The major cause of pneumonia is infection with Streptococcus pneumoniae or Haemophilus influenzae. These respond well to the antibiotics recommended below if recognised early.
Note: Paediatric dose starts at 2 months in IMNCI. For babies 1-2 months see neonatal doses in neonatal conditions. Well nourished children over 6 months with severe pneumonia can be managed with benzylpenicillin only.
- Give first dose of intramuscular benzylpenicillin and gentamicin and refer child urgently to hospital.
- If referral not possible repeat the benzylpenicillin 6 hourly and gentamicin once daily.
|
Medicine |
Paed Dose |
Frequency |
Duration |
|
benzylpenicillin im |
0.05-0.1MU/kg |
6 hourly |
10 days |
and |
gentamicin im |
5-7mg/kg |
once daily |
10 days |
Note: change to oral amoxicillin when patient improves and tolerates oral drugs.
If less than 6 months add high dose cotrimoxazole for 21 days and check HIV status. In HIV positive children consider steroids
Cotrimoxazole dosage per age group
Age or weight |
Paediatric tablet 120mg dispersible |
Syrup 240mg/5ml |
2-6 months (4-5.9 kg) |
1 |
2.5mls |
6months-3yrs (6-13.9kg) |
2 |
5mls |
3-5yrs (14 -19kg) |
3 |
7.5mls |
All HIV positive children should continue with cotrimoxazole prophylaxis at appropriate dose once daily. Infants confirmed HIV infected should commence ART as soon as possible.
If benzylpenicillin is not available, substitute with:
|
Medicine |
Paed Dose |
Frequency |
Duration |
|
ampicillin iv |
50mg/kg |
6 hourly |
5 days |
and |
procaine penicillin im |
<1yr 1-3 yrs 3-5 yrs |
½ ml (=150mg) 1ml (=300mg) 1½ ml (=450mg) |
5 days |
Supportive measures
- Prevent low blood sugar:
- If the child is able to breastfeed ask the mother to breast feed the child
- If the child cannot breastfeed but is able to swallow give expressed breast milk or a breast milk substitute. If neither are available give sugar water= 4 level teaspoons sugar (20gm) in 200ml clean water.
- If the child is not able to swallow, give 50ml of milk or sugar water by nasogastric tube.
- Fluids (po/iv/nasogastric) 100ml/kg/24hrs - iv fluids monitored closely
- Nasal suction (or normal saline nasal drops) to clear the airway.
- Continued feeding.
- Check oxygen saturation
- Give oxygen.