PNEUMONIA IN CHILDREN ABOVE 5 YEARS AND ADULTS

Clinical features

Moderate

  • Fever, chest pain, cough (with or without sputum), rapid breathing (> 30 bpm), no chest indrawing

Severe

  • As above plus
  • Chest indrawing
  • Pulse >120/minute
  • Temperature > 39.5 o C
  • Low BP < 90/60 mmHg
  • Oxygen saturation less than 90%

Note

  • Extrapulmonary features, e.g. confusion or disorientation, may predominate and may be the only signs of pneumonia
    in elderly or immunosuppressed patients

Management


Moderate pneumonia (ambulatory patients)

  • Amoxicillin 500 mg-1 g every 8 hours for 5 days
  • Children: 40 mg/kg every 12 hours for 5 days. Preferably use dispersible tablets in younger
    children (possible atypical pneumonia), give:
  • Doxycycline 100 mg every 12 hours for 7-10 days
  • Child > 8 years only: 2 mg/kg per dose
  • Or Erythromycin 500 mg every 6 hours for 5 days
    • 14 days in cases of atypical pneumonia Child: 10-15 mg/kg per dose

Severe pneumonia (hospitalised patients)

  • Give oxygen and monitor SpO2 saturation with pulse oximeter
  • Benzylpenicillin 2 MU IV or IM daily every 4-6 hours
    Child: 50,000-100,000 IU/kg per dose

If not better in 48 hours:

  • Ceftriaxone 1 g IV or IM every 24 hours
    Child: 50 mg/kg per dose (max: 1 g)

If S. Aureus is suspected

  • Cloxacillin 500 mg IV every 6 hours

If other options are not available

  • Chloramphenicol 1 g IV every 6 hours for 7 days
    Child: 25 mg/kg per dose (max: 750 mg)