Pneumonia in Children
Respiratory Infections
J18.0-2/J18-9
DESCRIPTION
- Pneumonia should be distinguished from viral upper respiratory infections. With viral URTIs’ the respiratory rate will be normal. A raised respiratory rate indicates an alternate diagnosis such as bronchiolitis or pneumonia
Assess the child for the severity of the pneumonia
Classify children according to the severity of the illness:
- Pneumonia: fever, cough and rapid breathing, but no chest indrawing (of the lower chest wall) and no flaring of nostrils
- Severe pneumonia: fever, cough, rapid breathing, chest indrawing and flaring nostrils, or grunting
Note:
Children <2 months of age with rapid breathing should be classified as having severe pneumonia
Rapid breathing is defined according to age:
|
Age
|
Respiratory rate
|
|
Birth–2 months
|
≥60 breaths/minute
|
|
2-12 months
|
≥50 breaths/minute
|
|
1–5 years
|
≥40 breaths/minute
|
Danger signs indicating urgent and immediate referral include:
- Oxygen saturation of <90% in room air
- Inability to drink
- Impaired consciousness
- Cyanosis
- <2 months of age
- Grunting
GENERAL MEASURES
- Ensure adequate hydration
- Continue feeding
MEDICINE TREATMENT
Pneumonia (non-severe):
- Amoxicillin, oral, 45 mg/kg/dose, 12 hourly for 5 days
LoE:IVb34
|
Weight
(kg)
|
Dose
mg
|
Use one of the following
|
Age
(Months/years) |
||||
|
Syrup (mg/5 mL)
|
Capsule (mg)
|
||||||
|
125
|
250
|
250
|
500
|
||||
|
>3.5-5 kg
|
175 mg
|
7 mL
|
3.5 mL
|
-
|
-
|
>1–3 months
|
|
|
>5–7 kg
|
250 mg
|
10 mL
|
5 mL
|
-
|
-
|
>3–6 months
|
|
|
>7–11 kg
|
375 mg
|
15 mL
|
7.5 mL
|
-
|
-
|
>6–18 months
|
|
|
>11–14 kg
|
500 mg
|
-
|
10 mL
|
2
|
1
|
>18 months–3 years
|
|
|
>14-17.5 kg
|
750 mg
|
-
|
15 mL
|
3
|
-
|
>3–5 years
|
|
|
>17.5–25 kg
|
1000 mg
|
-
|
20 mL*
|
4
|
2
|
>5–7 years
|
|
| >25–30 kg |
1250 mg
|
- |
25 mL*
|
5
|
- |
>7-10 years |
|
|
>30 kg
|
1500 mg
|
-
|
-
|
6
|
3
|
>10 years
|
|
*capsule/tablet preferred
Severe penicillin allergy:
Z88.0
Children:
- Macrolide, e.g:
- Azithromycin, oral, 10 mg/kg/dose daily for 3 days. See: dosing table
Severe pneumonia:
- Oxygen, using nasal cannula at 1–2 L/minute before and during transfer
- Ceftriaxone, IM, 80 mg/kg/dose immediately as a single dose. See: dosing table
- Do not inject more than 1 g at one injection site
|
CAUTION: USE OF CEFTRIAXONE IN NEONATES AND CHILDREN - If SUSPECTING SERIOUS BACTERIAL INFECTION in neonate, give ceftriaxone, even if jaundiced |
REFERRAL
Urgent
- All children with severe pneumonia, i.e. chest indrawing (of the lower chest wall), flaring nostrils or cyanosis
- All children <2 months of age
Non urgent
- Inadequate response to treatment
- Children coughing for >3 weeks to exclude other causes such as TB, foreign body aspiration or pertussis
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-4-Version 1.0_16 September 2024
Chapter 17: Respiratory Conditions_17.3. Respiratory infections_17.3.4. Pneumonia_17.3.4.1. Pneumonia in Children