Management of pneumonia

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SIGNS

Classify As

Treatment

Urgent pre-referral treatments are in bold print

Any general danger sign

or

chest indrawing

or

stridor in a calm child

Severe pneumonia

or

very severe disease

  • Give first dose of an appropriate antibiotic (Benzylpenicillin and gentamycin)
  • Treat to prevent low blood sugar (see below)
  • Keep the child warm
  • Treat wheeze if present
  • Refer URGENTLY to hospital

Fast breathing

Pneumonia

  • Give an appropriate antibiotic for 5 days
  • Treat wheeze if present
  • Advise mother to return immediately if condition worsens
  • Follow-up in 2 days

No signs of pneumonia or of very severe disease

No pneumonia:

cough or cold

  • If coughing more than 21 days, refer for assessment
  • Treat wheeze if present
  • Advise mother to return immediately if condition worsens
  • Follow-up in 7 days if not improving

Management of Severe Pneumonia

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.

Management of pneumonia

Management of pneumonia

First line:

Medicine

Paed Dose

Frequency

Duration

amoxicillin po

4 -<6 kg  = 62.5mg

6 - <14kg = 125mg

14-19kg = 250mg

three times a day

5 days

Alternative: Refer

or     

Medicine

Paed Dose

Frequency

Duration

procaine penicillin im

<1yr = ½ ml (=150mg)

1-3 yrs = 1ml (=300mg)

3-5 yrs = 1½ ml (=450mg)

once a day

5 days

Reassess after 2 days of antibiotic treatment If not responding then refer, as the second line choices are limited. Treat fever and pain, if present with:

or     

Medicine

Paed Dose

Frequency

Duration

Paracetamol po

10mg/kg

6 hourly

as required

Note: Do not give paracetamol to children under 3 months of age due to liver immaturity, if indicated give cautiously.

Give clear instructions on:

  • how to take medicines
  • home care:
    • continue breast-feeding 
    • maintain nutrition by giving easy-to-digest high energy
    • food 5-7 times a day 
    • and plenty of fluids a day.

Advise mother to return with the child in 2 days for re-assessment, or earlier if the child is getting worse:

  • increased difficulty in breathing
  • increased difficulty in drinking
  • increased respiratory rate, 

If the child returns with any of these, refer

Monitoring the child with pneumonia:

Child Worse

Child Same

Child better

  • Not able to drink
  • Has chest indrawing
  • Has other danger signs
  • Fast breathing
  • Slower breathing
  • Fever reduced
  • Eating better

Refer urgently

Refer

Finish course