PNEUMONIA
Pneumonia is the inflammation of the lung parenchyma presenting without signs of respiratory distress.
Pneumonia is the inflammation of the lung parenchyma presenting without signs of respiratory distress.
Diagnostic Criteria
• Cough or difficulty in breathing.
• Fast breathing.
Fast breathing according to age. Age | |
< 2 months | ≥60 breaths per minute |
2 – 12 months | ≥50 breaths per minute |
12 months to 5 years | ≥40 breaths per minute |
• No investigations required
• Treat the child as outpatient
• Encourage breastfeeding, balanced diet and adequate fluid intake.
• Give Amoxicillin DT PO 40mg/kg 12 hourly for 5 days
• For children above 5years, atypical pneumonia should be considered e.g. mycoplasma. Give macrolide as a drug of choice see below: o Erythromycin PO 12.5mg/kg 6 hourly for 5 days in pneumonia
• Bring the child back after 2 days or earlier if the child becomes sicker or is unable to breast feed or drink.
• On the second day, if breathing has improved (respiratory rate is within normal range for age), there is less fever (<37.5°C axillary), and the child is eating better, complete the 5 days of antibiotic treatment.
Common cold is a self-limiting viral infection of the upper respiratory tract. Most episodes end within 14 days, beyond this consider causes of chronic cough.
Diagnostic Criteria
• Cough or nasal discharge or mouth breathing
• Normal respiratory rate
• Fever may or may not be present
• Not required
• Treat the child as an outpatient
Non Pharmacological
• Soothe the throat and relieve the cough with a safe remedy, such as tea with lemon, lime or honey.
• Clear secretions from the child using a cloth soaked in water, which has been twisted to form a pointed wick.
• Relieve high fever of ≥38.5°C with Paracetamol 15mg/kg.
SEVERE PNEUMONIA
Severe pneumonia is a condition characterized by extensive inflammation of lung parenchyma presenting with signs of respiratory distress.
Diagnostic Criteria
Cough or difficulty in breathing plus at least one of the following:
• Central cyanosis or oxygen saturation <90% on pulse oximetry.
• Inability to breastfeed or drink, or vomiting everything
• Convulsions, lethargy or unconsciousness.
• Grunting, head nodding, lower chest wall in drawing.
Investigations
• Chest X-ray, PA and Lateral views
• Blood for culture and sensitivity.
• FBP
• ESR
• CRP
Treatment
Non pharmacological
• Give oxygen 2-4 litres/min
• Maintain the airway by gentle suction of any thick secretions
Pharmacological
• Give Ampicillin IV 50mg/kg 6 hourly and Gentamicin IV 7.5mg/kg once a day for at least 5 days; then complete treatment at home or at health facility with Amoxicillin PO 40mg/kg 12 hourly plus Gentamicin 7.5mg/kg IV/IM once daily for a further 5 days.
• If the child does not improve within 48 hours, add Cloxacillin IV 50 mg/kg 6 hourly to cover for staphylococcal pneumonia. When the child improves within 48 hours, continue Flucloxacillin PO 25mg/kg 6 hourly for a total course of 3 weeks. Complete a course of Ampicillin and Gentamicin for 10 days.
• If the child does not improve within 48 hours and staphylococcal pneumonia is not suspected use Ceftriaxone IV 75mg/kg once daily for 10 days or consider evaluation of other diseases or complications.
If
HIV exposed/infected add Co-trimoxazole IV or PO 8mg/kg of Trimethoprim and 40mg/kg
of Sulfamethoxazole 8 hourly for 3weeks for Pneumocystis pneumonia (PCP)
• If the child has fever (≥38.5°C), give Paracetamol PO 15 mg/kg
• If the child has a wheeze, give nebulized salbutamol 2.5mg i.e. 0.5ml of the 5mg/ml nebulizer solution.
Management of Complications of Severe Pneumonia
If the child has not improved after two days, consider the following complications:
Empyema/Pleural effusion.
Pleural effusion is the collection of fluid within the pleural cavity.
Diagnostic Criteria
• The chest is stony dull to percussion over the affected area and a pleural rub may be heard.
• Positive pleural tap.
• Homogenous opacification with meniscus sign on a Chest X ray
Investigations
• Chest X-ray
• Pleural fluid analysis : Microbiology, Biochemistry and Cytology
Treatment
Non pharmacological
• Drain any significant pleural effusion with under water seal drainage.
• If fever and other signs of illness continue, despite adequate chest drainage and antimicrobial therapy, investigate for Tuberculosis.
Other complications:
Pneumothorax, Pericardial effusion, Lung abscess, Bronchial ectasis and
Cor-pulmonale.
Note:
Refer patients to the next level health facility if there is inadequate expertise or facilities.
Severe pneumonia is a condition characterized by extensive inflammation of lung parenchyma presenting with signs of respiratory distress.
Diagnostic Criteria
Cough or difficulty in breathing plus at least one of the following:
• Central cyanosis or oxygen saturation <90% on pulse oximetry.
• Inability to breastfeed or drink, or vomiting everything
• Convulsions, lethargy or unconsciousness.
• Grunting, head nodding, lower chest wall in drawing.
• Chest X-ray, PA and Lateral views
• Blood for culture and sensitivity.
• FBP
• ESR
• CRP
Non pharmacological
• Give oxygen 2-4 litres/min
• Maintain the airway by gentle suction of any thick secretions
• Give Ampicillin IV 50mg/kg 6 hourly and Gentamicin IV 7.5mg/kg once a day for at least 5 days; then complete treatment at home or at health facility with Amoxicillin PO 40mg/kg 12 hourly plus Gentamicin 7.5mg/kg IV/IM once daily for a further 5 days.
• If the child does not improve within 48 hours, add Cloxacillin IV 50 mg/kg 6 hourly to cover for staphylococcal pneumonia. When the child improves within 48 hours, continue Flucloxacillin PO 25mg/kg 6 hourly for a total course of 3 weeks. Complete a course of Ampicillin and Gentamicin for 10 days.
• If the child does not improve within 48 hours and staphylococcal pneumonia is not suspected use Ceftriaxone IV 75mg/kg once daily for 10 days or consider evaluation of other diseases or complications.
• If the child has fever (≥38.5°C), give Paracetamol PO 15 mg/kg
• If the child has a wheeze, give nebulized salbutamol 2.5mg i.e. 0.5ml of the 5mg/ml nebulizer solution.
Management of Complications of Severe Pneumonia
If the child has not improved after two days, consider the following complications:
Empyema/Pleural effusion.
Pleural effusion is the collection of fluid within the pleural cavity.
Diagnostic Criteria
• The chest is stony dull to percussion over the affected area and a pleural rub may be heard.
• Positive pleural tap.
• Homogenous opacification with meniscus sign on a Chest X ray
• Chest X-ray
• Pleural fluid analysis : Microbiology, Biochemistry and Cytology
Non pharmacological
• Drain any significant pleural effusion with under water seal drainage.
• If fever and other signs of illness continue, despite adequate chest drainage and antimicrobial therapy, investigate for Tuberculosis.
Pneumothorax, Pericardial effusion, Lung abscess, Bronchial ectasis and
Cor-pulmonale.
Note:
Refer patients to the next level health facility if there is inadequate expertise or facilities.
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