Lower Respiratory Tract Infection

• Lower Respiratory Tract Infections are the leading cause of mortality in children under 5 years old
• In developing countries, Lower Respiratory Tract Infections occur 10 times more frequently than in developed countries
• In Africa, there are 3000-4000 cases per 100,000 people, with 0.28 episodes per child-year
• Defense mechanisms against Lower Respiratory Tract Infections include mucosa, mucus production, cilia, cough, and flora
• Innate Immunity factors involved in defense against Lower Respiratory Tract Infections include Toll-Like Receptors and Complement
• Fever, secretions, and cough are common symptoms of Lower Respiratory Tract Infections
• Volume loss in Lower Respiratory Tract Infections can lead to compensation by using healthy volume more intensively, resulting in increased minute volume and tachypnea
• Integrated Management of Childhood Illnesses (IMCI) is crucial for the diagnosis and management of Lower Respiratory Tract Infections
• Signs associated with pneumonia include crackles, bronchial breathing, dull percussion, and indrawings
• Investigations for Lower Respiratory Tract Infections may include chest X-ray and blood tests to identify pathogens
• Common pathogens causing Lower Respiratory Tract Infections include Group B Streptococcus, Enteric Gram-negatives, RSV, Influenza, Parainfluenza, Bordetella pertussis, and more
• Prevention of Lower Respiratory Tract Infections can be achieved through the Pneumococcal vaccine, which mainly prevents meningitis and also has an effect on pneumonia
• Special considerations in treatment may involve changing antibiotics based on the response to initial empiric treatment
• Empiric treatment for culture-negative neonates:

  • Change to ORAL Amoxy-Clav 45mg/kg/dose Q12hly po x5d
• If not responding well to initial empiric treatment:

  • Change to Ceftriaxone 50 mg/kg/dose Q12hly IVI x5d
  • Or Cefotaxim 50 mg/kg/dose Q8hly IVI x5d
• Special considerations for treatment:

  • If suspected 'atypical' organism (Mycoplasma, Chlamydia, Bordetella):
  • Add on Azithromycin 10mg/kg/dose Q24hly po x5d
  • If suspected Staphylococcus aureus:
  • Add on Flucloxacillin 50mg/kg/dose Q6hly po x14-28d
• For HIV positive patients:

  • Same treatment as HIV negative patients
  • Consider PCP / CMV pneumonitis (severe hypoxia)
  • Treatment: 5mg Trimethropin/ 25mg Sulfomethoxazole /kg/dose Q6hly po/IVI x21d
  • Gancyclovir 5mg/kg/dose Q12hly IVI, followed by oral treatment x21-42d
  • Prednisone 1-2mg/kg/dose Q24hly po for 7-14d
• Criteria for discharge:

  • Clinical improvement, indicated by improved activity, appetite, and resolution of fever for at least 12 hours
  • Pulse oximetry measurements consistently >90% at altitude (=1 800 m) or >92% at sea level in room air for at least 12 hours
  • Stable and/or return to baseline mental status
  • Ability to administer antibiotics at home, and child able to tolerate oral feeding and antibiotics
  • Acceptable home circumstances and ability to return to hospital if clinical deterioration
• Signs of respiratory distress that may require oxygen therapy:

  • Hypoxemia
• Modes of delivery for oxygen therapy:

  • Not specified
• Side effects of oxygen therapy:

  • Not specified
• Differential diagnosis for pediatric respiratory conditions:

  • Common cold and other URTI
  • Bronchiolitis and viral bronchopneumonia
  • PCP
  • Asthma
  • Pulmonary TB
  • Chronic Suppurative Lung Diseases