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IPA meeting 2010 – Pneumonia epidemiology and Treatment 1 |1 | Medicines recommended to prevent and manage the priority diseases at the community and health.

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Presentation on theme: "IPA meeting 2010 – Pneumonia epidemiology and Treatment 1 |1 | Medicines recommended to prevent and manage the priority diseases at the community and health."— Presentation transcript:

1 IPA meeting 2010 – Pneumonia epidemiology and Treatment 1 |1 | Medicines recommended to prevent and manage the priority diseases at the community and health facility level Shamim Qazi Department of Child and Adolescent Health and Development

2 IPA meeting 2010 – Pneumonia epidemiology and Treatment 2 |2 | Global Causes of Child Deaths Black et al. Lancet, 2010 WHO. The World Health Statistics 2010 Black et al. Lancet, % of under five deaths are associated with undernutrition

3 IPA meeting 2010 – Pneumonia epidemiology and Treatment 3 |3 | Background Main burden of infective diseases in children Pneumonia Diarrhoea Malaria Neonatal infections HIV TB

4 IPA meeting 2010 – Pneumonia epidemiology and Treatment 4 |4 | Diarrhoea RegimenPack sizeForm and strength Medicine According to the dehydration status/guidelines 1 litre, 500 and 200 ml As specified (low osmolarity) ORS Once daily for 10 days 10 of each10 or 20 mg FSOD Zinc Sulphate

5 IPA meeting 2010 – Pneumonia epidemiology and Treatment 5 |5 | Pneumonia Low HIV setting RegimenPack sizeForm and strength MedicineCategory Twice daily, 5 days 50mg/kg/day (3 days?) 8mg/kg/day (3 days?) 10 of either250 or 500 mg FSOD TMP 80+SMX 400mg; TMP 20+SMX 100 mg Oral amoxicillin Oral cotrimoxazole Pneumonia (Fast breathing) Twice daily, 5 days10 of either250 or 500 mg FSOD Oral amoxicillin Severe pneumonia (Chest Indrawing) As needed Variable daily x 10 days mg/day 5 days Variable Pack?? Single dose Cylinder/oxygen concentrators -500 mg or 1 G -20 mg or 40 mg/ml – 500 mg or 1 G Oxygen, Ampicillin + gentamicin or ceftriaxone Very severe pneumonia (danger signs)

6 IPA meeting 2010 – Pneumonia epidemiology and Treatment 6 |6 | Pneumonia High HIV setting RegimenPack sizeForm and strength MedicineCategory Twice daily, 5 days10 of either250 or 500 mg FSOD Oral amoxicillin Pneumonia (Fast breathing) Variable daily x 10 days mg/day 5 days Pack?? Single dose -500 mg or 1 G -20 mg or 40 mg/ml -500 mg or 1 G Ampicillin + gentamicin or ceftriaxone + cotrimoxazole Severe pneumonia (Chest Indrawing) As needed Variable daily x 10 days mg/day 5 days Variable Pack?? Single dose Cylinder/oxygen concentrators -500 mg or 1 G -20 mg or 40 mg/ml -500 mg or 1 G Oxygen, Ampicillin + gentamicin or ceftriaxone + cotrimoxazole Very severe pneumonia (danger signs)

7 IPA meeting 2010 – Pneumonia epidemiology and Treatment 7 |7 | Malaria RegimenPack sizeForm and strength MedicineCategory Daily or twice daily x 3 days For 3 day treatment 6x1 & 6x2 (30 blisters per box) 3 (25 blisters per box) Variable FSODArtemeter +Lumefantrine (FDC) Artesunate + amodiaquine (FDC) Malaria (uncomplicated) 2.4 mg/kg iv, 3 doses, then daily; 20mg infusion then 10mg/kg 8 hourly ?50/pack 100 ampoules/Pack 60 mg Injection 152 mg/ml injection Artesunate Quinine hydrochloride Malaria (severe or pre-referral) 10 mg/kg dose6 per pack50, 100, 200 mg Suppositories Artesunate rectal

8 IPA meeting 2010 – Pneumonia epidemiology and Treatment 8 |8 | HIV RegimenPack sizeForm and strength MedicineCategory Once or twice daily30 days mg+50 mg FDC tablet, scored 2nd one not yet available AZT+3TC+NVP (< 3 years) AZT+3TC+EFV (>3 years) HIV treatment 10 mg/kg mg TMP /day age related doses 30 days 100 mg TMP 80+SMX 400mg; TMP 20+SMX 100 mg Isoniazid Cotrimoxazole HIV - Prophylaxis AZT or ZDV: Zidovudine NVP: Nevirapine 3TC: Lamivudine EFV:Efavirenz

9 IPA meeting 2010 – Pneumonia epidemiology and Treatment 9 |9 | HIV – ARV Prophylaxis RegimenPack sizeForm and strength MedicineCategory Variable according to weight and age Daily from birth until one week after all exposure to breastmilk 30 daysAvailable: 10mg/ml/liquid &50 and 200 mg tablet Need 20 mg scored tablet NVP Breastfeeding population Variable according to weight and age For 4-6 weeks 15 days? 45 daysAZT: 10mg/ml/liquid & 60/300 mg tablet, 100/250 mg cap AZT or NVP Non breastfeeding population Variable according to weight and age For 4-6 weeks 15 days? 45 daysAZT or NVP All exposed infants

10 IPA meeting 2010 – Pneumonia epidemiology and Treatment 10 | Neonates RegimenPack sizeForm and strength MedicineCategory -50 mg/kg x2 doses for 1 week and x3 doses for 2-4 wk mg/kg/day in 0-6 days and mg/kg in 7-59 days x mg/kg /day -40,000-60,000 units/kg/day ?? Single dose -500 mg or 1 G -20 mg /ml – 500 mg or 1 G Ampicillin + gentamicin or ceftriaxone Procaine penicillin? Neonatal sepsis Topical application 0.5–1 mg x 1 at birth; 5mg/kg/day 500 ml Variable 4% solution 1 mg/1 ml, 10 mg/ml 20mg/ml injection or oral liquid?? Chlorhexidine Vitamin K Caffeine Hydrate Neonatal care

11 IPA meeting 2010 – Pneumonia epidemiology and Treatment 11 | Miscellaneous RegimenPack sizeForm and strength MedicineCategory 100,000 units every 6 months variable100,000 units capsule Vitamin A Child survival 15 mg/kg 4-6 hours5-10 days supplyVariable FSOD Tab mg Paracetamol Pain Variable every 6 hours 5 days10 mg oral dosage form 10m/ml injection Morphine

12 IPA meeting 2010 – Pneumonia epidemiology and Treatment 12 | TB RegimenPack sizeForm and strength MedicineCategory In this dose, weight based dosing, once daily 30 days4 component FDC, flexible oral solid dosage form containing Or product with same ratio Isoniazid Rifampicin Pyrazinamide ethambutol Treatment – intensive phase, 2 months 3 component FDC, flexible oral solid dosage form containing Or 2 component FDC, flexible oral solid dosage form Isoniazid Rifampicin Pyrazinamide Treatment, continuation phase, 4 months


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