eMedicine Specialties > Pediatrics: General Medicine > Pulmonology
Pneumatocele: Treatment & Medication
Updated: Apr 2, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Medical Care
Medical care for pneumatocele is treatment of the underlying condition. In most circumstances, this involves administration of broad-spectrum antibiotics to treat the pneumonia.
- Therapy should be directed against the most common bacterial organisms in children, including S aureus and S pneumoniae.
- Positive pressure ventilation can result in a sudden increase in size and tension of a pneumatocele. Therefore, careful monitoring is essential in patients receiving positive pressure ventilation when pneumatoceles have been documented.
Surgical Care
- Pneumatoceles almost never require surgical resection. As mentioned above, percutaneous catheter drainage of a pneumatocele that involves more than 50% of hemithorax with severe atelectasis, tension pneumatocele, bronchopleural fistula, or an infected pneumatocele is rarely required.
- Traumatic pneumatoceles commonly resolve with observation without additional therapy. Indications for surgical intervention with a traumatic pneumatocele are similar to those of a postinfectious pneumatocele (ie, development of tension pneumatoceles, a secondary infection of the pneumatocele, and cardiovascular compromise).
Consultations
Consider consulting a surgeon in the presence of an infected pneumatocele or a tension pneumatocele and/or in the presence of a persistent bronchopleural fistula.
Diet
No special dietary requirements are indicated.
Activity
Caution patients with pneumatocele against skydiving or exposure to very high altitudes because of an increased risk of pneumothorax. Scuba diving must be avoided until the pneumatocele completely heals.
Medication
Antimicrobials
Intravenous antibiotics should be directed against the most likely bacterial pathogens, including S aureus and S pneumoniae. Other considerations should include antibiotic coverage for K pneumoniae, E coli, and group A streptococci. Most often, an appropriate single agent can be used, but combined antibiotic therapy can be considered, especially if a specific organism is not identified. As community-associated methicillin-resistant S aureus (MRSA) has increasingly been identified, reconsideration of empiric choice of antistaph beta-lactam for seriously ill patients with suspected MRSA should be carefully considered.10 The following antimicrobials may be used to target an underlying pneumonia.
Oxacillin (Bactocill)
A very effective antibiotic for treating S aureus as well as S pneumoniae.
Adult
1-2 g IV/IM q4-6h
500-1000 mg PO q4-6h
Pediatric
<7 days, <2000 g: 50 mg/kg/d IV divided q12h
<7 days, >2000 g: 75 mg/kg/d IV divided q8h
>7 days, <2000 g: 75 mg/kg/d IV divided q8h
>7 days, >2000 g: 100mg/kg/d IV divided q6h
Infants and children: 150-200 mg/kg/d IV divided q4-6h
Oxacillin decreases effects of contraceptives and tetracycline; concomitant administration with disulfiram and probenecid may increase oxacillin levels; effect of anticoagulants increase when large IV doses of oxacillin
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Reported serious adverse effects include thrombocytopenia, neutropenia, hemolytic anemia, and agranulocytosis
Ampicillin and sulbactam (Unasyn)
Drug combination of beta-lactamase inhibitor with ampicillin. A very effective antibiotic for treating S aureus as well as S pneumoniae. Also effective for many anaerobic infections.
Adult
1.5 (1 g ampicillin + 0.5 g sulbactam) to 3 g (2 g ampicillin + 1 g sulbactam) IV/IM q6h; not to exceed 8 g/d of ampicillin
Pediatric
100-200 mg (based on ampicillin component) per kg/d IV/IM divided q6h
Probenecid and disulfiram elevate ampicillin levels; allopurinol decreases ampicillin effects and has additive effects on ampicillin rash; may decrease effects of PO contraceptives
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Reported serious reactions could include thrombocytopenia, agranulocytosis, anaphylaxis, pseudomembranous colitis, Stevens-Johnson syndrome, toxic epidermal necrolysis, leukopenia, anemia, seizures, and hepatotoxicity; decrease dose with severe renal impairment (ie, CrCl <30 mL/min)
Cefuroxime (Zinacef)
Very effective antibiotic for treating S aureus and S pneumoniae.
Adult
2.25 g IV/IM q6-8h; not to exceed 9 g/d
Pediatric
Neonates: 20-40 mg/kg/d IV/IM divided q12h
Infants and children: 50-100 mg/kg/d IV/IM divided q6-8h
A false-positive reaction for glucose in the urine can occur with copper reduction tests (ie, Clinitest tablets); false-negative results may occur with ferricyanide test (use glucose oxidase or hexokinase methods); disulfiramlike reactions may occur when alcohol is consumed within 72 h after taking cefuroxime; may increase hypoprothrombinemic effects of anticoagulants; may increase nephrotoxicity in patients receiving potent diuretics such as loop diuretics; coadministration with aminoglycosides increases nephrotoxic potential
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Reported serious reactions include thrombocytopenia, agranulocytosis, anaphylaxis, pseudomembranous colitis, interstitial nephritis, seizures, hemolytic anemia, and neutropenia; reduce dosage by one half if CrCl is 10-30 mL/min and by three fourths if CrCl <10 mL/min (high doses may cause CNS toxicity); bacterial or fungal overgrowth of nonsusceptible organisms may occur with prolonged or repeated therapy
Vancomycin (Lyphocin, Vancocin, Vancoled)
Very effective antibiotic for treating methicillin-resistant S aureus as well as for treating penicillin-resistant S pneumoniae.
To avoid toxicity, current recommendation is to assay vancomycin trough levels before fourth dose. Use CrCl to adjust dose in patients with renal impairment.
Adult
500 mg IV q6h
Pediatric
<7 days, <1200 g: 15 mg/kg/dose IV q24h
<7 days, 1200-2000 g: 15 mg/kg/dose IV q12-18h
<7 days, >2000 g: 30 mg/kg/d IV divided q12h
>7 days, <1200 g: 15 mg/kg/dose IV q24h
>7 days, 1200-2000 g: 15 mg/kg/dose IV q8-12h
>7 days, >2000 g: 45 mg/kg/d IV divided q8h
Infants and children: 40-60 mg/kg/d IV divided q8h
Erythema, histaminelike flushing, and anaphylactic reactions may occur when administered with anesthetic agents; concurrent administration with aminoglycosides may increase the risk of nephrotoxicity above that with aminoglycoside monotherapy; effects in neuromuscular blockade may be enhanced when coadministered with nondepolarizing muscle relaxants
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Reported serious reactions include neutropenia, anaphylaxis, Stevens-Johnson syndrome, thrombocytopenia, toxic epidermal necrolysis, nephrotoxicity, and ototoxicity; rapid infusion has been associated with red man syndrome, which can be mistaken for acute allergic reaction
Clindamycin (Cleocin)
Very effective antibiotic for treating S aureus as well as S pneumoniae. Lincosamide for treatment of serious skin and soft tissue staphylococcal infections. Also effective against aerobic and anaerobic streptococci (except enterococci). Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest.
Adult
300-900 mg IV/IM q6-12h; not to exceed 600 mg/dose IM or 4800 mg/d IV
150-450 mg PO qid
Pediatric
Infants and children: 15-40 mg/kg/d IV/IM divided q6-8h
10-25 mg/kg/d PO divided q6-8h
Increases duration of neuromuscular blockade induced by tubocurarine and pancuronium; erythromycin may antagonize effects of clindamycin; antidiarrheals may delay absorption of clindamycin
Documented hypersensitivity; regional enteritis; ulcerative colitis; hepatic impairment; antibiotic-associated colitis
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Reported serious reactions include pseudomembranous colitis, diarrhea, thrombocytopenia, anaphylaxis, Stevens-Johnson syndrome, granulocytopenia, and esophagitis
Ciprofloxacin (Cipro)
Very effective antibiotic for treating S aureus as well as S pneumoniae. A fluoroquinolone with activity against Pseudomonas, streptococci, MRSA, S epidermidis, and most gram-negative organisms but no activity against anaerobes. Inhibits bacterial DNA synthesis and consequently growth.
Adult
250-750 mg PO q12h
200-400 mg IV q12h
Pediatric
20-30 mg/kg/d PO divided q12h; not to exceed 1.5 g/d
10-20 mg/kg/d IV divided q12h; not to exceed 800 mg/d
Antacids, iron salts, and zinc salts may reduce serum levels; administer antacids 2-4 h before or after taking fluoroquinolones; cimetidine may interfere with metabolism of fluoroquinolones; ciprofloxacin reduces therapeutic effects of phenytoin; probenecid may increase ciprofloxacin serum concentrations; may increase toxicity of theophylline, caffeine, cyclosporine, and digoxin (monitor digoxin levels); may increase effects of anticoagulants (monitor PT)
Documented hypersensitivity; not approved for use in children <18 y; pregnancy; caution with impaired renal or liver function
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Reported serious reactions include hepatotoxicity, seizures, anaphylaxis, Achilles tendon rupture, and pseudomembranous colitis
More on Pneumatocele |
| Overview: Pneumatocele |
| Differential Diagnoses & Workup: Pneumatocele |
 Treatment & Medication: Pneumatocele |
| Follow-up: Pneumatocele |
| Multimedia: Pneumatocele |
| References |
| « Previous Page | Next Page » |
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Further Reading
Keywords
pneumatocele, infectious pneumatocele, traumatic pneumatocele, lung cysts, bullae, subpleural emphysema, postinfectious pulmonary cysts, Staphylococcus aureus, pneumonia, Streptococcus pneumoniae, Haemophilus influenzae, Escherichia coli, group A streptococci, Serratia marcescens, Klebsiella pneumoniae, adenovirus, tuberculosis, hydrocarbon ingestion, positive pressure ventilation, ball-valve obstruction, tension pneumatocele, pneumothorax, secondarily infected pneumatocele, hyperimmunoglobulin E syndrome, hyper-IgE syndrome, Buckley-Job syndrome
