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2. Respiratory diseases
T h e treatm ent is ad m inistered by parenteral route for at least 3 d ays th en, if th e clinical
cond ition h as im prov4ed and oral treatm ent can be tolerated , sw itch to th e oral route w ith
amoxicillin P O : 1 0 0 m g / kg / d ay in 3 d iv id ed d oses, to com plete 1 0 d ays of treatm ent
I f th e ch ild 's cond ition d eteriorates or d oes not im prov e4 after 4 8 h ours of correct
ad m inistration, ad d cloxacillin I V : 1 0 0 m g / kg / d ay in 4 d iv id ed d oses. A fter clinical
2im prov em ent and 3 d ays w ith no fev er, sw itch to th e oral route
awmoitxhicillin/clavulanic acid (co-amoxiclav) P O to com plete 1 0 to 1 4 d ays of treatm ent:
fTorhmeudlaotsioenis ienxaprreastisoeodf i8n :a1moro7xi:c1ill)in: 1 0 0 m g / kg / d ay in 2 d iv id ed d oses ( if using
5
N ote: th e d ose of clav ulanic acid sh ould not exceed 1 2 .5 m g / kg / d ay or 3 7 5
m g / d ay.
If th e ch ild 's cond ition d oes not im prov e after 4 8 h ours w ith ceftriaxone + cloxacillin,
consid er tuberculosis. F or th e d iag nosis, refer to th e M SF h and book, Tuberculosis.
If tuberculosis is unlikely, continue w ith ceftriaxone + cloxacillin and ad d azith rom ycin
(see Atypical pneumonia, pag e 7 2 ).
Notes:
– F or m alnourish ed ch ild ren, refer to specific protocol.
– In th e ev ent of m od erate-larg e em pyem a, assess if d rainag e is required . A d m inister
antibiotics activ e ag ainst pneum ococci and staph ylococci (see pag e 7 3 ).
Adjuvant therapy
– F ev er: paracetam ol P O (see Fever, pag e 2 6 ).
– Infants: keep w arm .
– Install on an incline (h ead elev ated ) or in sem i-sitting position.
– C lear th e airw ay (nasal irrig ation w ith 0 .9 % 2 sod ium ch lorid e if need ed ).
– O xyg en at th e flow rate required to m aintain SpO ≥ 9 0 % or, if pulse oxym eter is not
av ailable, m inim um 1 litre/ m inute.
– M aintain ad equate h yd ration and nutrition:
• I n ch ild ren w ith sev ere respiratory d ifficulty: place an I V line and g iv e 7 0 % of
norm al m aintenance fluid s. R esum e oral feed ing as soon as possible (no sev ere
respiratory d ifficulty, ability to eat norm ally).
U se a nasog astric tube only if an I V line cannot be establish ed : ch ild ren und er
1 2 m onth s: 5 m l/ kg / h our; ch ild ren ov er 1 2 m onth s: 3 to 4 m l/ kg / h our;
alternate
m ilk and w ater. R esum e norm al oral feed ing as soon as possible.
• In th e absence of sev ere respiratory d ifficulty: breastfeed on d em and ; m ilk/ food
and w ater by spoon on d em and .
• O R S w h en required (see d eh yd ration, pag es 3 1 5 to 3 2 0 ).
Pneumonia with no signs of serious illness
Infant under 2 months of age
A d m it th e ch ild for inpatient care and treat for sev ere pneum onia (pag e 6 8 ).
Improvement criteria include: fever reduction, diminished respiratory distress, improved O2 saturation, improved
appetite and/or activity.
If the only formulations of co-amoxiclav available are those with a 4:1 ratio, the dose is: 50 mg/kg/day.
4
5
T h e treatm ent is ad m inistered by parenteral route for at least 3 d ays th en, if th e clinical
cond ition h as im prov4ed and oral treatm ent can be tolerated , sw itch to th e oral route w ith
amoxicillin P O : 1 0 0 m g / kg / d ay in 3 d iv id ed d oses, to com plete 1 0 d ays of treatm ent
I f th e ch ild 's cond ition d eteriorates or d oes not im prov e4 after 4 8 h ours of correct
ad m inistration, ad d cloxacillin I V : 1 0 0 m g / kg / d ay in 4 d iv id ed d oses. A fter clinical
2im prov em ent and 3 d ays w ith no fev er, sw itch to th e oral route
awmoitxhicillin/clavulanic acid (co-amoxiclav) P O to com plete 1 0 to 1 4 d ays of treatm ent:
fTorhmeudlaotsioenis ienxaprreastisoeodf i8n :a1moro7xi:c1ill)in: 1 0 0 m g / kg / d ay in 2 d iv id ed d oses ( if using
5
N ote: th e d ose of clav ulanic acid sh ould not exceed 1 2 .5 m g / kg / d ay or 3 7 5
m g / d ay.
If th e ch ild 's cond ition d oes not im prov e after 4 8 h ours w ith ceftriaxone + cloxacillin,
consid er tuberculosis. F or th e d iag nosis, refer to th e M SF h and book, Tuberculosis.
If tuberculosis is unlikely, continue w ith ceftriaxone + cloxacillin and ad d azith rom ycin
(see Atypical pneumonia, pag e 7 2 ).
Notes:
– F or m alnourish ed ch ild ren, refer to specific protocol.
– In th e ev ent of m od erate-larg e em pyem a, assess if d rainag e is required . A d m inister
antibiotics activ e ag ainst pneum ococci and staph ylococci (see pag e 7 3 ).
Adjuvant therapy
– F ev er: paracetam ol P O (see Fever, pag e 2 6 ).
– Infants: keep w arm .
– Install on an incline (h ead elev ated ) or in sem i-sitting position.
– C lear th e airw ay (nasal irrig ation w ith 0 .9 % 2 sod ium ch lorid e if need ed ).
– O xyg en at th e flow rate required to m aintain SpO ≥ 9 0 % or, if pulse oxym eter is not
av ailable, m inim um 1 litre/ m inute.
– M aintain ad equate h yd ration and nutrition:
• I n ch ild ren w ith sev ere respiratory d ifficulty: place an I V line and g iv e 7 0 % of
norm al m aintenance fluid s. R esum e oral feed ing as soon as possible (no sev ere
respiratory d ifficulty, ability to eat norm ally).
U se a nasog astric tube only if an I V line cannot be establish ed : ch ild ren und er
1 2 m onth s: 5 m l/ kg / h our; ch ild ren ov er 1 2 m onth s: 3 to 4 m l/ kg / h our;
alternate
m ilk and w ater. R esum e norm al oral feed ing as soon as possible.
• In th e absence of sev ere respiratory d ifficulty: breastfeed on d em and ; m ilk/ food
and w ater by spoon on d em and .
• O R S w h en required (see d eh yd ration, pag es 3 1 5 to 3 2 0 ).
Pneumonia with no signs of serious illness
Infant under 2 months of age
A d m it th e ch ild for inpatient care and treat for sev ere pneum onia (pag e 6 8 ).
Improvement criteria include: fever reduction, diminished respiratory distress, improved O2 saturation, improved
appetite and/or activity.
If the only formulations of co-amoxiclav available are those with a 4:1 ratio, the dose is: 50 mg/kg/day.
4
5
