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, 2008 35% 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 50-100 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 50-100 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 50-100 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 days60+ 30 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 20-80 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 - 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 ?? 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 100 500 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 150+250+400+250 Or product with same ratio Isoniazid Rifampicin Pyrazinamide ethambutol Treatment – intensive phase, 2 months 3 component FDC, flexible oral solid dosage form containing 150+250+400 Or 2 component FDC, flexible oral solid dosage form Isoniazid Rifampicin Pyrazinamide Treatment, continuation phase, 4 months