PNEUMONIA IN A CHILD OF 2 MONTHS – 5 YEARS

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