniae is positive, this argues for this being the causative agent if nothing else is detected

– Procalcitonin testing (available in house at Harbor)

  • A negative procalcitonin test (<0.5) may suggest this is viral and could be an argument for close monitoring
  • Limited data in young children

– Pneumococcal Ag Urine, while sometimes helpful in adults, is often falsely positive in children (high colonization rates)

Outpatient management

– If viral etiology is suspected but unclear, consider Safety Net Antibiotic Prescription (SNAP) to be used if the patient is not improving in the next 24-48 hrs

– Azithromycin would be the best medication to choose given this patient’s presentation

  • Appropriate dosing is Zpack (500mg po x 1 dose, then 250mg po qday x 4 days) for adult size patient, or 10mg/kg x 1 day then 5mg/kg day x 4 days for child
  • Other regimens studied include 500mg po qday x 3 days and 1 gm PO x 1 dose

– No data in Pediatrics though