Diagnosis and treatment protocols for Pneumonia in Uganda
Uganda Clinical Guidelines 2023 · all from source →
General Adult
Diagnosis
Moderate Pneumonia
Fever, chest pain, cough, rapid breathing (>30 bpm), no chest indrawing.
Severe Pneumonia
Chest indrawing, pulse >120/min, Temp >39.5 C, BP <90/60 mmHg, SpO2 <90%.
Treatment
Moderate Pneumonia
Amoxicillin 500 mg-1 g every 8 hours for 5 days. If atypical (penicillin allergy or poor response): Doxycycline 100 mg every 12 hours for 7-10 days OR Erythromycin 500 mg every 6 hours for 5 days (14 days for atypical).
Severe Pneumonia
Give oxygen. Benzylpenicillin 2 MU IV or IM every 4-6 hours. If not better in 48 hours: Ceftriaxone 1 g IV/IM every 24 hours. If S. Aureus suspected: Cloxacillin 500 mg IV every 6 hours.
Staphylococcus pneumonia
Cloxacillin 1-2 g IV or IM every 6 hours for 10-14 days PLUS gentamicin 7.5 mg/kg IV in 1-3 divided doses daily (continue both for at least 21 days).
Klebsiella pneumonia
Gentamicin 5-7 mg/kg IV daily in divided doses OR ciprofloxacin 500 mg every 12 hours. Give 5-day course.
Neonatal
Diagnosis
Clinical Features (up to 2 months)
Consider all <2 months with pneumonia as SEVERE. Rapid breathing (>= 60 bpm), severe chest indrawing, grunting, inability to breastfeed, convulsions, drowsiness, stridor, wheezing, cyanosis (SpO2 <90%).
Treatment
Severe Pneumonia in Infant
Admit. Keep warm. Prevent hypoglycaemia. Oxygen if SpO2 <94%. Ampicillin 50 mg/kg IV every 6 hours PLUS gentamicin 7.5 mg/kg IV once daily (Neonates < 7 days old: 5 mg/kg).
Severely ill infant / Alternative
Ceftriaxone 100 mg/kg IV once daily. Alternative: Chloramphenicol 25 mg/kg IV every 6 hours (CONTRAINDICATED in premature babies and neonates < 7 days old).
Duration
Continue treatment for at least 5 days, and for 3 days after child is well. (Meningitis 21 days; Septicaemia 10 days).
General Pediatric
Diagnosis
Clinical Features (2 months - 5 years)
Pneumonia: Fast breathing (2-12 months: >=50 bpm, 1-5 years: >=40 bpm), mild chest wall indrawing, cough. Severe Pneumonia: Central cyanosis (SpO2 <90%), inability to feed, convulsions, severe respiratory distress.
Treatment
Non-Severe Pneumonia
Amoxicillin dispersible tabs (DT) 40 mg/kg every 12 hours for 5 days. If wheezing: Salbutamol inhaler 1-2 puffs every 4-6 hours.
Severe Pneumonia
Admit. Oxygen if SpO2 <90%. Ampicillin 50 mg/kg IV every 6 hours OR benzyl penicillin 50,000 IU/kg IM/IV PLUS gentamicin 7.5 mg/kg IM/IV once daily for at least 5 days.
Severe Pneumonia (No improvement after 48h)
Second line: Ceftriaxone 80 mg/kg IM/IV once daily. If staphylococcus suspected: Gentamicin 7.5 mg/kg once daily PLUS cloxacillin 50 mg/kg IM/IV every 6 hours.
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