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te pneumonia
Children from 2 months to 5 years of age (outpatients, except young infants)
amoxicillin P O : 1 0 0 m g / kg / d ay in 3 d iv id ed d oses for 5 d ays
F ollow -up in 4 8 to 7 2 h ours or sooner if th e ch ild ‟s cond ition d eteriorates:
– if th e cond ition is im prov in6g : continue w ith th e sam e antibiotic to com plete treatm ent.
– if th ere is no im prov em ent after 3 d ays of correct ad m inistration: ad d azith rom ycin
(see Atypical pneumonia, pag e 7 2 ).
– if th e cond ition is d eteriorating : h ospitalise and treat as sev ere pneum onia.
Pneumonia in children over 5 years and adults
T h e m ost com m on causes are v iruses, pneum ococcus, and Mycoplasma pneumoniae.
Clinical features
– C oug h , w ith or w ith out purulent sputum , fev er, th oracic pain, tach ypnoea
– O n pulm onary auscultation: d ecreased v esicular breath sound s, d ullness, localised
foci of crepitations, som etim es bronch ial w h eeze.
Sud d en onset w ith h ig h fev er (h ig h er th an 3 9 °C ) , th oracic pain and oral h erpes are
sug g estiv e of pneum ococcal infection. Sym ptom s m ay be confusing , particularly in
ch ild ren w ith abd om inal pain, m ening eal synd rom e, etc.
Sig ns of serious illness (sev ere pneum onia) includ e:
– cyanosis (lips, oral m ucosa, fing ernails)
– nasal flaring
– intercostal or subclav ial ind raw ing
– R R > 3 0 breath s/ m inute
– h eart rate > 1 2 5 beats/ m inute
– altered lev el of consciousness (d row siness, confusion)
P atients at risk includ e th e eld erly, patients suffering from h eart failure, sickle cell
d isease or sev ere ch ronic b ronch itis; im m unocom prom ised patients ( sev ere
m alnutrition, H IV infection w ith C D 4 < 2 0 0 ).
Treatment
Severe pneumonia (inpatient treatm ent)
benzylpenicillin procaine IM
C h ild ren: 5 0 0 0 0 IU / kg once d aily
A d ults: 1 .5 M I U once d aily
B enzylpenicillin procain m ust N E V E R be ad m inistered by I V route.
T h e treatm ent is g iv en by parenteral route for at least 3 d ays th en, if th e clinical
cond ition h as im prov e6d and oral treatm ent can be tolerated , sw itch to th e oral route
w ith amoxicillin P O to com plete 7 to 1 0 d ays of treatm ent:
C h ild ren: 1 0 0 m g / kg / d ay in 3 d iv id ed d oses
A d ults: 3 g / d ay in 3 d iv id ed d oses
6 Improvement criteria include: fever reduction, diminished respiratory distress, improved O2 saturation, improved
appetite and/or activity.
70
Children from 2 months to 5 years of age (outpatients, except young infants)
amoxicillin P O : 1 0 0 m g / kg / d ay in 3 d iv id ed d oses for 5 d ays
F ollow -up in 4 8 to 7 2 h ours or sooner if th e ch ild ‟s cond ition d eteriorates:
– if th e cond ition is im prov in6g : continue w ith th e sam e antibiotic to com plete treatm ent.
– if th ere is no im prov em ent after 3 d ays of correct ad m inistration: ad d azith rom ycin
(see Atypical pneumonia, pag e 7 2 ).
– if th e cond ition is d eteriorating : h ospitalise and treat as sev ere pneum onia.
Pneumonia in children over 5 years and adults
T h e m ost com m on causes are v iruses, pneum ococcus, and Mycoplasma pneumoniae.
Clinical features
– C oug h , w ith or w ith out purulent sputum , fev er, th oracic pain, tach ypnoea
– O n pulm onary auscultation: d ecreased v esicular breath sound s, d ullness, localised
foci of crepitations, som etim es bronch ial w h eeze.
Sud d en onset w ith h ig h fev er (h ig h er th an 3 9 °C ) , th oracic pain and oral h erpes are
sug g estiv e of pneum ococcal infection. Sym ptom s m ay be confusing , particularly in
ch ild ren w ith abd om inal pain, m ening eal synd rom e, etc.
Sig ns of serious illness (sev ere pneum onia) includ e:
– cyanosis (lips, oral m ucosa, fing ernails)
– nasal flaring
– intercostal or subclav ial ind raw ing
– R R > 3 0 breath s/ m inute
– h eart rate > 1 2 5 beats/ m inute
– altered lev el of consciousness (d row siness, confusion)
P atients at risk includ e th e eld erly, patients suffering from h eart failure, sickle cell
d isease or sev ere ch ronic b ronch itis; im m unocom prom ised patients ( sev ere
m alnutrition, H IV infection w ith C D 4 < 2 0 0 ).
Treatment
Severe pneumonia (inpatient treatm ent)
benzylpenicillin procaine IM
C h ild ren: 5 0 0 0 0 IU / kg once d aily
A d ults: 1 .5 M I U once d aily
B enzylpenicillin procain m ust N E V E R be ad m inistered by I V route.
T h e treatm ent is g iv en by parenteral route for at least 3 d ays th en, if th e clinical
cond ition h as im prov e6d and oral treatm ent can be tolerated , sw itch to th e oral route
w ith amoxicillin P O to com plete 7 to 1 0 d ays of treatm ent:
C h ild ren: 1 0 0 m g / kg / d ay in 3 d iv id ed d oses
A d ults: 3 g / d ay in 3 d iv id ed d oses
6 Improvement criteria include: fever reduction, diminished respiratory distress, improved O2 saturation, improved
appetite and/or activity.
70
