Pneumonia in children- Management

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.

Clinical presentation

• Fever (typically>38⁰C)

• Dry or productive cough

• Central cyanosis

• Respiratory distress

• Chest pain and tachypnoea

Table 1: Tool used for assessing Adult Patient with Pneumonia

Table 2: CURB-65 Score intrapretation in assessing Adult Patient with Pneumonia

DBP = diastolic blood pressure; SBP = systolic blood pressure. ^a Defined as a Mental Test Score of ≤8, or new disorientation in person, place or time. Predicted 30-day mortality

Note

• For patients with pneumonia treatment should be instituted when they have FEVER, COUGH AND CXR with findings suggestive of pneumonia.

• Consider alternative diagnosis when a patient is not responding.

• Pulmonary embolism should be investigated carefully for patient with shortness of breath and not responding to treatment of pneumonia

Table 3: Important clinical presentation of pneumonia in under-fives

Investigation

Initial assessment

• Measure oxygen saturation (SpO₂).

Laboratory investigations

• Full Blood Count (FBC)

  • Look for increased white blood cell count (WBC) and neutrophilia.

• C-Reactive Protein (CRP) and/or Erythrocyte Sedimentation Rate (ESR)

  • Usually elevated in bacterial infection.

• Arterial Blood Gas (ABG)

  • Assess pH, bicarbonate level, and oxygenation status.

• Blood culture.

• Sputum culture and sensitivity.

• HIV serology (if HIV status is unknown).

Imaging Studies

Chest X-ray (PA and lateral views)

Look for:

• Consolidation.

• Pleural effusion (>5 cm).

Bronchoscopy (Consider if)

• Immunosuppressed patient.

• Critically ill patient.

• Failure to respond to treatment.

• Suspected tuberculosis (TB).

• Suspected Pneumocystis pneumonia (PCP).

• Inadequate respiratory specimens.

CT Scan of the Chest (Consider if)

• Patient is not improving clinically.

• Suspicion of fungal infection.

• Suspicion of interstitial lung disease (ILD).

Non-Pharmacological treatment

• Oxygen therapy, if available.

• Supportive care:

  • Remove excess clothing.

  • If wheezing is present, administer a rapid-acting bronchodilator:

    • Nebulized salbutamol.

  • Ensure the child receives age-appropriate daily maintenance fluids.

  • Avoid overhydration.

  • Refer to IMCI/STG & Essential Medicines List for Children for fluid requirements.

• Encourage breastfeeding and adequate feeding.

Pharmacological Treatment of Non-Severe Pneumonia

Antibiotic Therapy

• Amoxicillin (PO) 25 mg/kg every 8 hours for 5 days.

Fever management (if fever is present)

Choose one of the following:

• Paracetamol (PO) 15 mg/kg every 8 hours for 5 days.

OR

• Paracetamol suppository 10–15 mg/kg.

OR

• Ibuprofen (PO) 15 mg/kg every 12 hours for 5 days.

Note: 

Give the first dose at the health facility and teach the mother/caregiver how to administer the remaining doses at home.

Pharmacological Treatment of Severe Pneumonia

Preferred regimen

• Benzyl penicillin (IV/IM) 50,000 units/kg every 6 hours for at least 3 days.

THEN

• Amoxicillin (PO) 40 mg/kg every 8 hours for 7 days.

Alternative regimen

• Ampicillin (IV/IM) 50 mg/kg every 6 hours for 5 days.

AND

• Gentamicin (IV/IM) 7.5 mg/kg once daily for 5 days.

THEN

• Amoxicillin (PO) 40 mg/kg every 8 hours for 7 days.

Note

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

• Consider alternative diagnosis after three visit /not responding, refer patient to a pediatrician