Case presentation on

Bronchopneumonia

BY
Y09PHD0123,V/VI pharmD
DEPT. OF PHARMACY PRACTICE
RUN BY :CHALAPATHI INSTITUTE OF PHARMACEUTICAL
SCIENCES, GUNTUR
Pneumonia
 Pneumonia is a form of acute respiratory
infection that affects the lungs. When an
individual has pneumonia, the alveoli are
filled with pus and fluid, which makes
breathing painful and limits oxygen intake.
Epidemiology
 Incidence is 290-536 per 1000 in Indian children.
 In 2008 pneumonia occurred in approximately
156 million children (151 million in the developing
world and 5 million in the developed countries).
 In India prevalence is 5.8%during2006-2008
 In the developed countries, the annual incidence of
pneumonia is estimated to be 33 per 10,000 in
children younger than five years and 14.5 per 10,000
in children 10 to 16 years
Etiology
 Streptococcus pneumoniae
 Haemophilus influenzae
 Respiratory syncytial virus
 in infants infected with HIV, Pneumocystis jiroveci

Risk factors:
 Malnourishment
 indoor air pollution caused by cooking and heating
with biomass fuels (such as wood )
 living in crowded homes
 parental smoking.
 SOAP NOTE
Subjective findings
 Fever since 2 days
 Cough and cold since 10 days
 Breathlessness since 10 days
 Wheeze and expectorent present
 Objective findings
 Pallor
 X-ray :Bilateral infiltration
 ASSESSMENT
DIAGNOSIS

Bronchopneumonia

ETIOLOGY

Community acquired pneumonia may be Bacterial infections.

Mainly in children streptococcus pneumonia
 Assessment of current therapy

1.O2 Inhalation
 Indications: Hypoxaemic patient to support alveolar
emergencies.
 Dose:40%-60% O2 using special oxygen therapy
 ADR: Conc> 80% have a toxic effect on lungs leading
to pulmonary congestion,exudation,atelectasis.
2.Inj.Ampicillin+Cloxacillin 500 mg IV QID D1-D6
 Indications: UTI,Sinusitis,Bronchitis,Community
acquired pneumonia.
 Dose:100mg/kg every 6 hrs
 ADR:Nausea,Vomiting,Diarrhoea
Assessment of current therapy

3.Syp.paracetamol 6ml tid (150mg/ml)D1-D6

 Indications:Hyper pyrexia,fever.
 Dose:1–5 years 120–250 mg, repeated every 4-6 hrs if necessary
 ADR: rarely rashes, blood disorders,(including thrombocytopenia,
leucopenia,neutropenia) reported . Hypotension ,liver damage following
overdosage,
4.Neb.Salbutamol 0.5cc+3.5cc NS4TH hrlyD1-D6
 Indications: Asthma, reversible airway obstruction.
 Dose:2.5 mg 4 times daily increase upto 5mg daily

 ADR:Tachycardia,palpitations,Headache,muscle cramps.
Assessment of current therapy

5.Neb.Budesonide0.3cc+3 ccNS 4th hrly

 Indications: Asthma,respitatory distress
 Dose:0.25mg to 0.5mg twice daily
 ADR: Hoarseness of voice,headache,opportunistic
fungal infection in oropharynx
 PLAN
Problem specific goals
 The goals of treatment are to cure the infection
 To prevent complications.
Patient specific goals
 To reduce the temperature
 To improve the breathing ability
 To improve the anemic condition
 Monitoring

 Therapeutic monitoring:
Temperature, PR, RR, Hb
 Toxicity monitoring:
Cyanosis, Convulsions, Respiratory depression.
 Drug monitoring:
Budesonide: Monitor for growth in paediatric
patients, for long term use.
Ampicillin:Signs of anaphylaxis, prolonged therapy monitor
liver,hematological functions.
Salbutamol:BP,HR,serum glucose, potassium,ABG analysis
DRUG BRAND DOSE COST

Ampicillin+cloxaci AMPOXIN(Unichem) Ampi250mg+cl 10.95

llin ox250mg
(Tab,cap,syp,Inj)
ROSCILOX(Ranbaxy 12.52
) 11.37
BAXIN INJ(hetero 7.90
hc)
DUOCLOX(fdc)
Paracetamol Doliprane(AHPL) Paracetamol 14.40
(Tab;syp,susp,inj) 125mg/ml

FEBREX(indoco) 24.23
Prodol(Radicura) 19.50
Genmole(Cadila) 15.70

Salbutamol(tab,sy Asthalin(cipla) 5mg/ml 14.84

p,resp.soln,MDI)
Salbutamol(gsk) 12.95
Salbair(Lupin) 16.93
 Points to physician
 Chlorpheneramine maleate shouldnot be given
as it causes cough supression and increases
secondary bacterial infections.
 Amikacin dose should be given 15mg/kg/day
 – Urea and electrolytes to inform severity
assessment.
 – Full blood count.
 – Liver function tests.
Points to patient

 Drink plenty of fluids to help loosen secretions and

bring up phlegm.
 Get lots of rest.
 Do not take cough medicines without first talking to
your doctor. Cough medicines may make it harder for
your body to cough up the extra sputum.
 Mother should be educated about the signs of
pneumonia i.e.rapid respiratory rate, difficulty in
feeding.
 Ginger,honey,tulsiwith warm beverages can be used
as and when required especially before feeds.
REFERENCE
 WHO GUIDELINES
 1. Maimunah AH, Patmanathan I. The under fives : Acute
respiratory illness. National Health and Morbidity Survey
Report 1987; 3: Ministry of Health Malaysia
 2. Maimunah AH, Noraini MS, Wong SL, Rugayah B, Jai
Mohan. Acute respiratory infections in children less than five.
National Health and morbidity survey 1996 - 1997 Report
1997; 12: Ministry of Health.
 3. Azizi BHO, Zulkifli HI and Kasim MS. Protective and risk
factors for acute respiratory infections in hospitalized urban
Malaysian children: a case control study.
 Southeast Asian J Trop Med Public Health 1995; 26: 280 85
WHO response
In 2013, WHO and UNICEF launched the integrated Global action
plan for pneumonia and diarrhoea (GAPPD). The aim is to
accelerate pneumonia control with a combination of interventions
to protect, prevent, and treat pneumonia in children with actions to:
protect children from pneumonia include promoting exclusive
breastfeeding and adequate complementary feeding;
prevent pneumonia with vaccinations, hand washing with soap,
reducing household air pollution, HIV prevention and
cotrimoxazole prophylaxis for HIV-infected and exposed children;
treat pneumonia which are focused on making sure that every sick
child has access to the right kind of care -- either from a
community-based health worker, or in a health facility if the
disease is severe -- and can get the antibiotics and oxygen they
need to get well.