Treatment of Infection in Severely Malnourished Children

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The usual signs of infection, such as fever are often absent in severe malnutrition. Therefore, presume infection in severe malnutrition and give routinely broad-spectrum antibiotic(s) AND measles vaccine if child is> 6months and not immunized {delay if the child is in shock).

1. If the child has no complications, give cotrimoxazole paediatric suspension orally or amoxicillin

	Medicine	Child Dose	Frequency	Duration
	cotrimoxazole po	BW≥4kg = 5ml          BW<4kg = 2.5ml	twice daily	5 days
or	amoxicillin po	15mg/kg	8 hourly	5 days

2. If the child is severely ill (apathetic, lethargic) or has complications (hypoglycaemia, hypothermia, raw skin/fissures, respiratory tract or urinary tract infection) give iv/im ampicillin AND gentamicin

If seriously unwell give ampicillin and gentamicin or kanamycin. If condition less severe, consider oral broad-spectrum antibiotics (cotrimoxazole or amoxicillin).

	Medicine	Child Dose	Freq	Duration
	ampicillin im/iv	50mg/kg	6hrly	2 days
then	amoxicillin po*	15mg/kg	8hrly	5 days
and	gentamicin im/iv	7.5mg/kg	once daily	7 days

Give benzylpenicillin if ampicillin is not available. If the child fails to improve after 48 hours

	Medicine	Paed Dose	Frequency	Duration
add	chloramphenicol im/iv	25mg/kg	8 hourly	5 days

If the child has chronic diarrhoea

	Medicine	Paed Dose	Frequency	Duration
add	metronidazole po	7.5mg/kg	8 hourly	7 days

* If amoxicillin is not available continue with ampicillin but give orally 50mg/kg every 6 hours

For parasitic worms, give albendazole 200mg orally a day for three days.