6. 1980: World Health Organization
(WHO) develop a pneumonia control
strategy.
7. What’s Unique in this Strategy
Simple signs are used to classify severities
of pneumonia followed by appropriate case
management.
8. Children with fast
breathing Pneumonia
Oral Antibiotics
for 5 days @
home
Children with chest
indrawing ± fast
breathing
Severe
Pneumonia
Injectable
Antibiotics @
nearest health
centre
Children with any
danger sign
Very Severe
Disease
Refer to higher
centre
9. Integrated Management of Childhood Illness
(IMCI) by WHO.
Integrated Management of Neonatal and Childhood
Illness (IMNCI) by India.
(after modifying WHO version)
11. The revisions include
1. Changing the recommendation for the first-line
antibiotic
2. Re-defining the classification of pneumonia severity
12. New classification
1. Pneumonia with fast breathing and/or chest
indrawing, which requires home therapy with oral
amoxicillin.
2. Severe pneumonia, pneumonia with any general
danger sign, which requires referral and
injectable therapy.
13. Recommendation_1
• Children with fast breathing pneumonia with no chest
indrawing or general danger sign should be treated
with oral amoxicillin for 3 days.
15. Recommendation_2
• Children aged 2–59 months with severe pneumonia
should be treated with parenteral ampicillin (or
penicillin) and gentamicin as a first-line treatment.
16. Recommendation_3
• Children aged 2–59 months with severe pneumonia
should be treated with parenteral ampicillin (or
penicillin) and gentamicin as a first-line treatment.
Ceftriaxone should be used as a second-line
treatment in children with severe pneumonia
having failed on the first-line treatment.
17. General danger signs of seriously ill young infant
Seriously ill
Difficulty in feeding
Reduced movements
Fever / low body temperature
18. Sign of severe illness
Not feeding
well
Severe Chest
indrawing
Convulsions Fast breathing
Fever/low
body
temperature
Less/no
movements
19. Chest indrawing : Yes / No
Source: https://www.who.int/maternal_child_adolescent/child/imci/training-video/en/
20. Chest indrawing : Yes / No
Source: https://www.who.int/maternal_child_adolescent/child/imci/training-video/en/
21. Chest indrawing : Yes / No
Source: https://www.who.int/maternal_child_adolescent/child/imci/training-video/en/
Hinweis der Redaktion
suitable for countries with limited resources and constrained health systems
These pneumonia classification and management guidelines had been developed based on evidence generated in the 1970s and early 1980s, and were incorporated into the original version of Integrated Management of Childhood Illness (IMCI). In the intervening time, new evidence has emerged which prompted the development of revised guidelines
Programmes should recognize the importance of these revisions, which will result in a substantially lower need for referral, and in better treatment outcomes. Local adaptations may be required, particularly the arrangements to include amoxicillin as the first-line therapy; facility-level
The revisions include changing the recommendation for the first-line antibiotic and re-defining the classification of pneumonia severity. The data show that oral amoxicillin is preferable to oral cotrimoxazole for the treatment of “fast breathing pneumonia” and is equivalent to injectable penicillin/ampicillin in cases of “chest indrawing pneumonia”. Hence, in a programmatic context, the distinction between previously defined “pneumonia” (fast breathing) and “severe pneumonia”
Ceftriaxone should be used as a second-line treatment in children with severe pneumonia having failed on the first-line treatment.