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1.5 y child was admitted with pneumonia, ttt on ceftriaxone for 10 days and azithromycin for 5 days, now pneumonia patches are still present with difficult breathing,
Recent blood culture: no growth
CRP : Negative
WBCs: 7.5
Normal temperature
Are these conditions indication to stop last antibiotics and start using meronam?
In this scenario, transitioning to meropenem (Meronem) may not be the most straightforward next step without further investigation, given the following details:
Key Considerations
1. Pneumonia Patches and Symptoms Persist Despite Treatment:
Persistence of radiological findings does not necessarily indicate treatment failure, as radiological resolution can lag behind clinical improvement.
However, difficulty breathing warrants a careful re-evaluation of the child’s condition.
2. Clinical Markers Suggest Limited Inflammation:
Negative CRP and normal WBC count (7.5 x10³/μL) suggest minimal ongoing systemic inflammation.
3. Negative Blood Culture:
Absence of growth reduces the likelihood of ongoing bacteremia.
Consider sputum/ETA culture.
4. Current Antibiotics:
Ceftriaxone and azithromycin cover common bacterial pathogens causing pneumonia. Extended treatment might already have addressed the likely causative agents.
5. Differential Diagnoses:
Persistent symptoms could arise from non-infectious causes (e.g., post-infectious bronchospasm, aspiration, or underlying conditions like primary ciliary dyskinesia or immune deficiency).
Atypical infections (e.g., fungal, mycobacterial) should also be considered.
Viral pneumonia should also be considered.
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Next Steps
1. Stop Current Antibiotics?
If clinical stability (afebrile, normal WBC, negative CRP) suggests no active bacterial infection, discontinuing antibiotics might be reasonable after consultation with the treating physician.
2. Start Meropenem?
Initiating meropenem without evidence of multidrug-resistant bacterial infection or treatment failure is not routinely indicated.
Consider only if new evidence (e.g., deterioration, resistant pathogen, or diagnostic clarity) emerges.
3. Further Evaluation:
Assess for complications (e.g., empyema, abscess).
Rule out viral pneumonia (e.g., RSV, influenza).
Consider non-infectious causes (e.g., asthma exacerbation).
4. Supportive Management:
Address respiratory distress with oxygen, bronchodilators, or corticosteroids if indicated.