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Sir,
my 18 mo old child just had an episode of B/L pneumonitis and was hospitalized for over a week. He goes to a day care center. He had mild fever and cough and the next day itself we took him to his Dr, started on Amox and Levolin. 2nd day onwards he had very high fever (104F) which was not comming down with paracetamol.And on the 3rd day he ended up in the ICU very sick.
On this I had asked you a few questions

Thank you for the precious time you spent and your patience in answering my questions. Your precise answers were extremely useful.

I still have a few doubts left over. May I ask them too.

1.   Was this episode of a simple respiratory infection going into B/L pneumonia preventable?
My kid goes to a day care centre and he gets URTIs almost every month. Is there the same risk of getting a lower resp. infection/ pneumonia every time when he gets an URTI…?
2.   Although this time he presented with  plain fever and cough only (instead of running nose), I wonder how had he ended up having pneumonia by day 3, just because he was not immunized?
3.   He is 18mo old, is it necessary to get him immunized now for pneumonia? I learn that the risk of pneumonia is high upto 2yrs of age.
4.   The fever had come down dramatically after the 2nd dose of augmentin (ie, on the 4thy day of his illness), and his resp. rate impreoved slowly over next 3 days you still believe it was a viral attack, not bacterial which was not sensitive to plain amox?
(His dr. put him on Augmentin 300mg TDS IV 7days+ oral moxclav BD for another 7 days)
5.   By the grace of God, my kid is fine now, but still Im not confident with his Dr. now...Do you think he managed my kid well?

Thank you for your kind help. I m sure you are worth the talent and brilliance entrusted to you by the God almighty… Thank you once again. God bless.

Answer
Hi, Anu,

1. The risk of a URI in an immunologically normal kid leading to a LRI is small and generally a multi-factored issue.  All URIs in your child will not lead to pneumonia.  This was bad luck and not preventable.

2.  Depending on what bacteria/virus caused the pneumonia, and this often is unknown, vaccinations may indeed have made a big difference in preventing things.  

3.  I recommend the pneumococcal and all vaccinations for everyone.  I think you would be foolish not to do this to lessen his chance of future infections.

4.  The fact he got better on Augmentin may have indicated an amoxicillin resistent bacteria, like some strains of pneumococcus or coincidentally better with fluids and time in a viral illness.  Hard to know for sure.

5.  We see lots of kids with URI illness and the vast majority do fine without antibiotics.  If one suspects a pneumonia, at least in the USA, Amoxicillin is the drug of choice.  Only you know how you feel about your doctor, but this stuff happens and the treatment seems to me, at this distance and without doing a chart review, to be appropriate.

Good luck, Dr. Olson

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David Olson, MD

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I would be happy to attempt to answer any questions about general pediatric topics, either medical issues or behavioral issues. This would include all the various questions one receives in a busy pediatric practice. I`m a board certified pediatrician in northern Michigan and have been in practice for over 15 years. I enjoy the teaching role I have in our practice and would enjoy the opportunity to help others with their pediatric problems.

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