Cystic fibrosis and primary ciliary dyskinesia Quiz: Ace Your Exams

A 12-year-old boy with a past medical history of primary ciliary dyskinesia presents to the emergency department with a fever and cough for one day. This morning his parent noticed that he was working hard to breathe and brought him in for further evaluation. His parents state that he has been doing well and has had no significant infections or hospitalizations in the past year. He receives chest physiotherapy daily and is up to date on immunizations. He is at the 24^th percentile for height and the 16^th percentile for weight. Temperature is 38.7°C (101.7F), pulse is 108/min, respirations are 28/min, blood pressure is 115/76 mmHg, and oxygen saturation is 90% on room air. On examination, he is in mild respiratory distress with tachypnea, belly breathing, and intercostal retractions. Bilateral inner ear effusions are present as are nasal congestion and polyps. No murmur is appreciated on cardiopulmonary exam. Rales are heard over the right lower lobe. The patient is started on 2L/min oxygen, IV access is achieved, and he is placed on cardiac monitoring. Chest x-ray confirms right lower lobe pneumonia. Which of the following is the best next step in management?