Pneumonia
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Description
- Pneumonia is inflammation of the lung parenchyma. Both bacteria and viruses are important causes of pneumonia.
- Bacterial causes are the most common in HIV-infected children. Common causes are; Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcocal aureus and Mycoplasma pneumoniae.
- Common viral causes include respiratory syncytial virus, adenovirus, cytomegalovirus
Signs and Symptoms
- Fever above 38 degrees Celsius
- Cough
- Difficulty breathing
- Increased respiratory rate of > 60 breaths in an infant and >50 breaths/min in older children
- Severe chest indrawing
- Reduced level of consciousness
- Severe acute malnutrition
- Seizures
- Vomiting and poor feeding
Cut offs for fast breathing:
|
Age |
Cut offs for fast breathing |
|
< 2 months |
60 breaths/min or more |
|
2 – 12 months |
50 breaths/min or more |
|
12 Months - 5 Years |
40 breaths/min or more |
WHO Classification of pneumonia:
|
Category |
Characteristics |
|
No Pneumonia |
No signs of Pneumonia |
|
Pneumonia |
Immune competent child aged 2 months and above. Tachypnoea:
|
|
Severe Pneumonia or Very Severe Disease |
Infants under 2 months: Any Danger signs.
|
Indications for admission
- Cyanosis, SpO2 < 92%
- Increased respiratory rate
- Subcostal recession
- Intermittent apnoea, grunting (infants)
- Poor feeding
- Convulsions
- Restlessness or agitation
- Signs of dehydration
- Unconscious or lethargic
- Capillary refill time >3 seconds
Investigations
- Chest x-ray
- FBC, ESR
- Urea, electrolytes
- Blood culture
Treatment
- Oxygen by nasal cannula or mask
- IV fluids if required should be < 2/3 of requirements (risk of SIADH in hypoxic children)
- Antipyretic and analgesia as indicated.
Antibiotic therapy
|
Drugs |
Classification |
|
Amoxicillin or Amoxicillin and Clavulanate
|
Pneumonia
|
|
1st Line 0-3 months Benzylpenicillin 50,000 IU/kg/dose every 6 hours PLUS Gentamicin 7.5 mg once a day or 3.75mg/kg 12 hourly. More than 3 months Benzylpenicillin 50,000 IU/kg/dose every 6 hours PLUS Gentamicin 7.5 mg once a day or 3.75mg 12 hourly. 2nd line Ceftriaxone 50-80 mg/kg/dose once daily IV or Cefotaxime 50 mg/kg 8 hourly IV. If no improvement and the infant with HIV infection or exposure, consider adding PCP therapy with high dose IV/PO cotrimoxazole (20 mg/kg/day of trimethoprim) |
Severe Pneumonia |
|
In suspected staphylococcus pneumonia, add IV Cloxacillin 12.5mg/kg- 25mg/kg 6 hourly. Macrolides should be considered in school-going children and adolescents who do not improve on 1st line treatment. Erythromycin (oral)
Azithromycin (oral)
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