5. • PNEUMONIA IS THE DEADLIIEST CHILDHOOD
DISEASE
• CAUSE DEATH OF CHILDREN UNDER 5 THAN
ANY OTHER INFECTIOUS DISEASE
• 1 IN 6 CHILDHOOD DEATH WERE DUE TO
PNEUMOINA IN 2015
• IT IS THE NUMBER ONE KILLER AMONG
LEADING INFECTIOUS DISEASE
6.
7. Launched in 1990
Thereafter integrated with :
National Child Survival And Safe Motherhood
Programme (CSSM)
Reproductive And Child Health Programme (RCH-II)
Integrated Management Of Neonatal And Childhood
Illnesses (IMNCI)
ARI control programme in India
8. • ETIOLOGICAL AGENT IS BACTERIAL IN 50 -60
% CHILDREN
• H.INFLUENZAE,S.PNEUMOINAE AND
STAPHLOCOCCI
9. Streptococcus pneumoniae – m.c cause of
bacterial pneumonia
Haemophilus influenza type B – 2nd m.c cause
Measles and Pertussis – imp. causes in less
developed countries
RSV – m.c. viral cause
HIV- Pneumocystis jiroveci (¼ th of all pneumonia
deaths in HIV infants)
10. • Management of child with cough or difficult
breathing
• 1. Assessing the child by asking
• 2. Classifying the illness of the child
• 3. Decision for treatment
• 4. Follow up of cases
11. ASSESS
• ASK:
- HOW OLD IS THE CHILD?
– IS THE CHILD COUGHING OR HAVING
DIFFICULT BREATHING?
– FOR HOW LONG?
12. AGE OF CHILD HISTORY FOR DANGER SIGNS
AGE 2 MONTHS TO 5 YEARS IS THE CHILD ABLE TO DRINK?
AGE LESS THAN 2 MONTHS HAS THE CHILD STOPPED FEEDING WELL?
FOR HOW LONG?
HAS THE CHILD HAD CONVULSIONS?
HAS THE CHILD HAD FEVER?
13. LOOK, LISTEN, FEEL
for Danger signs –
Chest indrawing
Stridor
Wheeze (? recurrent)
(danger sign in young infant)
Abnormally sleepy/difficult to wake?
Fever/low body temperature? - Danger sign in young
infant
Severe malnutrition?
Any Cyanosis / grunting / nasal flaring?
Inspiration
Expiration
14.
15. • CLINICAL CRITERIA FOR DIAGNOSIS OF
PNEUMONIA INCLUDE RAPID RESPIRATION
WITH OR WITHOUT DIFFICULTY IN
RESPIRATION
16. • RAPID RESPIRATION MEANS – count in one
minute
RR >60/MIN - <2MONTH
RR>50/MIN -2MONTH TO 1YR
RR>40/MIN -1 TO 5 YR
• DIFFICULTY IN RESPIRATION IS DEFINED AS
LOWER CHEST INDRAWING
17. CHILDREN BELOW 2MONTHOF AGE
PRESENCE OF ANY OF THE
FOLLOWING INDICATE SEVERE DISEASE
• FEVER (38 OR MORE)
• CONVULSIONS
• ABNORMALLY SLEEPY OR DIFFICULT TO WAKE
• STRIDOR IN CALM CHILD
• WHEEZING
• NOT FEEDING
• TACHYPNEA
• CHEST INDRAWING
• ALTERD SENSORIUM
• CENTAL CYANOSIS
• GRUNTING
• APNEIC SPELL
• DISTENDED ABDOMEN
18. DANGER SIGNS IN > 2MONTHS
• NOT ABLE TO DRINK
• CONVULSIONS
• ABNORMALLY SLEEPY OR DIFFICULT TO WAKE
• SRIDOR IN CALM CHILD
• SEVERE MALNUTRITION
19. CLASSIFICATION
• The pneumonia classification and
management guidelines had been developed
based on evidence generated in 1970s and
early 1980s
• But now with the emergence of new
evidences, new recommendations had been
made which lead to the revision of guidelines
21. CLASSIFICATION IN INFANTS <2
MONTH
• NO PNEUMONIA – COUGH AND COLD
• SEVERE PNEUMONIA – CHEST INDRAWING OR
FAST BREATHING
• VERY SEVERE PNEUMONIA – DANGER SIGNS
24. NO PNEUMONIA-Cough and cold -
<2month
• Advise mother:
•Keep young infant warm
•Breastfeed frequently
•Clear nose if it interferes with feeding
•Return quickly if:
•Breathing becomes difficult; or fast
•Feeding becomes a problem
•Young infant becomes sicker
27. TREATMENT IN 2MONTHS TO 5YR
Fast breathing pneumonia, no chest indrawing or general
danger signs
Oral Amoxicillin (80mg/kg/day BD) 5days or 3 days if child
is in low HIV prevalent area.(dispersible amox suitable)
Who fail on first line treatment
Referral to centre with facilities for second line
management
28. Its safe to treat chest indrawing pneumonia at
home with oral amoxicillin.
AT HOSPITAL LEVEL- children with chest
indrawing in low HIV prevalent area can be
treated at OP level, no need of refferal.
AT COMMUNITY LEVEL- children with chest
indrawing pneumonia should be reffered to
higher level.
29. Streptococcal pneumoniae and H.influenza –
serum level should be 40% more than MIC in
order to achieve a bacteriological cure of 85-
100%.
Increases the bactericidal activity.
Penicillin intermediate resistance- AMOXICILLIN
& CEFUROXIME
Penicillin resistant- AMOXICILLIN
WHY HIGH DOSE AMOXICILLIN ?
30. SEVERE PNEUMONIA should be treated with
parenteral ampicillin(or penicillin) and
gentamicin as first line treatment
32. Ampicillin 50 mg/kg or Benzyl penicillin 50000
unit/kg, IM/IV every 6 hr for atleast 5 days
AND
Gentamicin 7.5mg/kg IM/IV once a day for
atleast 5 days
Ceftriaxone should be used as a second line
treatment in children with severe pneumonia
having failed on 1st line
33. HIV
Infected and exposed children –Any of 1ST or
2nd line management.
PCP –Empirical cotrimoxaole for children of
2months to 1 year.
NOT recommended for children above 1 year
of age.
34. • For HIV infected and exposed infants and
children with chest indrawing or severe
pneumonia,who do not respond to treatment
with ampicillin or penicillin plus gentamicin,
ceftriaxone alone is recommended as
treatment
35. Managing pneumonia at community
level
• Recommended is oral daily amoxicillin 2 doses
36.
37. Community management of chest
indrawing pnemonia
• Community health workers when properly
trained and supported can effectively and
safely treat chest indrawing pneumonia at
home with oral amoxicillin
• Otherwise referral to higher centre
• Severe pneumonia require injectable
antibiotics and oxygen at the facility
38.
39. Summary
• All children with fast breathing and/or chest
indrawing are classified as “pneumonia” and
treated with oral amoxicillin 80 mg/kg/day for
5 days. In areas with low HIV prevalence
duration of treatment of fast breathing
pneumonia can be reduced to 3 days
40. • Its safe to treat chest indrawing pneumonia at
home with oral amoxicillin.
• AT HOSPITAL LEVEL- children with chest
indrawing in low HIV prevalent area can be
treated at OP level, no need of referral.
41. • Only those children who have either general
danger signs or who are HIV positive and have
chest indrawing need to be referred to to
higher facility of IP treatment with injectable
antibiotics
• Dispersible amoxicillin is the preferred form
42. BENEFITS OF CHANGE
• Oral amoxicillin is the most effective
treatment for both fast breathing and chest
indrawing pneumonia
• Increased access of antibiotic treatment closer
to home
• Decreased need for referrals
43. • Simplified pneumonia classification and
management
• Simplified training of health workers
• Cost benefits at individual,household,
community and health facility level
44. • Decreased probability of hospitalization and
thus the risk of hospital acquired and injection
borne diseases
• Reduced probability of increasing
antimicrobial resistance
46. • Improved basic living conditions
• Better nutrition,adequate vitamin A
supplementation
• Reduction of indoor pollution
• Better maternal and child health care
• Vaccines – Hib,, PCV13, PPV23, DPT, Measles
• Hand washing, clean water and good
saniatation
47.
48.
49. India launches PCV
• May 13TH 2013 – A major public health
milestone for India and the World
• Himachal Pradesh , Up , Bihar in the first year
• 2.1 million children in these 3 states in the
first year
• to scale up to the entire country ultimately
50.
51. IMPACT
• Significant reduction in morbidity and
mortality due to pneumonia, meningitis,
otitis media, sepsis
• Herd immunity
• Helps tackle antibiotic reisitance
52.
53.
54.
55. • By end of 2025:
• 90% coverage of relevant vaccine ( PCV,
Rotavac)
• 90% access to appropriate health care
• At least 50% coverage of breast feeding during
first 6 months of life
• Virtual elimination of pediatric HIV
