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Q. My son's X-ray shows a pneumonitic patch. Should we get him hospitalized?

Answered by
Dr. Preeti Puranik
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Oct 28, 2017 and last reviewed on: Jul 26, 2019

Hi doctor,

My 2 and a half year old son had a high fever of 103 for four days. Then he was normal for five days but caught up with a cough and fever of less than 102. The doctor administered antibiotic Cefixime and Ibuprofen for five days, but the cough persisted. Though he appears normal at daytime, at night, a fever of 99 to 101 comes and he coughs excessively. Today, we did his X-ray and the doctor asked us to admit him to the hospital as he had developed a pneumonitic patch. I have attached the X-ray. He did not comment if this patch is H1N1 induced or a bacterial infection. He said he would administer H1N1 medicine once admitted as a precautionary measure. We need advice whether we should get him hospitalized. He appears normal, eats well and appears active. The only thing that we are concerned about is the coughing and the low-grade fever at night. He has prescribed Amoxicillin now. Should we wait for the antibiotic to cure the patch or get him hospitalized?

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#

Hello,

Welcome to icliniq.com.

Please resend the attachment.

  • If there is pneumonitis on the X-ray, it is better to admit him as it can spread. Intravenous antibiotics are more effective and the response is quick.
  • We cannot differentiate H1N1 and pneumonia on the X-ray. We need to send the throat swab for a test.
  • Also, he should be isolated as if it turns out to be H1N1, it will spread to everyone around him.
  • He may also need other supportive treatments like nebulization, monitoring his condition, etc. which is best done in a hospital set up.

For more information consult a paediatrician online --> https://icliniq.com./ask-a-doctor-online/paediatrician

Thank you doctor,

Here are the X-ray reports and other prescriptions by the doctor along with the admission note. I am awaiting reports for the hemogram, SGPT, and Widal test.

#

Hello,

Welcome back to icliniq.com.

I have gone through the files uploaded by you (attachment removed to protect patient identity).

  • There is pneumonia present. I think giving IV antibiotic is a better option than Amoxicillin-Clavulanic acid. Consult your specialist doctor, discuss with him or her and start taking the medicines with their consent.
  • If suspecting H1N1, the test has to be sent and the medicine is to be started quickly as outbreaks of H1N1 are going on.

For more information consult a paediatrician online --> https://icliniq.com./ask-a-doctor-online/paediatrician

Thank you doctor,

I received his hemogram, routine urine, and SGPT reports. We consulted the doctor again. Since my son has not been having any fever currently, he asked us to monitor his fever for the next 12 hours. Can you advise if this is viral pneumonia or mycoplasma pneumonia based on the CBC report?Are there any other tests to confirm that? Do you think antibiotics (oral or IV) will help him if it is a viral one? Do you suggest antiviral medicines instead? Should we admit him to the hospital even if no fever is observed?

#

Hello,

Welcome back to icliniq.com.

  • The counts indicate a viral picture, but this can also happen in an antibiotic-treated bacterial infection.
  • A mycoplasma infection cannot be made out by CBC. I did not know that his fever has reduced. If he does not have a fever and is active, eating fine and taking medicines, you may wait.
  • Viral pneumonia will reduce by itself only by symptomatic treatment and does not need any antibiotic or antiviral drugs except H1N1 which need antiviral medicines.
  • In this case, as he was treated by antibiotics, we cannot rely only upon the blood counts.
  • Hence, it is better to give oral antibiotics. It takes 48 hours for the antibiotic to start showing a response.

For more information consult a paediatrician online --> https://icliniq.com./ask-a-doctor-online/paediatrician

Hello doctor,

Thank you for the helpful advice that you are providing. This is the second day without fever and he is showing signs of recovery. Though he coughs, such episodes have reduced drastically. Breathing is also not rigorous as it used to be two days ago. I need your advice on the further line of treatment as his Amox-Clav dose will be over by tomorrow. Should we continue with the Amox-Clav (Delpoclav suspension) dose for the next three days again? His current dosage is 3.5 ml twice a day. Or, do you suggest any other combination? How long should he be treated with antibiotics? We are also giving him Levonil syrup. Should we continue with this and for how long? His Hb is 9. Is it too low to take some medication as he will likely be on antibiotics for few more days? Or can we wait till this illness subsides? Can we rule out H1N1 since he does not have fever anymore? I do not want the doctors to unnecessarily give him Oseltamivir as I heard that it will reduce the effectiveness, if god forbid, he catches the real infection in the future. After how many days should we do the follow-up X-ray to see if the patch has reduced actually? Is any other test needed now or during follow up?

#

Hello,

Welcome to icliniq.com.

  • I suggest you continue the same antibiotic and give it for seven to 10 days based on the response.
  • Continue Levolin (Levosalbutamol) syrup till the cough subsides. It may take up to a week.
  • The medicine for low Hb (hemoglobin) should be taken only after he completes the antibiotic course and recovers completely.
  • If the doctor still suspects H1N1 and advised Oseltamivir, please take it. Do not bother about a future infection as it is a serious disease. You can vaccinate your child for that every year.
  • Repeat the X-ray after three weeks as it takes that long for the patch to reduce or clear, though the clinical response is early.
  • If taking Oseltamivir, an H1N1 swab test is recommended.

For more information consult a paediatrician online --> https://icliniq.com./ask-a-doctor-online/paediatrician


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