ARI CONTROL PROGRAME Dr.Vinu A Thomas

INTRODUCTIONCommonest cause of deaths in developing countries

25% of deaths in children under 5 years

WHO developed this programme with aim of reducing morbidity and mortality due to ARI

Definition

Episode of acute symptoms and signs resulting from infection of any part of the respiratory tract and related structures.

Includes common cold, purulent nasal discharge, pharyngitis, bronchitis and ASOM.

Guidelines are intended for use in children under 5 years.

Treatment regimes are designed for use in hospitals where Xray and lab facilities are limited or do not exist.

Diagnosis based on clinical examination.

Clinical diagnostic criteriaRespiratory rate fast breathingChest indrawing. Fast breathing:> 40/mt in children 1-5 years.> 50/mt in children 2-12 months.> 60/mt in children < 2 months.

Clinical diagnostic criteriaChest indrawing:Definite inward motion of lower chest wall on breathing in.Significant only if continuously present and definitely visible.Occurs because with progression of pneumonia, the elastic recoil of the lung is gradually reduced.

Classification No pneumonia

Pneumonia

Severe pneumonia

Very severe disease

No pneumoniaNo fast breathing No chest indrawingFeeding well

look for upper respiratory tract infection and treat at home.Assess and treat ear problem / sore throat / fever if present.

Pneumonia Fast breathing No chest indrawingChild feeding well

Treated at home with oral Cotrimoxazole.reassess after 2 days improvement shown by decreased resp rate ,fever and better feeding.mother advised to continue Cotrimoxazole for 5 days.

Severe pneumoniaFast breathingChest indrawingNo central cyanosis, child able to drink.

Hospitalization required.Oxygen if resp rate > 70/min or if severe chest indrawing.Antibiotics given are Benzyl Pencillin iv/im 6hrly for 3 days.If the child improves change to oral amoxycillin or ampicillin for at least 5 days.Antibiotics cont. for at least 3 days after child is well.Switch to Chloramphenicol if no improvement after 48hrs of Benzyl pencillin.

Very severe diseaseYoung infants < 2 monthsSuspect pneumonia / sepsis/meningitis if the infant has any of the following danger signs:

Stopped feeding well.Convulsions.Abnormally sleepy / difficult to wake.Stridor in a calm child.Wheezing / grunting.Severe chest indrawing.Central cyanosis.Apnoea.

Treatment AdmissionOxygenCholoramphenicol im / iv 6th hrly; 3-5 days.If better- change to oral; totla of at least 10 days. Alternatively benzyl pencillin + aminoglycoside.Treat wheezing if presentReassess twice daily.

Thank you

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