Transcript Severe pneumonia

Severe pneumonia in
childhood.
Robert Gie
Department Paediatrics and Child
Health
Stellenbosch University.
3 month old infant
Doing well after birth
Onset of cough and fast
breathing
Severely hypoxic with rapid
progression of disease
Started on PJP treatment
HIV infected
Proven PJ pneumonia
Initially improves then
deteriorates
Proven CMV co-infection
2 month old ex-premature
Presented with cough and
progessive respiratory distress
Required ventilatory support
Due to hypercarbia
Culture proven PTB.
Source case CXR:
10 year old child
Previous well
Develops the symptoms
of an influenza like disease
Rapid progression of
respiratory failure
H1N1 proven
Predominant cause of pneumonia by age and HIV status
HIV-uninfected children
For children 2-12 months:
S. pneumoniae
H. influenzae
S. aureus
Gram-negative bacteria
Viruses
For children 12 – 59 months:
S. pneumoniae
H. influenzae
S. aureus
Viruses.
Additional organisms
HIV-infected children
For children 2-12 months
Pneumocystis jiroveci
Cytomegalovirus
M Tuberculosis
Co-infections
For children 12-59 months
M Tuberculosis
Gram-negative bacteria
Co-infections
P Enarson 2010
Table 3 WHO standard antibiotic regimens for low and high HIV prevalent settings
Child 259
months
Low HIV
setting
prevalence High HIV prevalence
setting
HIV infected or HIV
suspected
Very
severe
pneumo
nia
Ampicillin 50 mg/kg IM 6
hourly plus gentamicin 7.5
mg/kg IM once daily OR
if ampicillin unavailable
replace with benzylpenicillin
50 000units/kg
The total course of
treatment is 10 days
Ampicillin (OR
PENICILLIN) 50 mg/kg IM 6
hourly plus gentamicin 7.5
mg/kg IM once daily (10
days)
AND
High-dose cotrimoxazole
(8 mg/kg trimethoprine/40
mg/kg sulfamethoxazole IV
8 hourly or orally 3 times a
day for 3 weeks
Severe
pneumo
nia
Benzylpenicillin 50 000
units/kg 6 hourly for at least
3 days when improved
switch to oral amoxicillin
25mg/kg twice daily
The total course of
treatment is 5 days
Ampicillin 50 mg/kg IM 6
hourly plus gentamicin 7.5
mg/kg IM once daily (10
days)
AND
High-dose cotrimoxazole
(8 mg/kg trimethoprine/40
mg/kg sulfamethoxazole) IV
8 hourly or orally 3 times a
day for 3 weeks
[1] World Health Organisation. Management of Children with Pneumonia and HIV in low-resource settings.
Report of a consultative meeting. Harare, Zimbabwe,Jan 30–31, 2003.
Geneva: World Health Organisation/Boston University, 2004.)
Further adaptation:
Consider PJP CMV
co-infection in infants
Less than 6 months
Add Gancyclovir for
21 days
Surgical enucleation
of obstructing glands.
Indication: hypercapnea
and not able to wean
Micronutrients
Zinc supplementation
10mg/day
Predicting for failure
Child lung Health Project:
Malawi
• In 5 years 48702 in hospital children treated for
pneumonia
• Age
– 52%
– 37%
2-11 months
12-59 months
• Severity of disease
– 62.8%
– 25.2%
severe pneumonia
very severe pneumonia
• Mortality
– Decreased from 18.6% to 8.4%
P Enarson