Philippine Pediatric Society, Inc.

32 Misamis St., Bago Bantay, Quezon City

Tel. No.: 922-2435; Fax No.: (632) 926-2381

Officers and Board Members 1996-1998

President Mary N. Chua, M.D.

Vice President Zenaida L. Antonio, M.D.
Secretary Myrna B. Rosel, M.D.
Assistant Secretary Emilio A. Hernandez, M.D.
Treasurer Rosalinda B. Soriano, M.D.
Assistant Treasurer Vivian C. Chiu, M.D.

Board of Trustees Carmelo A. Alfiler, M.D.

Joel S. Elises, M.D.
Jocelyn J. Franco, M.D.
Rizal V. Faylona, M.D.
Salud B. Javelosa, M.D.
Dimpna P. Torrevillas, M.D.
Estrella P. Villar, M.D.

Immediate Past President Xerxes R. Navarro, M.D.

Honorary President Fe Del Mundo, M.D.

ACUTE RESPIRATORY
INFECTION
ACUTE RESPIRATORY INFECTION CPM 1st EDITION

Algorithm for the Management of Acute Respiratory

­Infection (ARI)/Pneumonia for 2 mos. to 4 yrs. old

Cough

2 Y 3
Mild ARI; simple cough
Tachypnea N and cold -
RR ≥50/min? Provide supportive therapy
at home
4 Y 5
Pneumonia -
Chest N Treat as an outpatient;
indrawing? supportive plus oral
Cotrimoxazole
6 Y no improvement
7
Severe Pneumonia -
Cyanosis N Admit to hospital -
Failure to
supportive plus IM
feed/drink?
benzyl penicillin
no improvement

8
Very Severe Pneumonia -
Admit to hospital; -
oxygen, supportive plus
IM chloramphenicol

For patients 0-2 mos. old: RR >60/min (sustained) - Severe Pneumonia - admit to hospital,
give supportive therapy plus IM benzylpenicillin and IM gentamicin

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TRIZOLE
PEDIATRICA, INC
CPM 1st EDITION ACUTE RESPIRATORY INFECTION

Guidelines in the Management of

Acute Respiratory Infection

Cough or difficult breathing in infants <2 months

Clinical Classify Summary of Treatment

SIGNS AS Instructions

• Stopped feeding well ADMIT
• Convulsions SEVERE Give oxygenb if:
• Abnormally sleepy or difficult to wake PNEUMONIA OR • central cyanosis
• Stridor in calm child VERY SEVERE • not able to drink
• Wheezing DISEASE
• Fever (38oC or more) or low Give antibiotics:
body temperature (below 35.5oC) benzylpenicillin and gentamicin
• Fast breathinga
• Severe chest indrawing Careful fluid management.
• Central cyanosis Maintain a good thermal environment
• Grunting Specific management of wheezing or
• Apneic episodes or stridor.
• Distended and tense abdomen

• No fast breathing & NO PNEUMONIA: ADVICE MOTHER TO GIVE THE

• No signs of pneumonia or very COUGH OR COLD FOLLOWING HOME CARE:
severe disease. • Keep young infant warm.
• Breast-feed frequently.
• Clear nose if it interferes with feeding
Return quickly if:
• Breathing becomes difficult.
• Breathing becomes fast.
• Feeding becomes a problem.
• The young infant becomes sicker.

a
Fast breathing is 60 breaths per minute or more in the young infant (age <2 months):
• repeat the count
b
If oxygen supply is ample, also give oxygen to a young infant with:
• restlessness (if oxygen improves the condition);
• severe chest indrawing, or;
• grunting

Adapted from WHO/ARI/90.5

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ACUTE RESPIRATORY INFECTION CPM 1st EDITION

Cough or difficult breathing in infants AND CHILDREN

(2 months TO 5 YEARS)a

Clinical Classify Summary of Treatment

SIGNS AS Instructions

• Central cyanosis or VERY SEVERE ADMIT
• Not able to drink PNEUMONIA Give oxygen.
Give an antibiotic: chloramphenicol.
Treat fever, if present.
Treat wheezing, if present.
Give supportive care.
Reassess twice daily.

• Chest indrawing & SEVERE ADMITa

• No central cyanosis & PNEUMONIA Give an antibiotic benzylpenicillin
• Able to drink If child is wheezing Treat fever, if present.
assess further Treat wheezing, if present.
before classifying Give supportive care.
Reassess daily.

• No chest indrawing & PNEUMONIA ADVISE MOTHER TO GIVE HOME

• Fast breathingc CARE: Give an antibiotic (at home):
cotrimoxazole or amoxicillin, or
procaine penicillin G.
Treat fever, if present.
Treat wheezing, if present.
Advise the mother to return in 2 days
for reassessment or earlier if the child
is getting worse.

• No chest indrawing & NO PNEUMONIA: If coughing more than 30 days assess for
• No fast breathing COUGH OR causes of chronic cough.
COLD Assess & treat ear problem or sore
throat, if present.
Assess & treat other problems.
ADVISE MOTHER TO GIVE HOME
CARE:
Treat fever, if present.
Treat wheezing, if present.

a
Only for those without stridor, severe undernutrition or meningitis.
If the child has severe undernutrition, admit for nutritional rehabilitation & medical therapy.
Treat pneumonia with chloramphenicol.
If the child has signs suggesting meningitis, admit & treat with chloramphenicol.
b
If oxygen supply is ample, also give oxygen to a child with:
• restlessness (if oxygen improves the condition),
• severe chest indrawing, or;
• breathing rate of 70 breaths per minute or more.
c
Fast breathing is:
• 50 breaths per minute or more in a child age 2 months up to 12 months;
• 40 breaths per minute or more in a child 12 months up to 5 years

Modified from WHO/ARI/90.5

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CPM 1st EDITION ACUTE RESPIRATORY INFECTION

Drugs Mentioned in the Treatment Guideline

The following index lists therapeutic classifications as recommended by the treatment guideline. For the prescriber's
reference, available drugs are listed under each therapeutic class.

Antibacterials Chloramphenicol Garamycin Injectable

Amoxicillin Bactichlor Progara
Amoxicillin Bio-Strata Chlorabicine Servigenta
Amoxicillin-Boie Chloromycetin Topigen
Amoxil Kemicetine UL Gentamicin
Amoxsteryl Chloromycetin USÁ-Gentamicin Sulfate
Amoxtrex Kemicetine Penicillin G benzathine/
Ampidroxyl Neocol Penicillin G potassium/
Apamax/Apamax Forte Optomycin Penicillin G procaine
Apectruxil Plivacol Penadur 6-3-3/Penadur L-A
Athenalyn Scanicol Inj
Bactigent Venimicetin
Britamox Cotrimoxazole
Chrisomox Atomexin
Clearamox Bacidal
Coamoxin Bactam
Daisamox Bactille TS
DLI-Amoxicillin Bactrim
Emilex Bacxal
Glenox Bestofens
Himox Cotrimoxazole-Ashford
IHC-Amoxicillin Cotrimoxazole-BOIE
Intermox Cotrimoxazole-Vamsler
Jamox/Jamox Forte Dhatrin
Maelenoxyl DLI-Cotrimoxazole
Medimoxil Doctrimox
Metaxyl Elitrim
Moxillin Genoxzole/Genoxzole Forte
Neomox Genzaprim/Genzaprim Forte
Pediamox Groprim/Groprim Forte
Pemoxin Gutrisul
Pharex-Amoxicillin Lagatrim
Pharmamox Lextrizole
Pimsylin Macromed
Polymox Microbid/Microbid DS
Servimox Pharex-Cotrimoxazole
Shinamox Septrin
Sumoxil Servitrim
Teramoxyl Sulfotrim
Termox Syltrifil
UL-Amoxicillin Syndal
USA Amoxicillin Thoprim
USÁLab Amoxicillin Triforam
Wyamox Trimetazole
Yugoxil Trimezol-Scanpharm
Zymoxil Trizole Suspension
Benzylpenicillin UL Cotrimoxazole
(Penicillin G) USÁ Cotrimoxazole
Benzylpenicillin Sodium-YSS Gentamicin
Pengeemil DBL Gentamicin Inj
UL Benzylpenicillin Potassium Delta West Gentamicin
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