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
IPA meeting 2010 – Pneumonia epidemiology and Treatment2 |
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
IPA meeting 2010 – Pneumonia epidemiology and Treatment3 |
BackgroundBackground
Main burden of infective diseases in children
Pneumonia
Diarrhoea
Malaria
Neonatal infections
HIV
TB
IPA meeting 2010 – Pneumonia epidemiology and Treatment4 |
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
IPA meeting 2010 – Pneumonia epidemiology and Treatment5 |
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
10 of eitherTwice daily, 5 days
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
IPA meeting 2010 – Pneumonia epidemiology and Treatment6 |
Pneumonia High HIV settingPneumonia High HIV setting
CategoryMedicineForm and strength
Pack sizeRegimen
Pneumonia (Fast breathing)
Oral amoxicillin250 or 500 mg FSOD
10 of eitherTwice daily, 5 days
Severe pneumonia (Chest Indrawing)
Ampicillin + gentamicin or ceftriaxone
+ cotrimoxazole
-500 mg or 1 G -20 mg or 40 mg/ml -500 mg or 1 G
Pack??
Single dose
Variable daily x 10 days
50-100 mg/day 5 days
Very severe pneumonia (danger signs)
Oxygen,
Ampicillin + gentamicin or ceftriaxone
+ 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
Variable daily x 10 days
50-100 mg/day 5 days
IPA meeting 2010 – Pneumonia epidemiology and Treatment7 |
MalariaMalaria
CategoryMedicineForm and strength
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
IPA meeting 2010 – Pneumonia epidemiology and Treatment8 |
HIVHIV
CategoryMedicineForm and strength
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
IPA meeting 2010 – Pneumonia epidemiology and Treatment9 |
HIV – ARV ProphylaxisHIV – ARV Prophylaxis
CategoryMedicineForm and strength
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
IPA meeting 2010 – Pneumonia epidemiology and Treatment10 |
NeonatesNeonates
CategoryMedicineForm and strength
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
IPA meeting 2010 – Pneumonia epidemiology and Treatment11 |
MiscellaneousMiscellaneous
CategoryMedicineForm and strength
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
IPA meeting 2010 – Pneumonia epidemiology and Treatment12 |
TBTB
CategoryMedicineForm and strength
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