Influenza

Influenza viruses A and B can cause pneumonia in pediatric and adult patients. Aman-tidine and rimantidine are available oral agents with activity against influenza virus type A. If started within 48 hours of the onset of the first symptoms, they reduce the duration of the illness by about 1.3 days. Oseltamivir and zanamivir also are oral agents that reduce the duration of the illness by about 1.3 days if initiated within 40 to

48 hours of the first symptoms. For active infection beyond the first 48 hours, none of these agents is effective in treating infection, and supportive care is the best treatment for these patients.

Aspiration

Anaerobes and Streptococcus spp. are the primary pathogens if a patient aspirates his or her oral contents and develops pneumonia. Antibiotics active against these organisms include penicillin G, ampicillin/sulbactam, and clindamycin. If the patient aspirates oral and gastric contents then anaerobes and gram-negative bacilli are the primary pathogens. The preferred treatment regimen is a ^-lactam/^-lactamase inhibitor combination (ampicillin/sulbactam, amoxicillin/clavulanate, piperacillin/tazobactam, or

ticarcillin/clavulanate).

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