ARI CONTROL PROGRAME
[Link] A Thomas
INTRODUCTION
Commonest
cause of deaths in developing
countries
25%
of deaths in children under 5 years
WHO
developed this programme with aim of
reducing morbidity and mortality due to ARI
Definition
Episode
of acute symptoms and signs resulting from
infection of any part of the respiratory tract and
related structures.
Includes
common cold, purulent nasal discharge,
pharyngitis, bronchitis and ASOM.
Guidelines
years.
are intended for use in children under 5
Treatment
regimes are designed for use in
hospitals where Xray and lab facilities are
limited or do not exist.
Diagnosis
based on clinical examination.
Clinical diagnostic criteria
Respiratory
rate fast breathing
Chest indrawing.
Fast breathing:
> 40/mt in children 1-5 years.
> 50/mt in children 2-12 months.
> 60/mt in children < 2 months.
Clinical diagnostic criteria
Chest indrawing:
Definite inward motion of lower chest wall
on breathing in.
Significant only if continuously present and
definitely visible.
Occurs because with progression of
pneumonia, the elastic recoil of the lung is
gradually reduced.
Classification
No
pneumonia
Pneumonia
Severe
Very
pneumonia
severe disease
No pneumonia
No
fast breathing
No chest indrawing
Feeding well
look for upper respiratory tract infection
and treat at home.
Assess and treat ear problem / sore throat / fever if
present.
Pneumonia
Fast
breathing
No chest indrawing
Child feeding well
Treated at home with oral Cotrimoxazole.
reassess after 2 days improvement
shown by decreased resp rate ,fever and
better feeding.
mother advised to continue Cotrimoxazole for 5
days.
Severe pneumonia
Fast breathing
Chest indrawing
No central cyanosis, child able to drink.
Hospitalization required.
Oxygen if resp rate > 70/min or if severe chest indrawing.
Antibiotics given are Benzyl Pencillin iv/im 6hrly for 3
days.
If the child improves change to oral amoxycillin or
ampicillin for at least 5 days.
Antibiotics cont. for at least 3 days after child is well.
Switch to Chloramphenicol if no improvement after 48hrs
of Benzyl pencillin.
Very severe disease
Young
infants < 2 months
Suspect pneumonia / sepsis/meningitis if the infant has any of the
following danger signs:
Stopped feeding well.
Convulsions.
Abnormally sleepy / difficult to wake.
Stridor in a calm child.
Wheezing / grunting.
Severe chest indrawing.
Central cyanosis.
Apnoea.
Treatment
Admission
Oxygen
Choloramphenicol
im / iv 6th hrly; 3-5 days.
If better- change to oral; totla of at least 10
days. Alternatively benzyl pencillin +
aminoglycoside.
Treat wheezing if present
Reassess twice daily.
Thank you