Pneumonia defined as inflammation of lung parchayma, is caused virtually by every classes of microorganisms and a specific etiologic diagnosis is often difficult in children. Viruses and mycoplasma pneumoniae are the primary agents causing pneumonia followed by bacteria. WHO recommends diagnosis of pneumonia when children under five have acute on-set cough with tachypnea. Pneumonia can be classified as severe pneumonia, pneumonia or no pneumonia.
Severe Pneumonia is diagnosed when there is cough or difficult breathing plus at least either of the following signs: lower chest in drawing, nasal flaring, or grunting in young infants. Fast breathing or abnormal breath sounds may also be present.
Pneumonia is diagnosed when a coughing child also develops fast breathing but no signs for severe pneumonia.
No pneumonia cough or cold; if no sign for pneumonia or severe pneumonia.
Diagnosis is clinical and chest X ray. The decision to treat a child who has pneumonia is usually made clinically. Antibiotic therapy is directed at the most likely pathogens as suggested by the child’s age, clinical presentation (including severity of illness).
Treatment
1. No pneumonia but only cough or cold
Soothe the throat, relieve the cough with a safe remedy.
Non drug treatment:
Safe remedies to recommend:
Breast milk for exclusively breast-fed infants
Home fluids such as tea with honey, fruit juices
Harmful remedies to discourage: cough syrups containing diphenyl hydramine and or codeine
Drug Treatment:
Paracetamol, 10-15 mg/kg up to 4 times a day for the relieve of high fever equal to or above 39 0C.
(For S/E, C/I and dosage forms: see page 22)
2. Pneumonia
Drug treatment:
First line
Cotrimoxazole (4-mg/kg-trimethoprim-20mg/kg sulphamethaxozole twice a day for five days.
S/E: headache, mental depression, nausea, voming, diarrhea, hypersensitivity, Stevens Johnson’s syndrome.
C/I:infants under 6 weeks (risk of kernicterus), jaundice, hepatic failure, blood disorder,porphyria
Dosage forms:Pediatric tablet-trimethoprim 20mg and sulphamethoxazole 100mg;Tablet trimethoprim 80 and sulphamethoxazole 400mg;Suspension trimethoprim 40 and sulphamethoxazole 200mg; Ampoule 5ml (trimethoprim 80mg and sulphamethoxazole 400mg).
Alternative
Amoxicillin, 15 mg/kg PO three times daily. (For S/E and C/I see page 4)
Dosage: capsule, 250mg, 500mg; Injection, 250mg, 500mg in vial; Syrup, 250mg/5ml.
3. Severe Pneumonia
Drug treatment:
Benzyl penicillin 50,000units/kg/24hrs IM or IV every 6 hours for at least 3 days. (For S/E, C/I and Dosage forms, see page 19).
When the child improves switch to oral Amoxicillin: 15-mg/kg 3 times a day. The total course of treatment is 5 days.
If the child doesn’t improve with in 48 hours, switch to Chloramphenicol 25 mg/kg every 8 hours IM/IV until the child has improved and continue orally for the total course of 10 days (S/E, C/I and dosage forms: see page 7)
