CHILD WITH PNEUMONIA

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Pneumonia is a respiratory infection caused by viruses or bacteria. It is classified as non-severe or severe on the basis of clinical features.

Non-severe pneumonia

Severe pneumonia

Fast breathing:

-   ≥ 50 breaths/min in a child aged 2–11 months

-   ≥ 40 breaths/min in a child aged 1–5 years

Chest indrawing

 

Cough or difficulty in breathing with:

-   Oxygen saturation < 90% or central cyanosis

-   Severe respiratory distress (e.g. grunting, very severe chest indrawing)

-   Signs of pneumonia with a general danger sign (inability to breastfeed or drink, lethargy or reduced level of consciousness, convulsions)

Investigations

  • Measure oxygen saturation with pulse oximetry in all children suspected of having pneumonia.
  • Chest X-ray to identify pleural effusion, empyema, pneumothorax, pneumatocele, interstitial pneumonia or pericardial effusion.
  • Gene-Xpert 

Non-pharmacological and pharmacological treatment

Admit the child to the hospital. 

Oxygen therapy

Give oxygen to all children with oxygen saturation < 90%

  • Use a pulse oximetry to guide oxygen therapy (to keep oxygen saturation > 90%).
  • If a pulse oximeter is not available, continue oxygen until the signs of hypoxia (such as inability to breastfeed or breathing rate ≥ 70/min) are no longer present.

Antibiotic therapy

1st line

IV ampicillin 50 mg/kg every 6 h for at least 5 days 

OR

Benzylpenicillin 50 000 U/kg IM or IV every 6 h for at least 5 days

PLUS

Gentamicin 7.5 mg/kg IM or IV once a day for at least 5 days.

 

If the child does not show signs of improvement within 48 hours and if staphylococcal pneumonia is suspected, switch to

Gentamicin 7.5m/kg IM or IV once a day

PLUS

Cloxacillin 50mg/kg IM or IV every 6 hours 

 

2nd line

Ceftriaxone 80mg/kg IM or IV daily (if 1st line medicines fail)

Other treatments

  • Remove by gentle suction any thick secretions at the entrance to the nasal passages or throat, which the child cannot clear.
  • If the child has fever (≥ 39 °C) give paracetamol 10 mg/kg every 4-6 hours for fever
  • If wheezing, give salbutamol 1-2 puffs every 4-6 hours and start steroids when appropriate.
  • Rehydrate appropriately but avoid over-hydration
  • If convulsions occur, give diazepam 0.5 mg/kg rectally or 0.2 mg/kg IV
  • Encourage breastfeeding and oral fluids.
  • Encourage the child to eat as soon as food can be taken