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Acute respiratory infections (ARI)

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



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 



  • 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     


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


  • 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


  • Amoxicillin 40 mg/kg 8 hourly for 7 days. 


  • Ampicillin 50 mg/kg IV/IM every 6 hourly


  • 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


  • 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


  • 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


  • Azithromycin 10mg/kg once daily for 5 days

Pneumonia in adults

Community Acquired Pneumonia

  • Investigation

  • FBC, CRP and ABG

  • CHEST X-ray


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


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


  • Sulbactam (IV) 500mg once daily for 7 days 

Updated on, 2.11.2020


1. STG 

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