shamim qazi department of child and adolescent health and development

IPA meeting 2010 – Pneumonia epidemiology and Treatment1 |

Medicines recommended to prevent and manage the priority diseases at

the community and health facility level

Medicines recommended to prevent and manage the priority diseases at

the community and health facility level

Shamim QaziDepartment of Child and Adolescent Health and Development


Global Causes of Child DeathsGlobal Causes of Child Deaths

Black et al. Lancet, 2010WHO. The World Health Statistics 2010Black et al. Lancet, 2008 35% of under five deaths are associated with undernutrition


BackgroundBackground

Main burden of infective diseases in children

Pneumonia

Diarrhoea

Malaria

Neonatal infections

HIV

TB


DiarrhoeaDiarrhoea

MedicineForm and strength

Pack sizeRegimen

ORS As specified (low osmolarity)

1 litre, 500 and 200 ml

According to the dehydration status/guidelines

Zinc Sulphate10 or 20 mg FSOD 10 of eachOnce daily for 10 days


Pneumonia Low HIV settingPneumonia Low HIV setting

CategoryMedicineForm and strength

Pack sizeRegimen

Pneumonia (Fast breathing)

Oral amoxicillin

Oral cotrimoxazole

250 or 500 mg FSOD

TMP 80+SMX 400mg;

TMP 20+SMX 100 mg

10 of eitherTwice daily, 5 days

50mg/kg/day (3 days?)

8mg/kg/day (3 days?)

Severe pneumonia (Chest Indrawing)

Oral amoxicillin

250 or 500 mg FSOD


Very severe pneumonia (danger signs)

Oxygen,

Ampicillin + gentamicin or ceftriaxone

Cylinder/oxygen concentrators

-500 mg or 1 G -20 mg or 40 mg/ml – 500 mg or 1 G

Variable

Pack??

Single dose

As needed

Variable daily x 10 days

50-100 mg/day 5 days


Pneumonia High HIV settingPneumonia High HIV setting


Pack sizeRegimen

Pneumonia (Fast breathing)

Oral amoxicillin250 or 500 mg FSOD


Severe pneumonia (Chest Indrawing)


+ cotrimoxazole

-500 mg or 1 G -20 mg or 40 mg/ml -500 mg or 1 G

Pack??

Single dose



Very severe pneumonia (danger signs)

Oxygen,


+ cotrimoxazole

Cylinder/oxygen concentrators

-500 mg or 1 G -20 mg or 40 mg/ml -500 mg or 1 G

Variable

Pack??

Single dose

As needed




MalariaMalaria


Pack sizeRegimen

Malaria (uncomplicated)

Artemeter +Lumefantrine (FDC)

Artesunate + amodiaquine (FDC)

Variable FSODFor 3 day treatment 6x1 & 6x2 (30 blisters per box)

3 (25 blisters per box)

Daily or twice daily x 3 days

Malaria (severe or pre-referral)

Artesunate Quinine hydrochloride

60 mg Injection

152 mg/ml injection

?50/pack

100 ampoules/Pack

2.4 mg/kg iv, 3 doses, then daily;

20mg infusion then 10mg/kg 8 hourly

Artesunate rectal50, 100, 200 mg Suppositories

6 per pack10 mg/kg dose


HIVHIV


Pack sizeRegimen

HIV treatmentAZT+3TC+NVP

(< 3 years)

AZT+3TC+EFV (>3 years)

60+ 30 mg+50 mg FDC tablet, scored

2nd one not yet available

30 daysOnce or twice daily

HIV - Prophylaxis

Isoniazid

Cotrimoxazole

100 mg

TMP 80+SMX 400mg;

TMP 20+SMX 100 mg

30 days

30 days

10 mg/kg

20-80 mg TMP /day age related doses

AZT or ZDV: ZidovudineNVP: Nevirapine3TC: LamivudineEFV:Efavirenz


HIV – ARV ProphylaxisHIV – ARV Prophylaxis


Pack sizeRegimen

Breastfeeding population

NVPAvailable: 10mg/ml/liquid &50 and 200 mg tablet

Need 20 mg scored tablet

30 daysVariable according to weight and age

Daily from birth until one week after all exposure to breastmilk

Non breastfeeding population

AZT or NVPAZT: 10mg/ml/liquid & 60/300 mg tablet, 100/250 mg cap

15 days? 45 days Variable according to weight and age

For 4-6 weeks

All exposed infants

AZT or NVP15 days? 45 daysVariable according to weight and age

For 4-6 weeks


NeonatesNeonates


Pack sizeRegimen

Neonatal sepsisAmpicillin + gentamicin

or

ceftriaxone

Procaine penicillin?

-500 mg or 1 G -20 mg /ml

– 500 mg or 1 G

??

Single dose

Single dose

-50 mg/kg x2 doses for 1 week and x3 doses for 2-4 wk - 4-5 mg/kg/day in 0-6 days and 5-6.5 mg/kg in 7-59 days x 1

-50 -100 mg/kg /day

-40,000-60,000 units/kg/day

Neonatal careChlorhexidine

Vitamin K

Caffeine Hydrate

4% solution

1 mg/1 ml, 10 mg/ml

20mg/ml injection or oral liquid??

500 ml

Variable

Variable

Topical application

0.5–1 mg x 1 at birth;

5mg/kg/day


MiscellaneousMiscellaneous


Pack sizeRegimen

Child survivalVitamin A100,000 units capsule

variable100,000 units every 6 months

PainParacetamolVariable FSOD

Tab 100‐500 mg

5-10 days supply15 mg/kg 4-6 hours

Morphine10 mg oral dosage form

10m/ml injection

5 daysVariable every 6 hours


TBTB


Pack sizeRegimen

Treatment – intensive phase, 2 months

Isoniazid

Rifampicin

Pyrazinamide

ethambutol

4 component FDC, flexible oral solid dosage form containing

150+250+400+250

Or product with same ratio

30 daysIn this dose, weight based dosing, once daily

Treatment, continuation phase, 4 months

Isoniazid

Rifampicin

Pyrazinamide

3 component FDC, flexible oral solid dosage form containing

150+250+400

Or 2 component FDC, flexible oral solid dosage form

shamim qazi department of child and adolescent health and development

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