
Clinical features
- Fever, may be high, low grade or absent (in severe illness)
Pneumonia
- Cough
- Fast breathing (2-12 months: ≥ 50 bpm, 1-5 years: ≥ 40 bpm)
- Mild chest wall in-drawing
Severe pneumonia
- As above plus at least one of the following
- Central cyanosis (blue lips, oral mucosa, finger nails or oxygen saturation < 90% using a pulse oximeter)
- Inability to feed, vomiting everything
- Convulsions, lethargy, decreased level of consciousness
- Severe respiratory distress (severe chest indrawing, grunting, nasal flaring)
- Extrapulmonary features, e.g. confusion or disorientation, may predominate and may be the only signs of pneumonia
in malnourished or immunosuppressed children
Management of pneumonia
Non severe pneumonia
- Give oral amoxicillin dispersible tabs (DT) 40 mg/kg every 12 hours for 5 days O
- 2-12 months 250 mg (1 tab) every 12 hours for 5 days
- 1-3 years 500 mg (2 tabs) every 12 hours for 5 days
- 3-5 years 750 mg (3 tabs) every 12 hours for 5 days
If wheezing present
- Salbutamol inhaler 1-2 puffs every 4-6 hours until wheezing stops
- Reassess child for progress after 3 days
Severe pneumonia
- Refer to hospital after 1st dose of antibiotic
- Admit
- Give Oxygen if SpO2 < 90% with nasal prongs and monitor through pulse oximetry
- Give ampicillin 50 mg/kg IV every 6 hours or benzyl penicillin 50,000 IU/kg IM or IV
- Plus gentamicin 7.5 mg/kg IM or IV once daily
- Continue treatment for at least 5 days, up to 10 days
If not better after 48 hours, use second line
- Ceftriaxone 80 mg/kg IM or IV once daily
- If staphylococcus is suspected (empyema, pneumatocele at X ray) , give gentamicin 7.5 mg/
kg once daily plus cloxacillin 50 mg/kg IM or IV every 6 hours
Once the patient improves
- Switch to oral amoxicillin 40 mg/kg every 12 hours for 5 days to complete a total of at least 5
days of antibiotics
Alternative (if above not available/not working)
- Chloramphenicol 25 mg/kg IV every 6 hours
Other treatments
- Give Paracetamol 10 mg/kg every 4-6 hours for fever
- If wheezing, give salbutamol 1-2 puffs every 4-6 hours
- Gentle suction of thick secretions from upper airway
- Daily maintenance fluids – careful to avoid overload especially in small and malnourished children
- If convulsions, give diazepam 0.5 mg/kg rectally
or 0.2 mg/kg IV
If convulsions are continuous
- Give a long-acting anticonvulsant, e.g. phenobarbital 10-15 mg/kg IM as a loading dose.
Depending on response, repeat this dose after 12 hours or switch to oral maintenance dose of 3-5 mg/kg every 8-12 hours- Monitor and record
- Respiratory rate (every 2 hours)
- Body temperature (every 6 hours)
- Oxygen saturation (every 12 hours)
- Improvement in appetite and playing
- Use of accessory muscles of respiration
- Ability to breastfeed, drink and eat