akinohanayuki ブログ

学位を持っても、センスのない、感染制御専門薬剤師のブログ.  I have Ph.D. but less sense ID pharmacist.

小児 マイコプラズマ肺炎

知人の高校生が発熱と呼吸苦で入院
 
 
まずは、肺結核を除外することが重要
 
UpToDate 
 

 

●Mycoplasma pneumoniae accounts for approximately 20 percent of acute pneumonias in middle and high school students and up to 50 percent of cases in college students and military recruits.


●The signs and symptoms of M. pneumoniae infection vary according to the stage of illness. Extrapulmonary manifestations may include hemolysis, rash, musculoskeletal pain, and central nervous system, gastrointestinal, or cardiac involvement. 
 
●Plain radiograph findings include bronchopneumonia, plate-like atelectasis, nodular infiltration, hilar adenopathy, and pleural effusions. 
 
●Laboratory features of M. pneumoniae infection may include positive Coombs test, elevated reticulocyte count, elevated cold agglutinin titers, normal or slightly elevated white blood cell count, thrombocytosis, and elevation of the erythrocyte sedimentation rate. 
 
●Compared to children with bacterial pneumonia, those with mycoplasma pneumonia tend to have a more gradual onset of symptoms, less respiratory distress, and a normal white blood cell count. However, these findings are neither sufficiently sensitive nor specific to exclude other etiologies (eg, chlamydia or viral pneumonia).
 
●Specific diagnosis of M. pneumoniae relies upon nonculture techniques, including serology and antigen detection. 
 
●We suggest that suspected or documented M. pneumoniae lower respiratory tract infection be treated with antimicrobial therapy (Grade 2B). 
 
We generally use a macrolide or tetracycline antibiotic. Alternative regimens include :
 
Azithromycin 10 mg/kg in one dose (maximum dose 500 mg) on the first day and 5 mg/kg in one dose (maximum dose 250 mg) for four days
 
Clarithromycin 15 mg/kg per day in two divided doses (maximum daily dose 1 g) for 10 days
 
Erythromycin 30 to 40 mg/kg per day in four divided doses (maximum daily dose 2 g) for 10 days
 
Doxycycline 2 to 4 mg/kg per day in one or two divided doses for 10 days (maximum daily dose 200 mg) may be used in children ≥8 years of age
 
Tetracycline 20 to 50 mg/kg per day in four divided doses for 10 days (maximum daily dose 1 to 2 g) may be used in children ≥8 years of age
 
●Doxycycline or a fluoroquinolone (eg, levofloxacin) antibiotic should be used if macrolide-resistance is suspected or documented, particularly if the child is severely ill. 
 
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