This document discusses acute respiratory infections (ARIs) which cause 20% of childhood deaths under 5 years old, with pneumonia responsible for 90% of ARI deaths. ARI mortality is highest in children who are HIV-infected, under 2 years old, malnourished, weaned early, from poorly educated families, or with difficult healthcare access. ARIs are classified as upper or lower respiratory tract infections. Treatment depends on classification and severity, ranging from symptomatic treatment at home to hospitalization and intravenous antibiotics. Prevention involves reducing risk factors through vaccination, nutrition, and treating infections early according to IMNCI guidelines.
2. Epidemiology
โข ARI RESPONSIBLE FOR 20% OF CHILDHOOD (<
5 YEARS) DEATHS (IN WHICH 90% FROM
PNEUMONIA)
โข ARI MORTALITY HIGHEST IN CHILDREN-
โข HIV-infected
โข Under 2 year of age
โข Malnourished
โข Weaned early
โข Poorly educated parents
โข Difficult access to healthcare
โข OUT- PATIENT VISITS
โข 20-60%
โข ADMISSIONS
โข 12-45%
3. ACUTE RESPIRATORY
INFECTIONS(ARI)
โข May cause the inflammation of respiratory tract
anywhere from nose to alveoli.
โข May be classified as โ
AURI โ Acute Upper Respiratory Infection
(common cold, pharyngitis, epiglottitis & otitis media etc.)
or
ALRI โ Acute Lower Respiratory Infection
(laryngitis, layngotracheitis, bronchitis, bronchiolitis &
pneumonia)
8. VIRUSES AGE GROUP
AFFECTED
CHRACTERISTIC
CLINICAL FEATURES
Enterovirus All ages Febrile pharyngitis
Influenza A, B, C All ages variable
Measles Young children variable
Parainfluenza 1, 2, 3 Young children variable
Respiratory Syncytial
Virus
Infants and young
children
Severe bronchiolitis
and pneumonia
Rhinovirus All ages Common cold
Coronavirus All ages Common cold
AGENT FACTORS
9. AGENT FACTORS
BACTERIA
AGE GROUP
AFFECTED
CHRACTERISTIC CLINICAL
FEATURES
Bordetella pertussis
Infants & young
children
Poroxysmal cough
Corynebacterium
diphtheriae
Children diphtheria
Hemophilus influenzae
Adults
Children
Acute ex of ch bronchitis
Acute epiglottitis
Klebsiella pneumoniae Adults Lobar pneumonia
Legionella pneumophila Adults Pneumonia
Staph. pyogenes All ages Lobar and bronchopneumonia
Strep. pneumoniae All ages Pneumonia
Strep. Pyogenes All ages Acute pharyngitis and tonsillitis
10. Factors Affecting Type of
Illness and Physical
Response in Acute
Respiratory Infections:
11. Agent Factor
โข Nature of infectious agent:
โ Bacteria > viruses
โข Size and frequency of dose:
โ The larger the dose
โ More frequent the exposure
Host Factor
โข Age of child:
โ Children of preschool and school age
โ Airways are smaller in young children
โ considerable narrowing from edema
โข Nutritional status of children
โข Immunization status
โข Birth weight of children
12. โข Presence of great conditions:
โ Malnutrition, anemia, fatigue, chilling of the body
and immune deficiencies
โข Presence of disorders affecting respiratory tract:
โ Allergies, cardiac abnormalities and cystic fibrosis
Environmental factors
โข Air pollution: Indoor
โข Smoking: Passive
โข Seasons:
โ During winter and spring months
โข Living conditions
13. โข Primodial prevention (Adoption of healthy life style)
โข Primary prevention (Reduction of risk factors)
โ Health promotion
โ Specific protection
โข Secondary prevention (Early diagnosis & Treatment)
โ IMNCI approach
โ F โ IMNCI integration
โข Tertiary prevention
โ Disease limitation
โ Rehabilitation
ยป Medical
ยป Psychological
ยป Social
ยป Vocational
Prevention of Hypertension
๏ Quaternary
prevention
๏ผ Prevention of
over diagnosis
๏ผ Prevention of
resistance
14. Primodial Prevention
โข Healthy life style
โ Good antenatal care
โ Early initiation of breast feeding
โ Exclusive Breast feeding
โ Proper complementary feeding
โ Proper nutrition
โข Achieve through health promotion & health
education
15. Primary prevention
โข Health promotion
โข Adequate nutrition
โข Parenthood counselling
โข Reduction of passive smoking
โข Reduction of indoor pollution
โข Improved living condition
โข Specific protection
โข Vaccination
โข Chemoprophylaxis
20. โข Chest in drawing
โข Stridor
โข Fever
โข Danger signs
โ Inability to drink or breast feed
โ Convulsions
โ Lethargy or unconsciousness
โ Stridor in calm child
23. Classify
โข In children < 2 months
โ Serious bacterial infection
โข Any danger sign
โข Chest in drawing
โข Tachypnea
โ Bacterial infection (URTI)
โข Fever with sneezing / cough
24. โข In children > 2 months
โ Very Severe pneumonia
โข Any danger sign
โ Severe pneumonia
โข Chest in drawing
โข Stridor
โข Cyanosis
โข Nasal flaring
โ Pneumonia
โข Tachypnea
โ No Pneumonia
25. WHO Classification and management
NO PNEUMONIA COUGH
NO TACHYPNEA
-HOME CARE
-SOOTHE THE THROAT AND RELIEVE
COUGH
-ADVISE MOTHER WHEN TO RETURN
-FOLLOWUP IN 5 DAYS IF NOT
IMPROVING
PNEUMONIA -COUGH
-TACHYPNEA
-NO RIB OR STERNAL
RETRACTION
-ABLE TO DRINK
- NO CYANOSIS
-HOME CARE
-ANTIBIOTICS FOR 5 DAYS
-SOOTHE THE THROAT AND RELIEVE
COUGH
-ADVISE MOTHER WHEN TO RETURN
-FOLLOWUP IN 2 DAYS
SEVERE PNEUMONIA -COUGH
-TACHYPNEA
-RIB AND STERNAL
RETRACTION
-ABLE TO DRINK
-NO CYANOSIS
-ADMIT IN HOSPITAL
-GIVE RECOMMENDED ANTIBIOTICS
-MANAGE AIRWAY
-TREAT FEVER IF PRESENT
VERY SEVERE
PNEUMONIA
-COUGH
-TACHYPNOEA
-CHEST WALL RETRACTION
-UNABLE TO DRINK
-CENTRAL CYANOSIS
-ADMIT IN HOSPITAL
-GIVE RECOMMENDED ANTIBIOTICS
-OXYGEN
-MANAGE AIRWAY
-TREAT FEVER IF PRESENT
26. Treatment
โข Place of treatment
โข No pneumonia
โข pneumonia
Domiciliary treatment
โข Severe pneumonia
โข Very severe pneumonia
Hospital treatment
โข Serious bacterial infection Hospital treatment
โข Acute URTI Domiciliary treatment
27. โข Type of Treatment
โข No pneumonia Symptomatic treatment
โข Pneumonia Oral Antibiotics + Symptomatic treatment
โข Severe pneumonia Injectable Antibiotics + Symptomatic
treatment
โข Very severe
pneumonia
Injectable Antibiotics + Symptomatic
treatment
โข Serious bacterial
infection
Injectable Antibiotics + Symptomatic
treatment
โข Acute URTI Symptomatic treatment
28. โข Drugs used
Symptomatic treatment
๏Fever โ Paracetamol
๏Cough and sneezing โ H-1 antagonist (not preferred
in children < 6 months)
๏Nasal obstruction
๏Nasal saline drops
๏Nasal decongestants (not preferred in children
< 6 months
Antibiotics
๏Oral antibiotics - Cotrimoxazole
๏Injectable antibiotics
๏Benzyl penicillin
๏Ampicillin
๏Chloramphenicol( preferred drug in Very
sever disease
๏Gentamycin
29. โข Dosage of drugs
โข Symptomatic treatment
โ CPM(0.1 mg/kg wt/dose)
โ Paracetamol (15mg/kg/dose)
โข Oral antibiotics
Oral Antibiotics (Cotrimoxazole)
Age / Weight Paediatric tablet:
Sulphamethoxazole
100 mg &
Trimethoprim 20 mg
Paediatric syrup; each spoon
(5ml): Sulphamethoxazole 200 mg
and Trimethoprim 40 mg
<2 months (Wt. 3-5
kg)
1 tablet BD Half spoon (2.5 ml) twice a day
2-12 months (wt 6-9
kg)
2 tablets BD One spoon (5 ml) twice a day
1-5 years (wt 10-19 kg) 3 tablets BD One & half spoon (7.5 ml) twice
a day
Reassess the child after 48 hrs
If improved = continued antibiotics for 3 days
No improvement = continued for another 48 hr (only one cycle)
Deterioration = refer to hospital for injectable antibiotics
30. โข Injectable antibiotics
Injectable Antibiotics (2 Months - 5 Years)
Dose Interval Mode
First 48 hours โ
Benzyl penicillin Or
Ampicillin Or
Chloramphenicol
50000lU
per kg/dose
50 mg/kg/dose
25 mg/kg/dose
6 hourly
6 hourly
6 hourly
IM
IM
IM
1. If condition IMPROVES, then for the next 3 days give:
Procaine penicillin Or
Ampicillin or
Chloramphenicol
50000 IU/kg (maximum 4 lac IU)
50 mg/kg/dose
25 mg/kg/dose
Once
6 hourly
6 hourly
IM
Oral
Oral
2. If NO IMPROVEMENT, then for the next 48 hour: CHANGE
ANTIBIOTIC โ
If ampicillin is used change to chloramphenicol IM;
If chloramphenicol is used, change to cloxacillin 25mg/kg/dose, every 6
hours along with gentamycin 2.5 mg/kg/dose, every eight hours.
If condition improves continue treatment orally
31. โข Injectable antibiotics
children aged less than 2 months
ANTIBIOTIC DOSE Frequency
< 7 days Age 7
days to 2
months
Inj. Benzyl penicillin or 50000IU/kg/dose 12 hourly 6 hourly
Inj. Ampicillin 50 mg/kg/dose 12 hourly 8 hourly
and
Inj. Gentamycin 2.5 mg/kg/dose 12 hourly 8 hourly