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Infection/Condition and Likely Organism |
Suggested Treatment |
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Pneumonia (for children 2 -59 months) Causative organism Streptococcus pneumoniae |
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After revision of Integrated Management of Childhood Illness guideline, revised guideline classifies pneumonia in children below 5 years into following category and plans the treatment for each one of them as follows
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Children aged 2-59 months with fast breathing Pneumonia with no chest indrawing or general danger signs |
Amoxicillin 40mg/kg/dose PO q12h for 5 days |
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Children aged 2-59 months with Pneumonia with chest indrawing |
Amoxicillin 40mg/kg/dose PO q12h for 5 days |
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Children 2-59 months with severe Pneumonia |
Ampicillin 50mg/kg/dose IV q6h for at least 5 days OR Benzyl penicillin 50,000U/ kg IM/IV q6h for at least 5 days PLUS Gentamicin 7.5mg/kg IM/ IV q24h for at least 5 days |
Ceftriaxone 100mg/kg once then 50mg/kg IV q24h for at least 5 days |
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RESPIRATORY TRACT INFECTION
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Infection/Condition and Likely Organism |
Suggested Treatment |
Comments |
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Alternative |
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Pneumonia (for children >5 years) |
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Outpatient Causative organism Streptococcus pneumoniae Haemophilus influenzae type b Atypical pneumonia Mycoplasma pneumoniae Chlamydia pneumoniae |
Amoxicillin 40mg/kg/dose q12h for 5-7 days If not vaccinated for Streptococcus pneumoniae or Hemophilus influenzae Amoxicillin-clavulanate 30mg/kg/dose PO q8h PLUS If Atypical pneumonia is considered Azithromycin 10mg/kg PO once then 5mg/kg q24h for 4 days (or 10mg/kg/day q24h for 3 days) |
Penicillin allergic Clindamycin 13mg/kg/ dose IV q8h for 5-7 days OR Cefuroxime 15mg/kg/ dose PO q8h for 5-7 days If not vaccinated for Streptococcus pneumoniae or Haemophilus influenzae and allergic to penicillin Levofloxacin 10mg/kg/ dose PO q24h for 5 days |
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Inpatient (uncomplicated or simple pleural effusion) Causative organism Streptococcus pneumoniae Haemophilus influenzae type b Atypical pneumonia Mycoplasma pneumoniae Chlamydia pneumoniae |
Ampicillin 50mg/kg/dose IV q6h (max: 2 g/dose) 5-7 days Penicillin allergic Clindamycin 13mg/kg/ dose IV q8h (max: 900mg/ dose) If not vaccinated for Streptococcus pneumoniae or Haemophilus influenzae or failed high dose Amoxicillin: Ceftriaxone 100mg/kg once then 50mg/kg/dose IV q24h (max: 2 gm/dose) Alternative to Ceftriaxone if severe Penicillin/ Cephalosporin allergy: Levofloxacin 10mg/kg/ dose daily (max: 750mg/ dose) PLUS If atypical pneumonia is to be considered Azithromycin 10mg/kg PO once then 5mg/kg q24h for 4 days (or 10mg/kg/ day q24h for 3 days) |
Ceftriaxone 100mg/kg once then 50mg/kg/dose IV q24h (max: 2gm/dose) |
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Complicated and/or severe pneumonia (empyema, abscess, necrosis, pneumonia requiring ICU care including those with severe sepsis) Causative organisms Streptococcus pneumoniae Staphylococcus aureus Streptococcus pyogenes Anaerobes Haemophilus influenzae type b Atypical pneumonia Mycoplasma pneumoniae Chlamydia pneumoniae |
Ceftriaxone 100mg/kg once then 50mg/kg/dose IV q12h (max: 2g/dose) PLUS Vancomycin 15mg/kg/ dose IV q6h Severe penicillin/ cephalosporin allergy Levofloxacin 10mg/kg/ dose IV/PO q24h (max: 750mg) PLUS Vancomycin 15mg/kg/ dose IV q6h PLUS If abscess or necrotizing pneumonia Metronidazole 10mg/ kg/dose IV/PO q8h (max: 500mg/dose) to either of the regimen PLUS If Atypical pneumonia is considered Azithromycin 10mg/kg PO/IV once then 5mg/kg q24h for 4 days (or 10mg/ kg/day q24h for 3 days) |
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Duration 7 days from afebrile period. Longer duration may be required for empyema and abscess. |