A 10 months old child weighing 5 kg and length 65 cm presents with cough and cold. He was found to have a respiratory rate of 48 per minute with no retraction, grunting or cyanosis. There is no history of convulsions. Which of the following is true about this child?: (A) No pneumonia, only cough and cold, (B) Child has pneumonia, (C) Severe pneumonia, (D) Very severe disease
Answer is A. Ans. a. No pneumonia, only cough and cold (Ref: Ghai 8/e p759)Respiratory rate of 48 per minute with no retraction, grunting or cyanosis in a 10 months old child weighing 5 kg and length 65 cm with cough and cold without history of convulsions is suggestive of no pneumonia (only cold and cough).Acute Respiratory Infection (ARI)/ PneumoniaNo Pneumonia: Cough or ColdPneumonia (Not severe)Severe PneumoniaVery Severe Pneumonia* No chest indrawing, No fast breathingQManagement:* No antibiotics necessary* Treat symptomatically* If cough > 30 days, refer for assessment* No chest indrawingQ* Fast breathing presentQSignsQ:* Chest indrawing* Nasal flaring* Grunting* CyanosisManagement:* Give first dose of referral antibiotic (Ampicillin + Gentamicin)* Refer urgently to hospital;* Drugs of ChoiceQ- Benzyl Penicillin (or Ampicillin or Chlorampheniciol) for first 48 hours and then Procaine Penicillin (or Ampicillin or Chiorampheniciol) for next 3 days* Antibiotics to be changed if there is no improvement after first 48 hoursSignsQ:* Convulsions, abnormally sleepy or difficult to awake* Stridor when calm* Stopped feeding* Wheezing* Fever or low body temperature* Severe malnutritionManagement:* Give first dose of referral antibiotic (Ampicillin + Gentamicin)Q* Refer urgently to hospital* Drug of ChoiceQ - Chloramphenicol IM for first 48 hours and then oral chloramphenicol till total 10 days* Antibiotics to be changed (to IM Cloxacillin + Gentamicin) if there is no improvement after first 48 hoursAge groupRespiratory rate0-2 months>60/minute2-12 months>50/minute12 months-5years>40/minuteManagement:* At home* Give antibiotics- Drug of choice CotrimoxazoleQ* Reassessment after 2 days