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