Classification and management of ARI in a child under 2 months

Academic Desk, Medical Gurukul, GOLN

14 years ago

Today is our topic of discussion Classification and management of ARI in a child under 2 months

Classification and management of ARI in a child under 2 months

Fig. 20-1: Visualization of lower chest wall indrawing

Investigations:

Pulse oximetry (if available) –

to guide when to start and stop oxygen therapy

Chest X-ray –

Severe pneumonia not responding to treatment or with complications.

Treatment:

Very severe disease:

Admit the child to hospital.

Antibiotic therapy (any one of the following options):

a) Inj. Ampicillin (10 mg/kg IM every 6 hours) and gentamicin (7.5 mg/kg IM once a day) for 5 days; complete treatment at home or hospital with oral amoxicillin (15 mg/kg three times a day) plus IM gentamicin once daily for a further 5 days.

b) Ceftriaxone (20-25 mg/kg IM or IV once daily or BD) – 5 to 7 days.
c) Chloramphenicol (25 mg/kg IM or IV every 8 hours) until the child has improved. Then continue orally 4 times a day for a total course of 10 days.
d) Gentamicin (7.5 mg/kg IM once a day) and cloxacillin (10 mg/kg IM or IV every 6 hours). When the child improves, continue cloxacillin orally 4 times a day for a total course of 3 weeks..

Oxygen therapy:

To all children with very severe disease. If pulse oximetry is available, use this to guide oxygen therapy & give O2 to those with oxygen saturation <90%.

Supportive care:

a) If temperature ≥101°F→ Paracetamol

b) If wheeze→→ Nebulization with bronchodilator
c) Suction of any thick secretions in the nasopharynx, if the child cannot clear.
d) Daily maintenance fluid appropriate for the child’s age. Encourage breastfeeding and oral fluids.

Severe pneumonia:

1. Admit or refer the child to hospital.

2. Antibiotic therapy: As before.
3. Oxygen therapy: If available, give oxygen to any child with severe lower chest wall indrawing or fast breathing.
4. Supportive care: As before.

Pneumonia:

1. Treat the child as an outpatient.
2. Antibiotic therapy: Amoxicillin (15 mg/kg 3 times/ day) or cephradine (10 mg/kg 4 times/ day for 3- 5 days. Give the first dose on visit and teach the mother how to give the other doses at home.

Cough or cold:

1. Treat the child as an outpatient.
2. Soothe the throat and relieve the cough with a safe remedy, such as warm honey drink.
3. Relieve high fever (≥101°F) with paracetamol.
4. Clear secretions from the child’s nose.
[Other antibiotics also used: Ceftazidime, Cefixime, Cefuroxime, Cefepime, azithromycin & erythromycin]