Pediatric case study answers

Pediatric Community Acquired Pneumonia CPPD Cases
Case 1
PN is a 5 month old, previously health male who presents to your pharmacy with a runny nose, cough,
increased work of breathing (tracheal tugging), decreased feeding and irritability. Mom says that this has
been going on for just over 24 hours and he is not acting like himself.
You would suggest:
a) It is likely a viral infection requiring no doctor visit.
b) PN go visit a family doctor for further assessment within 24-48 hours.
c) PN should go to the emergency department for immediate assessment.
Answer C: Recommendations 1 and 2. Irritability can be a sign of hypoxemia. Tracheal tugging is a sign of
respiratory distress.
Case 2
EU is a 3 year old female with a history of eczema whose mom presents with you a new prescription for
azithromycin shown below to treat a suspected bacterial CAP. EU weighs 11.7 kg (25th percentile). She
has no drug allergies and is up to date with her immunizations.
You would consider:
a) Fill the prescription as written and counsel EU’s family on the medication and appropriate follow
b) Phone Dr. Brotics to suggest changing drugs to amoxicillin 500 mg BID x 10 days
c) Phone Dr. Brotics to suggest changing the dose to 120 mg x 1 day then 60 mg daily x 4 days
d) Phone Dr. Brotics to suggest amoxicillin-clavulanate 500/125 mg PO TID x 10 days
Answer: B Recommendations 42/43
Pediatric Community Acquired Pneumonia CPPD Cases
Case 3
MO is a 8 year old, previously healthy female who comes in to your pharmacy with her family with a
new prescription for a pneumonia diagnosed by her family doctor. MO weighs 33 kg and her
immunizations are up to date. She has had an anaphylactic reaction to penicillin in the past. Her history
of present illness includes cough and fever for 2 days with localized right sided chest pain. MO’s mom
reports that the doctor said she heard wheezing on the right side and the chest x-ray showed something
fuzzy. The doctor said it was suggestive of bacterial infection.
The prescription reads: Clarithromycin 250 mg PO BID x 10 days
You would:
a) Fill the prescription as written with the appropriate counselling and follow up recommendations
b) Recommend changing to amoxicillin-clavulanate 500/125 mg PO TID x 10 days
c) Recommend changing to erythromycin 325 mg PO QID x 10 days
d) Recommend changing to moxifloxacin 400 mg PO once daily x 10 days
Answer: A Recommendation 44. Findings suggestive of bacterial pneumonia. Atypical pathogen
suspected given age (school-age), history of a 2 day fever.
Case 4
Dr. NIA has phoned your pharmacy regarding a 13 year old male who is currently sitting in his office. Dr.
MO would like more information on how long he should prescribe amoxicillin for a presumed bacterial
Would you recommend:
a) 3 days
b) 5 days
c) 10 days
Form groups of 3-5 people and discuss what you would recommend and why.
Challenge each other and justify your answer!
Answer: This is meant to be a discussion question to promote the discussion of the evidence. One trial
and guideline recommendations were discussed. Goal is to generate a discussion about the limitations
of the evidence and the strength/quality of the guideline recommendations. This component is to
emphasize a monitoring plan.
Pediatric Community Acquired Pneumonia CPPD Cases
Case 5
In an unvaccinated 3 year old child presenting with CAP, what pathogens are the possible causes:
Viral (influenzae, rhinovirus, human metapneumovirus, parainfluenza)
Streptococcus pneumoniae
Haemophilus influenzae type B
Mycoplasma pneumoniae
Mycoplasma tuberculosis
Chlamydophila pneumoniae
Legionella pneumophila
Staphylococcus aureus
Pseudomonas aeruginosa
Answers: Viral, strep, H flu B, mycoplasma pneumoniae, chlamydophila, staphylococcus