By ULY CLINIC

Acute respiratory infections (ARI)

It is an infection affecting upper or lower respiratory tract. Can be caused by bacteria or viruses

Pneumonia

Introduction

Pneumonia is the inflammation of the lung tissue. Pneumonia can either be primary (to the causing organism) or secondary to pathological damage in the respiratory system

Diagnostic Criteria

Fever
Dry or productive cough
Central cyanosis
Respiratory distress
Chest pain and tachypnea

Pneumonia in Children

(For more details, refer to Integrated Management of Childhood Illness (IMCI) guidelines)

Important clinical features of pneumonia in under-fives

Investigations

FBC, CRP and ABG
CHEST X-ray
Oxygen saturation

Non-Pharmacological Treatment:

Oxygen therapy if available
Supportive care

Remove clothes
If wheezing giving rapid-acting bronchodilator: Nebulized Salbutamol
Ensure that the child receives daily maintenance fluid appropriate for the child’s age but avoid over-hydration refer to IMCI/ STG & Essential Medicines List for Children

Pharmacological Treatment:

Non-severe pneumonia

Amoxicillin 25 mg/kg 8 hourly for 5 days

Plus

Paracetamol suppositories 10–15mg/kg (if there is fever)

OR

Ibuprofen 15mg/kg 12 hourly for 5 days
Give the first dose at the clinic and teach the mother how to give the other doses at home.

Encourage breasting and feeding.

Severe Pneumonia

Benzyl Penicillin 50000 units/kg IV or IM every 6 hours for at least 3 days

THEN

Amoxicillin 40 mg/kg 8 hourly for 7 days.

OR

Ampicillin 50 mg/kg IV/IM every 6 hourly

AND

Gentamicin (7.5 mg/kg IV/IM once a day) for 5 days; then,

If child responds well, complete treatment at home or in hospital with

Amoxicillin 30 mg/kg 8 hourly for 7 days.

Very severe Pneumonia:

Ampicillin 50 mg/kg IV/IM every 6 hours

AND

Gentamicin (7.5 mg/kg IV/IM once a day) for 5 days; then,

If child responds well, complete treatment at home or in hospital with

Amoxicillin (40 mg/kg12 hourly 10 days

Alternatively,

Ceftriaxone 80 mg/kg IV or IM once daily for 10 days.

Note: For children above 5 years, atypical pneumonia should be considered e.g. mycoplasma

Erythromycin 125–250mg 8hourly for 10 days

OR

Azithromycin 10mg/kg once daily for 5 days

Pneumonia in adults

Community Acquired Pneumonia

Investigation
FBC, CRP and ABG
CHEST X-ray
OXYGEN SATURATION

Non Pharmacological treatment

Stop smoking if previously smoking

Pharmacological Treatment

First-Line Treatment

Treatment of Typical Community Acquired Pneumonia

Second line treatments

If no response to first line further investigation is required.
If patient is in respiratory distress, or no response after 3 days of first line treatment, or patient’s condition deteriorates, then investigate.

Treatment of Atypical Community Acquired Pneumonias

Note: In severe Pneumocystis jirovecii pneumonia (PCP), add 30 – 40mg prednisolone for 14 days

Alternative in Staphylococcal and Klebsiella Pneumonia:

Ceftazidime (IV/IM) 8 hourly for 7–14 days

Hospital Acquired Pneumonia

This is defined as pneumonia that occurs 48 hours or more after hospital admission but that was not incubating at the time of admission.

Pharmacological treatment

Empirical treatment until bacteriology available

Ampicillin (IV) 1g every 6 hours for 7 to 10 days

AND

Gentamicin (IV) 4 to 5mg/kg/day in 2 divided doses 7–10 days

OR

Sulbactam (IV) 500mg once daily for 7 days

Updated on, 2.11.2020

References

1. STG