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— With high HIV prevalance, give amoxicillin of at least 40mgkgdose twice daily for 5 days.
Weak recommendation, moderate quality evidence
b Children with non-severe pneumonia who fail on the irst line treatment with amoxicillin should have the option of referral to a facility where there is appropriate
second line treatment.
Weak recommendation, expert opinion
4.12 Antibiotics treatment for severe pneumonia
a Children aged 2–59 months with severe pneumonia chest indrawing should be treated with oral amoxicillin at least 40mgkgdose twice daily for 5 days.
Strong recommendation, moderate quality evidence
b In HIVAIDS infected children, speciic guidelines for treatment of severe pneumonia in the context of HIV should be followed.
Strong recommendation, low quality evidence
4.13 Antibiotic treatment for very severe pneumonia
a Children aged 2–59 months with very severe pneumonia should be treated with parenteral ampicillin or penicillin and gentamicin as a irst line treatment.
— Ampicillin: 50 mgkg, or Benzyl penicillin: 50,000 units per kg IMIV every 6 hours for at least 5 days
— Gentamicin: 7.5 mgkg IMIV once a day for at least 5 days
Strong recommendation, moderate quality evidence
b Cetriaxone should be used as a second line treatment in children with severe pneumonia with failure on the irst line treatment.
Strong recommendation, expert opinion
4.14 Inhaled salbutamol for treatment of acute wheezeasthma and
bronchoconstriction
a Children with acute wheezeasthma and bronchoconstriction should be treated with inhaled salbutamol using a metered dose inhaler MDI with spacer devices
to relieve bronchoconstriction.
Strong recommendation, low quality evidence
b Oral salbutamol should not be used for treatment of acute or persistent wheeze except where inhaled salbutamol is not available. Oral salbutamol is not useful in
testing response to bronchodilators.
Strong recommendation, low quality evidence
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Recommendations for treatment of dysentery 4.15
Antibiotics for treatment of dysentery
a Children with diarrhoea and blood in stool i.e. dysentery should be treated with ciproloxacin as a irst line treatment. Cetriaxone should be given as a second
line treatment in severely ill children where local antimicrobial sensitivity is not known.
— Ciproloxacin: 15 mgkgdose twice daily for 3 days — Cetriaxone: 50–80 mgkg daily for 3 days
Strong recommendation, low quality evidence
b Where local antimicrobial sensitivity is known, local guidelines should be followed.
Strong recommendation, low quality evidence
Recommendations for treatment of common causes of fever 4.16
Antibiotics for treatment of acute bacterial meningitis
a Children with acute bacterial meningitis should be treated empirically with 3rd generation cephalosporins.
— Cetriaxone: 50mgkg per dose IV every 12 hours or 100 mgkg once daily, or — Cefotaxime: 50mgkg per dose every 6 hours for 10–14 days.
Strong recommendation, moderate quality of evidence
b Where it is known that there is no signiicant resistance to chloramphenicol and beta lactam antibiotics among bacteria-causing meningitis follow national
guidelines or choose any of the following two regimens: — Chloramphenicol: 25 mgkg IM or IV every 6 hours plus ampicillin: 50 mg
kg IM or IV every 6 hours OR
— Chloramphenicol: 25 mgkg IM or IV every 6 hours plus benzyl penicillin: 60 mgkg 100 000 unitskg every 6 hours IM or IV.
Conditional recommendation, moderate quality evidence
4.17 Antibiotics for treatment of acute otitis media
a Children with acute otitis media should be treated with oral amoxicillin at 40 mg kg twice per for 7–10 days.
Strong recommendation, low quality evidence
b Where pathogens causing acute otitis media are known to be sensitive to co- trimoxazole, this antibiotic could be used as an alternative given twice per day for
7–10 days.
Strong recommendation, low quality evidence
