Pneumonia in children

(up to 2 months)

In infants, not all respiratory distress is due to infection. But as pneumonia may be rapidly fatal in this age group,
suspected cases should be treated promptly and referred for parenteral treatment with antimicrobials. Consider all
children < 2 months with pneumonia as SEVERE disease.

Clinical features

    • Rapid breathing (≥60 breaths/minute)
    • Severe chest indrawing, grunting respiration
    • Inability to breastfeed
    • Convulsions
    • Drowsiness
    • Stridor in a calm child, wheezing
  • Fever may or may not be present
  • Cyanosis and apnoeic attacks (SpO2 less than 90%)


Infants with suspected pneumonia should be referred to hospital after pre-referral dose of antibiotics.

  • Admit
  • Keep baby warm
  • Prevent hypoglycaemia by breastfeeding/giving expressed breast milk/NGT
  • If child is lethargic, do not give oral feeds. Use IV fluids with care
  • Give oxygen to keep SpO2 >94%
  • Ampicillin 50 mg/kg IV every 6 hours
  • Plus gentamicin 7.5 mg/kg IV once daily Neonates < 7 days old: 5 mg/kg IV once daily
  • In premature babies, the doses may need to be reduced (specialist only)

In severely ill infants

  • Ceftriaxone 100 mg/kg IV once daily

Alternative (only use if above not available)

  • Chloramphenicol 25 mg/kg IV every 6 hours (contraindicated in premature babies and
    neonates < 7 days old)
  • Continue treatment for at least 5 days, and for 3 days after the child is well
  • If meningitis is suspected, continue for 21 days
  • If septicaemia is suspected, continue for 10 days