pneumonia ppt

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RATIONALE USE OF ANTIBIOTICS FOR PNEUMONIA : 

RATIONALE USE OF ANTIBIOTICS FOR PNEUMONIA INDIAN CLINICAL EPIDEMILOGICAL NETWORK TASK FORCE FOR PNEUMONIA Indian Pediatrics Vol 47- Jan 17,2010

Introduction : 

Introduction Pneumonia affects 156 million children under the age of 5 yrs every year across the globe. Leading cause of mortality in Under 5 yrs. Most of these deaths- preventable. Most effective intervention- Early diagnosis and appropriate case management

Slide 3: 

Percentage of children that die from pneumonia, by country From Williams et al. Lancet Infect Dis, 2002.

Pneumonia leads causes of childhood deaths : 

Pneumonia leads causes of childhood deaths ource: WHO estimates of the causes of death in children, 2000-03

Slide 5: 

Case Definition Moderate – Severe Lower Respiratory Infection in children: 1) Fever + 2) Cough + 3) Rapid breathing (tachypnea) A child has tachypnea if Respiratory rate >60/min in children <2 months Respiratory rate >50/min in children 2-12 months Respiratory rate >40/min in children 12-60 months

Clinical definition of pneumonia : 

Clinical definition of pneumonia respiratory symptoms / signs wheezing abnormal chest x-ray

What causes Pneumonia: Viruses : 

What causes Pneumonia: Viruses Respiratory Syncytial Virus Adenovirus Rhinovirus Parainfluenza/Influenza

What causes Pneumonia: Bacteria : 

What causes Pneumonia: Bacteria Streptococcus pneumoniae Mycoplasma and others Haemophilus influenzae

Leading Etiologic Agents of Pneumonia Infants and Children : 

Leading Etiologic Agents of Pneumonia Infants and Children

Symptoms and signs : 

Symptoms and signs Nonspecific and toxicity Signs of lower respiratory disease Signs of pneumonia Sign of plueral effusion and empyema Any signs of complications of Pneumonia (plueral effusion, empyema and meningitis)

Slide 11: 

Pneumonia : differential diagnosis

Management of a case of Pneumonia : 

Management of a case of Pneumonia Investigations Treatment

investigations : 

investigations Chest X ray.

Slide 14: 

Haemogram with ESR Sputum culture Blood culture Urine antigen test – latex agglutination

Slide 15: 

Lung tap Pleural fluid culture

Treatment of Pneumonia : 

Danger signs* YES Refer to hospital Give antibiotics: IV NO Assess for chest indrawing YES NO Refer to hospital Give antibiotics:IVPencillin VERY SEVERE DISEASE * Danger signs include cyanosis, convulsions, severe malnutrition, difficult to wake, not able to drink SEVERE PNEUMONIA Assess for fast breathing (RR>50/40 breaths/minute) YES NO=NO PNEUMONIA; COUGH OR COLD Give antibiotics PNEUMONIA Treatment of Pneumonia Home remedi

Treatment of Pneumonia : 

Assess for fast breathing (RR>50/40 breaths/minute NO Home remedies YES Assess for chest indrawing YES Refer to hospital Give antibiotics:IVPencillin * Danger signs include cyanosis, convulsions, severe malnutrition, difficult to wake, not able to drink Danger signs YES Refer to hospital Give antibiotics: IV Treatment of Pneumonia Give antibiotics PNEUMONIA SEVERE PNEUMONIA VERY SEVERE DISEASE

Domicillary treatment of pneumonia : 

Domicillary treatment of pneumonia Give Cotrimoxazole (trimethoprim[T] + Sulfamethozazole[S]) (5-7 mg/kg/day of T + 25-35 mg/kg/day of S) in two divided doses for 5 days OR Amoxicillin (30-40 mg/Kg/day) in 2-3 divided doses for 3-5 days Follow-up after 2 days Ask: Is the child breathing slower? Is there less fever? Is the child eating better? YES ---- complete 5 days of cotrimoxazole or 3-5 days of Amoxicilin *Check for danger signs NO CONTINUE ANTIBIOTICS x 5 day * Assess difficult breathing and Chest Indrawing YES REFER CONTINUE ANTIBIOTICS for 5days REFER FOR HOSPITILIZATION COMPLETE 5 days of Cotrimozazole OR 3- 5 days Amoxicilin

Management of severe pneumonia in children aged > 2yrs : 

Management of severe pneumonia in children aged > 2yrs

Management of severe Pneumonia in children aged ≤ 2 yrs. : 

Management of severe Pneumonia in children aged ≤ 2 yrs.

Management of Very-severe Pneumonia : 

Management of Very-severe Pneumonia assess at 48 hrs Chest X ray is to be done for all cases of very severe pneumonia to look for empyema & pneumothorax O2 IV fluids IV Ampicillin + Gentamicin Improved No improvement Complete IV antibiotics for 10 days Third generation cephalosporin (Cefotaxime or Ceftriaxone) + Cloxacillin for 7-10days

Control of Lower Respiratory Infections : 

WHO focuses on the reduction of mortality requiring: Early/adequate diagnosis Correct case management Hospitalize for danger signs Access to health care Trained health staff Simple treatment protocols Immunization Control of Lower Respiratory Infections

THANK YOU : 

THANK YOU

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