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P. 77
2. Respiratory diseases
or
ceftriaxone IM or slow I V7 (ov er at least 3 m inutes)
C h ild ren: 5 0 m g / kg once d aily
A d ults: 1 g once d aily
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 e8d and oral treatm ent can be tolerated , sw itch to th e oral route 2
w ith am oxicillin P O as abov e, to com plete 7 to 1 0 d ays of treatm ent.
or
ampicillin IV or IM
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
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 e8d and oral treatm ent can be tolerated , sw itch to th e oral route
w ith am oxicillin P O as abov e, to com plete 7 to 1 0 d ays of treatm ent.
I f th e clinical cond ition d eteriorates or d oes not im prov e after 4 8 h ours of correct
ad m inistration, ad m inister ceftriaxone as abov e + cloxacillin IV :
C h ild ren: 1 0 0 m g / kg / d ay in 4 d iv id ed d oses
A d ults: 8 g / d ay in 4 d iv id ed d oses
A fter clinical im prov em ent and 3 d ays w ith no fev er, sw itch to th e oral route w ith
amoxicillin/clavulanic acid (co-amoxiclav) P O to com plete 1 0 to 1 4 d ays of treatm ent:
T h e d ose is expressed in am oxicillin:
C h ild ren: 1 0 0 m g / kg / d ay in 2 d iv id ed d oses ( if using form ulations in a ratio of 8 :1
or 7 :1 9)
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.
A d ults: 2 .5 to 3 g / d ay in 3 d iv id ed d oses. D epend ing on th e form ulation of co-
am oxiclav av ailable:
R atio 8 :1 : 3 0 0 0 m g / d ay = 2 tablets of 5 0 0 / 6 2 .5 m g 3 tim es per d ay
R atio 7 :1 : 2 6 2 5 m g / d ay = 1 tablet of 8 7 5 / 1 2 5 m g 3 tim es per d ay
N ote: th e d ose of clav ulanic acid sh ould not exceed 3 7 5 m g / d ay.
If th e clinical 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 ).
Adjuvant therapy
– F ev er: paracetam ol P O (see Fever, pag e 2 6 ).
– C lear th e airw ay (nasal irrig ation w ith 0 .9 % 2 sod ium ch lorid e if need ed ). eter is not
– O xyg en at th e flow rate required to m aintain SpO ≥ 9 0 % or, if pulse oxym
av ailable, m inim um 1 litre/ m inute.
– M aintain ad equate h yd ration and nutrition.
The solvent of ceftriaxone for IM injection contains lidocaine. Ceftriaxone reconstituted using this solvent must
7 never be administered by IV route. For IV administration, water for injection must always be used.
Improvement criteria include: fever reduction, diminished respiratory distress, improved O2 saturation, improved
8 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.
9
71
or
ceftriaxone IM or slow I V7 (ov er at least 3 m inutes)
C h ild ren: 5 0 m g / kg once d aily
A d ults: 1 g once d aily
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 e8d and oral treatm ent can be tolerated , sw itch to th e oral route 2
w ith am oxicillin P O as abov e, to com plete 7 to 1 0 d ays of treatm ent.
or
ampicillin IV or IM
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
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 e8d and oral treatm ent can be tolerated , sw itch to th e oral route
w ith am oxicillin P O as abov e, to com plete 7 to 1 0 d ays of treatm ent.
I f th e clinical cond ition d eteriorates or d oes not im prov e after 4 8 h ours of correct
ad m inistration, ad m inister ceftriaxone as abov e + cloxacillin IV :
C h ild ren: 1 0 0 m g / kg / d ay in 4 d iv id ed d oses
A d ults: 8 g / d ay in 4 d iv id ed d oses
A fter clinical im prov em ent and 3 d ays w ith no fev er, sw itch to th e oral route w ith
amoxicillin/clavulanic acid (co-amoxiclav) P O to com plete 1 0 to 1 4 d ays of treatm ent:
T h e d ose is expressed in am oxicillin:
C h ild ren: 1 0 0 m g / kg / d ay in 2 d iv id ed d oses ( if using form ulations in a ratio of 8 :1
or 7 :1 9)
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.
A d ults: 2 .5 to 3 g / d ay in 3 d iv id ed d oses. D epend ing on th e form ulation of co-
am oxiclav av ailable:
R atio 8 :1 : 3 0 0 0 m g / d ay = 2 tablets of 5 0 0 / 6 2 .5 m g 3 tim es per d ay
R atio 7 :1 : 2 6 2 5 m g / d ay = 1 tablet of 8 7 5 / 1 2 5 m g 3 tim es per d ay
N ote: th e d ose of clav ulanic acid sh ould not exceed 3 7 5 m g / d ay.
If th e clinical 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 ).
Adjuvant therapy
– F ev er: paracetam ol P O (see Fever, pag e 2 6 ).
– C lear th e airw ay (nasal irrig ation w ith 0 .9 % 2 sod ium ch lorid e if need ed ). eter is not
– O xyg en at th e flow rate required to m aintain SpO ≥ 9 0 % or, if pulse oxym
av ailable, m inim um 1 litre/ m inute.
– M aintain ad equate h yd ration and nutrition.
The solvent of ceftriaxone for IM injection contains lidocaine. Ceftriaxone reconstituted using this solvent must
7 never be administered by IV route. For IV administration, water for injection must always be used.
Improvement criteria include: fever reduction, diminished respiratory distress, improved O2 saturation, improved
8 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.
9
71
