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Severe pneumonia in childhood. Robert Gie Department Paediatrics and Child Health Stellenbosch University

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  • Severe pneumonia in childhood. Robert Gie Department Paediatrics and Child Health Stellenbosch University.
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  • 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
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  • 2 month old ex-premature Presented with cough and progessive respiratory distress Required ventilatory support Due to hypercarbia Culture proven PTB. Source case CXR:
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  • 10 year old child Previous well Develops the symptoms of an influenza like disease Rapid progression of respiratory failure H1N1 proven
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  • Predominant cause of pneumonia by age and HIV status HIV-uninfected childrenAdditional organisms HIV-infected 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. 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
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  • Table 3 WHO standard antibiotic regimens for low and high HIV prevalent settings Child 2- 59 months Low HIV prevalence setting 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 3031, 2003. Geneva: World Health Organisation/Boston University, 2004.)
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  • Further adaptation: Consider PJP CMV co-infection in infants Less than 6 months Add Gancyclovir for 21 days
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  • Surgical enucleation of obstructing glands. Indication: hypercapnea and not able to wean
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  • Zinc supplementation 10mg/day Micronutrients
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  • Predicting for failure
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  • Child lung Health Project: Malawi In 5 years 48702 in hospital children treated for pneumonia Age 52%2-11 months 37%12-59 months Severity of disease 62.8% severe pneumonia 25.2%very severe pneumonia Mortality Decreased from 18.6% to 8.4% P Enarson

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