Page 73 - Learnwell EVS
P. 73
te pneumonia
Treatment
Severe pneumonia (inpatient treatm ent)
Infants under 2 months of age
T h e first line treatm ent is th e com bination ampicillin I V for 1 0 d ays + gentamicin I M for 7
to 1 0 d ays:
≤2 kg ampicillin 1 0 0 m g / kg / d ay in 2 d iv id ed d oses
+ gentamicin 3 m g / kg once d aily
C h ild ren < 7 d ays
ampicillin 1 5 0 m g / kg / d ay in 3 d iv id ed d oses
> 2 kg + gentamicin 5 m g / kg once d aily
≤2 kg ampicillin 1 5 0 m g / kg / d ay in 3 d iv id ed d oses
d ays + gentamicin 5 m g / kg once d aily d oses
C h ild ren ≥ 7 ampicillin 2 0 0 m g / kg / d ay in 4 d iv id ed
> 2 kg + gentamicin 5 m g / kg once d aily
F or am picillin, I V route is preferred but IM route m ay be an alternativ e.
benzylpenicillin procain IM , 5 0 0 0 0 IU / kg once d aily (5 0 m g / kg once d aily) for 1 0 d ays
( com bined w ith g entam icin I M as abov e) , m ay be an alternativ e to am picillin in
contexts w h ere am picillin cannot be properly ad m inistered . H ow ev er am picillin
rem ains th e d rug of ch oice.
B enzylpenicillin procain m ust N E V E R be ad m inistered by I V route.
I f penicillins are not av ailable, alternativ es m ay be cefotaxime slow I V (ov er at least
3 m inutes) or infusion (ov er at least 2 0 m inutes) or IM : 1 5 0 m g / kg / d ay in 3 d iv id ed
d oses for 1 0 d ays, or, as a last resort: ceftriaxone slow 2I V (ov er at least 3 m inutes) or
infusion ( ov er 3 0 m inutes; 6 0 m inutes in neonates) or I M : 5 0 m g / kg once d aily for
1 0 d ays.
If th e ch ild 's cond ition d oes not im pro3v e after 4 8 h ours of w ell ad m inistered treatm ent,
ad d cloxacillin IV * for 1 0 to 1 4 d ays
≤ 2 kg cloxacillin 5 0 m g / kg / d ay in 2 d iv id ed d oses
C h ild ren < 7 d ays
> 2 kg cloxacillin 7 5 m g / kg / d ay in 3 d iv id ed d oses
C h ild ren ≥ 7 ≤2 kg cloxacillin 7 5 m g / kg / d ay in 3 d iv id ed d oses
d ays
> 2 kg cloxacillin 1 0 0 m g / kg / d ay in 4 d iv id ed d oses
* E ach d ose is to be ad m inistered in 1 0 0 m l of 0 .9 % sod ium ch lorid e.
Children from 2 months to 5 years of age
T h e first line treatm ent is:
ceftriaxone I M or slow IV2 (ov er at least 3 m inutes): 5 0 m g / kg once d aily
or, if not av ailable:
ampicillin IV or I M : 2 0 0 m g / kg / d ay in 3 to 4 d iv id ed d oses + gentamicin I M : 7 .5 m g / k
once d aily
2 The solvent of ceftriaxone for IM injection contains lidocaine. Ceftriaxone reconstituted using this solvent must
never be administered by IV route. For IV administration, water for injection must always be used.
3 Improvement criteria include: fever reduction, diminished respiratory distress, improved O2 saturation, improved
appetite and/or activity.
68
Treatment
Severe pneumonia (inpatient treatm ent)
Infants under 2 months of age
T h e first line treatm ent is th e com bination ampicillin I V for 1 0 d ays + gentamicin I M for 7
to 1 0 d ays:
≤2 kg ampicillin 1 0 0 m g / kg / d ay in 2 d iv id ed d oses
+ gentamicin 3 m g / kg once d aily
C h ild ren < 7 d ays
ampicillin 1 5 0 m g / kg / d ay in 3 d iv id ed d oses
> 2 kg + gentamicin 5 m g / kg once d aily
≤2 kg ampicillin 1 5 0 m g / kg / d ay in 3 d iv id ed d oses
d ays + gentamicin 5 m g / kg once d aily d oses
C h ild ren ≥ 7 ampicillin 2 0 0 m g / kg / d ay in 4 d iv id ed
> 2 kg + gentamicin 5 m g / kg once d aily
F or am picillin, I V route is preferred but IM route m ay be an alternativ e.
benzylpenicillin procain IM , 5 0 0 0 0 IU / kg once d aily (5 0 m g / kg once d aily) for 1 0 d ays
( com bined w ith g entam icin I M as abov e) , m ay be an alternativ e to am picillin in
contexts w h ere am picillin cannot be properly ad m inistered . H ow ev er am picillin
rem ains th e d rug of ch oice.
B enzylpenicillin procain m ust N E V E R be ad m inistered by I V route.
I f penicillins are not av ailable, alternativ es m ay be cefotaxime slow I V (ov er at least
3 m inutes) or infusion (ov er at least 2 0 m inutes) or IM : 1 5 0 m g / kg / d ay in 3 d iv id ed
d oses for 1 0 d ays, or, as a last resort: ceftriaxone slow 2I V (ov er at least 3 m inutes) or
infusion ( ov er 3 0 m inutes; 6 0 m inutes in neonates) or I M : 5 0 m g / kg once d aily for
1 0 d ays.
If th e ch ild 's cond ition d oes not im pro3v e after 4 8 h ours of w ell ad m inistered treatm ent,
ad d cloxacillin IV * for 1 0 to 1 4 d ays
≤ 2 kg cloxacillin 5 0 m g / kg / d ay in 2 d iv id ed d oses
C h ild ren < 7 d ays
> 2 kg cloxacillin 7 5 m g / kg / d ay in 3 d iv id ed d oses
C h ild ren ≥ 7 ≤2 kg cloxacillin 7 5 m g / kg / d ay in 3 d iv id ed d oses
d ays
> 2 kg cloxacillin 1 0 0 m g / kg / d ay in 4 d iv id ed d oses
* E ach d ose is to be ad m inistered in 1 0 0 m l of 0 .9 % sod ium ch lorid e.
Children from 2 months to 5 years of age
T h e first line treatm ent is:
ceftriaxone I M or slow IV2 (ov er at least 3 m inutes): 5 0 m g / kg once d aily
or, if not av ailable:
ampicillin IV or I M : 2 0 0 m g / kg / d ay in 3 to 4 d iv id ed d oses + gentamicin I M : 7 .5 m g / k
once d aily
2 The solvent of ceftriaxone for IM injection contains lidocaine. Ceftriaxone reconstituted using this solvent must
never be administered by IV route. For IV administration, water for injection must always be used.
3 Improvement criteria include: fever reduction, diminished respiratory distress, improved O2 saturation, improved
appetite and/or activity.
68
