IMCI SEssion 4 - Main Symptoms

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Main Symptoms- cough or difficult breathing- diarrhea- fever- ear problems

Session 4

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Learning Objectives

By the end of this session, the students will be able to:(1) recall the anatomy and pathophysiology;

(2) recognize the symptoms and signs;

(3) assess and classify symptoms and signs;

(4) identify the correct treatment and when to refer;

(5) provide counseling; and

(6) specify necessary follow-up care

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Cough or Difficult Breathing

Session 4-a

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•Nasal passages •Windpipe or trachea •Lungs

Parts of the Respiratory System

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Inside the alveolus

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ASK: Does the child have cough or difficult breathing?

If YES

IF YES, ASK:•For how long?

LOOK, LISTEN, FEEL:•Count the breaths in one minute•Look for chest indrawing•Look and listen for stridor

Child must be calm

If the child is: Fast breathing is: 2 mos – 12 mos. 50 breaths/min or more 12 mos – 5 yrs 40 breaths/min or more

Classify child’s illness using the color-coded classification table for cough or difficult breathing

If NO

Ask about next main

symptoms:diarrhea, fever, ear problems


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Video of child with chest indrawing

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Video of child with stridor

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•Any general danger sign or•Chest indrawing or•Stridor in a calm child

SEVERE PNEUMONIA OR VERY SEVERE DISEASE

Give first dose of an appropriate antibioticRefer URGENTLY to hospital

•Fast breathing PNEUMONIA

Give an appropriate oral antibiotic for 5 daysSoothe the throat and relieve the cough with a safe remedyAdvise mother when to return immediatelyFollow-up in 2 days

No signs of pneumonia or very severe disease

NO PNEUMONIA: COUGH OR COLD

If coughing > 30 days, refer for assessmentSoothe the throat and relieve the cough with a safe remedyAdvise mother when to return immediatelyFollow-up in 5 days if not improving

SIGNS CLASSIFY AS IDENTIFY TREATMENT

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Treatment

Soothe the Throat, Relieve the Cough with a Safe RemedySafe remedies to recommend:

Breastmilk for exclusively breastfed infant

tamarind, calamansi, ginger

Harmful remedies to discourage:Codeine cough syrupOther cough syrupsOral and nasal decongestants

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Treatment for Pneumonia or Very Severe Disease

CotrimoxazoleGive 2 times daily

for 5 days

AmoxycillinGive 3 times daily

for 5 days

Age orWeight

Adulttab.

80mgTMP

400 mgSMX

Syrup40 mgTMP

200 mgSMX

Tablet

250 mg

Syrup

125mg/ 5 ml

2 -12 mos 1/2 5.0 ml. 1/2 5.0 ml

12mos-5yrs 1 7.5 ml 1 10 ml.

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Vitamin A Supplementationfor Severe Pneumonia or Very Severe Disease

Vitamin A CapsuleAge

100,000 IU 200,000 IU

6 to 12 mos. 1 capsule ½ capsule

12 mos-5 yrs 2 capsules 1 capsule

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DIARRHEA

Session 4-b

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Anatomy of the Gastrointestinal System

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DiarrheaFor ALL sick children ask the mother about the child’s problem, check for general danger signs,ask about cough or difficult breathing and then

ASK: DOES THE CHILD HAVE DIARRHOEA?

If NO If YES

Does the child have diarrhoea?

IF YES, ASK: LOOK, LISTEN, FEEL:œFor how long? œLook at the child’s general condition. Is the child:œIs there blood in thestool Lethargic or unconscious? Restless or irritable?œLook for sunken eyes.

œOffer the child fluid. Is the child: Not able to drink or drinking poorly? Drinking eagerly, thirsty?

œPinch the skin of the abdomen. Does it go back: Very slowly (longer than 2 seconds)? Slowly?

CLASSIFY the child’s illness using the colour-coded classification tables for diarrhoea.

Then ASK about the next main symptoms: fever, ear problem, and CHECK for malnutrition andanaemia, immunization status and for other problems.

Classify DIARRHOEA

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DIARRHEA

Does the child have diarrhea?IF YES, ASK:For how long?Is there blood in the stool?

LOOK, LISTEN, FEEL: Look at the child’s general

condition, is the child: Lethargic or unconscious? Restless or irritable? Look for sunken eyes Offer the child fluid. Is the

child: Not able to drink or drinking

poorly? Drinking eagerly, thirsty?

Pinch the skin of the abdomenDoes it go back: Very slowly (> than 2 secs)?Slowly?

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Video of a child with sunken eyes

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Video of Skin Pinching

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Two of the following signs:Lethargic or unconsciousSunken eyesNot able to drink or drinking poorlySkin pinch goes back very slowly

SEVERE

DEHYDRATION

If child has no other severe classification:

— Give fluid for severe dehydration (Plan C).

OR

If child also has another severe classification:

— Refer URGENTLY to hospital with mother giving frequent sips of ORS on the way.

Advise the mother to continue breastfeeding

If child is 2 years or older and there is cholera in your area, give antibiotic for cholera.

Two of the following signs:Restless, irritableSunken eyesDrinks eagerly, thirstySkin pinch goes back slowly

SOME

DEHYDRATION

Give fluid and food for some dehydration (Plan B).If child also has a severe classification:

— Refer URGENTLY to hospital with mother

giving frequent sips of ORS on the way.

Advise the mother to continue breastfeedingAdvise mother when to return immediately.Follow-up in 5 days if not improving.

Not enough signs to

classify as some or

severe dehydration. NO DEHYDRATION

Give fluid and food to treat diarrhoea at home (Plan A).

Advise mother when to return immediately.

Follow-up in 5 days if not improving.

CLASSIFICATION TABLE FOR DEHYDRATION

SIGNS CLASSIFY ASIDENTIFY TREATMENT

(Urgent pre-referral treatments are in bold print.)

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No Dehydration

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Some Dehydration

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Severe Dehydration

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Tell the Mother:

(a) Breastfeed frequently and longer for each feed.

(b) If the child is exclusively breastfed, give ORS or clean water in addition to breastmilk.

(c) If the child is NOT exclusively breastfed, give 1 or more of the following:ORSFood-based fluidsClean Water

No Dehydration

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Treatment Plan A

Age Amount of Fluid Type of Fluid

< 2 yrs 50-100 ml (¼-½ cup) after each loose stool2-10 yrs 100-200 ml (½-1 cup) after each loose stool

ORS, rice water, yogurt, soup with salt

No Dehydration

• Give frequent small sips from a cup.

• If the child vomits, wait 10 minutes. Then continue, but more slowly.

• Continue giving extra fluids until the diarrhea stops.

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Give frequent small sips from a cup. If the child vomits, wait 10 minutes. Then

continue, but more slowly. Continue giving extra fluids until the

diarrhea stops. Reassess after 4 hours and classify the

child for dehydration.

Some Dehydration

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If the mother must leave before completing treatment:show her how to prepare the ORS solution at home.show her how much to give to finish the 4 hour treatment at homegive her enough ORS packets to complete rehydration.

Some Dehydration

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Treatment Plan B (Determine amount of ORS to be given in 4 hours)

Age Up to 4 mos 4mos - 12mos 12mos – 2years 2 years – 5years

Some Dehydration

< 6kg 6 - < 10kg 10 - <12kg 12-19kg 200-400 400-700 700-900 900-1400

• The approximate amount of ORS can also be calculated by multiplying the child’s weight (in kg) by 75.

WEIGHT In ml

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Severe Dehydration

Can you give Intravenous fluids (IV) immediately?

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Severe Dehydration

Treatment Plan CTo treat severe dehydration (IV fluid: pLRS)

Age Initial Phase Subsequent Phase (30 ml/kg) (70 ml/kg)

Infants (<12 mos) 1 hour *5 hours

Older children 30 minutes* 2½ hours

*Repeat once if radial pulse is still very weak or imperceptible.

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Reassess the child every 1-2 hours. If hydration status is not improving, give the IV drip more rapidly.

Also give ORS (5ml/kg/hr) as soon as the child can drink.

Reassess the infant after 6 hours & a child after 3 hours. Classify dehydration.

Severe Dehydration

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If trained to use a nasogastric tube for

rehydration?

Severe Dehydration

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Start hydration by tube (or mouth) with ORS solution. Give (20ml/kg/hr) for 6 hours. (Total of 120ml/kg)

Reassess the child every 2 hours.– If there is repeated vomiting or increasing abdominal

distention, give the fluid more slowly.– If hydration status is not improving after 3 hours, send

the child for IV therapy.

After 6 hours, reassess the child. Classify dehydration.

Severe Dehydration

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Dehydration present SEVERE

PERSISTENT

DIARRHOEA

Treat dehydration before referral unless the child has another severe classification.Refer to hospital.

No dehydration PERSISTENT

DIARRHOEA

Advise the mother on feeding a child who has PERSISTENT DIARRHOEA.Follow-up in 5 days.



CLASSIFICATION TABLE FOR PERSISTENT DIARRHEA

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After 5 days: Ask: If the diarrhoea has NOT stopped (3 or more

stools) do a full reassessment, give the treatment, then refer to hospital.

If the diarrhoea has stopped (< 3 stools per day) Tell the mother to follow the usual feeding recommendations for the child’s age.

Persistent Diarrhea

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Blood in the stool

DYSENTERY

Treat for 5 days with an oral antibiotic recommended for Shigella in your area.Follow-up in 2 days.

CLASSIFICATION TABLE FOR DYSENTERY



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After 2 days:Ask: if the child is dehydrated, treat hydration.

if the number of stools, amount of stools, fever, abdominal pain or eating is same or worse: Change to 2nd line antibiotics & give for 5 days. Advise to return in 2 days.

Dysentery

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EXCEPTIONS:

If the child is less than 12 months old or was dehydrated on the 1st visit or had measles within the last 3 months. REFER TO HOSPITAL.

If fewer stools, less blood in stools, less fever, less abdominal pain & eating better, continue antibiotics.

Dysentery

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Session 4-c

Fever

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Assess FEVER

A child has the main symptom of fever if:

– the child has history of fever– the child feels hot– the child has an axillary temperature of

37.5 or above

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Does the child have fever?(by history, or feels hot or temperature 37.5C and above)

Decide Malaria RiskAsk: Does the child live in a malaria area?

Has the child visited malaria area in the past 4 weeks?

If yes to either, obtain a blood smear.

Then Ask: For how long does the child has fever?

If >7 days, has the fever been present everyday?

Has the child had measles within the last 3 months?

Look and Feel: Look and feel for stiff neck. Look for runny nose

Look for signs of Measles:• Generalized rash.• One of these: cough, runny nose or

red eyes

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If the child has measles now or within the last three months:

Look for mouth ulcers.– Are they deep and extensive?

Look for pus draining from the eye.

Look for clouding of the cornea.

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Then Ask: Has the child had any bleeding

from the nose or gums or in the vomitus or stools?

Has the child had black vomitus or stools?

Has the child had abdominal pain?

Has the child been vomiting?

Look and Feel: Look for bleeding from nose or

gums.

Look for skin petechiae Feel for cold clammy extremities.

If none of the above ASK or LOOK and FEEL signs are present and the child is 6 months or older and fever present for more than 3 days.

Perform Torniquet Test.

Decide Dengue Risk: Yes or NoIf Dengue Risk:

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Decide Malaria Risk:


Decide Dengue Risk: Yes or No

If Dengue Risk:

Classify FEVER

Malaria Risk (including travel to malaria area)

No Malaria Risk

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Deciding Malaria Risk

Malaria is caused by parasites in the blood called “plasmodia”– “Plasmodium falciparum”

Transmitted by Anopheles mosquito

Know the malaria risk in your areas.

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Malaria Risk Areas

1. Palawan

2. Davao Oriental

3. Davao del Norte

4. Compostela Valley

5. Tawi-tawi

6. Sulu

7. Agusan del Sur

8. Mindoro Occidental

9. Kalinga Apayao

10. Agusan del Norte

11. Isabela

12. Cagayan

13. Quezon

14. Ifugao

15. Zamboanga del Sur

16. Bukidnon

17. Misamis Oriental

18. Quirino

19. Mountain Province

20. Basilan

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Classify FEVER

Classify FEVER

Malaria Risk (including travel to malaria area)

No Malaria Risk

Malaria Risk Any general danger sign or Stiff Neck

VERY SEVERE FEBRILE DISEASE/MALARIA

Blood smear (+)If blood smear not done:NO runny nose and, NO measles, and NO other

causes of fever

MALARIA

Blood smear (-), orRunny nose, orMeasles orOther causes of fever.

FEVER:

MALARIA UNLIKELY

No Malaria Risk Any general danger sign or Stiff Neck

VERY SEVERE

FEBRILE DISEASE

No sign of very severe

febrile disease

FEVER:

NO MALARIA

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Malaria Risk

Any general danger

sign or Stiff Neck

VERY SEVERE FEBRILE DISEASE

/MALARIA

Give first dose of Quinine (under medical supervision or if a hospital is not accessible withing 4 hours)Give first dose of appropriate antibiotics.Treat the child to prevent low blood sugar.Give one dose of Paracetamol in health center for

high fever (38.5C or above.)Send a blood smear with the patient.

Refer URGENTLY to a hospital.

Blood smear (+)If blood smear not

done:NO runny nose and, NO measles, and NO other causes of fever

MALARIA

Treat the child with an oral antimalarial.Give one dose of Paracetamol in health center for

high fever (38.5C or above.)Advise mother when to return immediately.Follow up in 2 days if fever persists.If the fever is present every day for more than 7 days, refer for assessment.

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Malaria Risk

Blood smear

(-), or Runny nose,

or Measles or Other causes

of fever.

FEVER:

MALARIA UNLIKELY

Give one dose of Paracetamol in

health center for high fever (38.5C

or above.) Advise mother when to return

immediately. Follow up in 2 days if fever persists. If the fever is present every day for

more than 7 days, refer for

assessment.Treat other causes of fever.

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TREAT THE CHILD: Antimalarial Agents

Give an Oral Antimalarial1st line Antibiotics: Chloroquine and Primaquine2nd line Antibiotics: Sulfadoxine and Pyrimethamine

If Chloroquine:The child should be watched closely for 30 minutes. If the child vomits, give another dose.

Itching is a possible side effect of the drug.

If Sulfadoxine and Pyrimethamine:Give single dose in health center.

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Antimalarial AgentsCHLOROQUINE

Give for 3 days

PRIMAQUINE

Single dose for P.

falciparum

PRIMAQUINE

Daily for 14 days for P.

vivax

SULFADOXINE + PYRIMETHAMINE

Single dose

AGE Tablet (150mg base)

Tablet(15mg base)

Tablet(15mg base)

Tablet(500mg Sulfadoxine 25mg

Pyrimethamine)Day 1 Day 2 Day 3

2 months up to 5 months (4 - <7kg) ½ ½ ½ 1/4

5 months up to 12 months (7 - <10kg) ½ ½ ½ 1/2

12 months up to 3 years (10 - <14kg) 1 1 ½ 1/2 1/4 3/4

3 years up to 5 years (14 – 19kg) 1½ 1½ 1 3/4 1/2 1

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Chloroquine is given for 3 days.

Explain to the mother that itching is a possible side effect. It is NOT dangerous. The mother should continue to give the drug.

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If the species of malaria is identified through blood smear, give the following:

– P. falciparum – single dose Primaquine with the first dose of Chloroquine

– P. vivax – first dose of Primaquine with Chloroquine and give mother enough for one dose each day for the next 13 days.

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If you do not have the blood smear or you do not know which species of malaria is present, treat as P. falciparum.

Do not give Primaquine to children under 12 months of age.

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TECHNICAL UPDATES: Antimalarial Agents

TECHNICAL BASIS: Artemisinin Based Combination TherapiesBased on available safety and efficacy data, the following therapeutic options are available and have potential for deployment (in prioritized order) if costs are not an issue: Arthemether – lumefantrine (Coarthem TM) Artesunate (3 days) + amodiaquine Artesunate (3 days) + SP in areas where SP remains high SP + Amodiaquine in areas where both SP and Amodiaquine remain high. This mainly limited to West Africa.

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TECHNICAL UPDATES: Antimalarial Agents

Administer intramuscular antibiotic if the child cannot take an oral antibiotic

Quinine for severe malaria

Breastmilk or sugar to prevent low blood sugar.

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Give an Intramuscular Antibiotic

A child may need an antibiotic before he leaves for the hospital, if he/she:– is not able to drink or breastfeed– vomits everything– has convulsions– is abnormally sleepy or difficult to awaken

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Give an Intramuscular Antibiotic

Age or Weight CHLORAMPHENICOLDose: 40 mg/kg

Add 5 ml sterile water to vial containing 1000mg = 5.6 ml at 180mg/ml

2 – 4 months (4 - <6kg) 1 ml = 180 mg

4 – 9 months (6 - <8kg) 1.5 ml = 270 mg

9 – 12 months (8 -10 kg) 2 ml = 360 mg

1 – 3 years (10 - <14kg) 2.5 ml = 450 mg

3 – 5 years (14 – 19 kg) 3.5 ml = 630 mg

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Give Quinine for Severe Malaria

Quinine is the preferred because it is rapidly effective.

Quinine is more safe and effective than intramuscular Chloroquine.

Possible side effects of Quinine injections are: sudden drop in blood pressure, dizziness, ringing in the ears and a sterile abscess.

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For children being referred with very severe febrile disease/Malaria:

– Give the 1st dose of IM Quinine and refer the child urgently to the hospital

If referral is not possible:– Give the 1st dose of IM Quinine– The child should remain lying down for 1 hour– Repeat the Quinine injection 4 to 8 hours later, and then every 12

hours until the child is able to take an oral antimalarial.– Do not continue Quinine injection for more than 1 week.– DO NOT GIVE QUININE TO A CHILD LESS THAN 4 MONTHS

OF AGE.

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Age or WeightINTRAMUSCULAR QUININE

300 mg/ml (In 2 ml ampules)

4 months – 12 months

(6 - <10kg)0.3 ml

12 months – 2 years

(10 - <12kg)0.4 ml

2 – 3 years

(12 - <14kg)0.5 ml

3 – 5 years (14 – 19kg) 0.6 ml

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TREAT THE CHILD: To Prevent Low Blood Sugar

If the child is able to breastfeed:– Ask the mother to breastfeed the child.

If the child is not able to breastfeed but is able to swallow:– Give expressed breastmilk or breastmilk

substitute. If neither is available, give sugar water. Give 30 – 50 ml of milk or sugar water before departure.

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TREAT THE CHILD: To Prevent Low Blood Sugar

To make Sugar Water:

Dissolve 4 level teaspoons of sugar (20 grams)

in a 200 ml cup of clean water.

If the child is not able to swallow:– Give 50 ml of sugar water by nasogastric tube.

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TREAT THE CHILD: Paracetamol for High Fever

PARACETAMOL

Age or WeightTablet

(500mg)

Syrup

(120mg/5ml)

2 months up to 3 years (4 - <14kg)

1/4 5ml (1 tsp)

3 years up to 5 years (14 – 19 kg)

1/2 10 ml (2 tsp)

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No Malaria Risk

Any general danger sign or Stiff Neck

VERY SEVERE

FEBRILE DISEASE

Give first dose of appropriate antibiotics.Treat the child to prevent low blood sugar.Give one dose of Paracetamol in health center for high fever (38.5C or above.)Refer URGENTLY to a hospital.

No sign of very severe febrile disease

FEVER:

NO MALARIA

Give one dose of Paracetamol in health center for high fever (38.5C or above.)Advise mother when to return immediately.Follow up in 2 days if fever persists.If the fever is present every day for more than 7 days, refer for assessment.

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Decide Malaria Risk:If the child has measles now or within the last threemonths:


If Dengue Risk:

Classify FEVER

Severe Complicated Measles

Measles with Eye or Mouth Complications

Measles

If dengue Risk, classify page 77 of the module Assess and Classify the Sick Child Age 2 months up to 5 years

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Look for mouth ulcers: are they deep and extensiveLook for pus draining from the eyeLook for clouding of the cornea


If measles now or within last three months, classify

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Measles

Fever and generalized rash are the main signs of measles.

Highly infectious. Over crowding and poor housing increases

the risk of developing measles. Caused by a virus that infects the layers of

cells that line the lung, gut, eye, mouth and throat.

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Measles

Complications of measles occur in about 30% of all cases– diarrhea (including dysentery and persistent

diarrhea)– pneumonia and stridor– mouth ulcers– ear infection– severe eye infection (which may lead to corneal

ulceration and blindness) Encephalitis occurs in about 1/1000 cases. (look for

danger signs such as convulsions, abnormally sleepy or difficult to awaken)

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Classify MEASLESClouding of the corneaDeep extensive mouth ulcers

SEVERE COMPLICATED

MEASLES

Give Vitamin AGive first dose of an appropriate

antibioticsIf clouding of the cornea or pus draining

from the eye, apply Tetracycline eye

ointmentRefer URGENTLY to the hospital

Pus draining from the eyeMouth ulcers

MEASLES WITH EYE OR MOUTH

COMPLICATIONS

Give Vitamin AGive first dose of an appropriate

antibioticsIf pus draining from the eye, apply

Tetracycline eye ointmentIf mouth ulcers, teach the mother to treat

with gentian violetFollow up in two days

Measles now or within the last 3 months

MEASLES Give Vitamin A

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Children with Measles

71 Koplik’s spots

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TREAT THE CHILD: Give Vitamin A

TREATMENT Give one dose of Vitamin A in the Health Center

SUPPLEMENTATION Give one dose of Vitamin A in the Health Center

if:– Child is 6 months of age or older– Child has not received a dose of Vitamin A in

the past 6 months

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TREAT THE CHILD: Give Vitamin A

AGEVitamin A Capsule

100,000 IU 200,000 IU

2 – 6 months 50,000 IU

6 – 12 months 1 cap 1/2 cap

1 – 5 years 2 caps 1 cap

200,000 IU = 6 drops 100,000 IU = 3 drops

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Decide Malaria Risk:

If the child has measles now or within the last threemonths:

Classify FEVER

Severe DHF

Fever; DHF Unlikely

Torniquet Test 1.3gp

Torniquet Test 2.3gp


If Dengue Risk:

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Tourniquet Test

Inflate blood pressure cuff to a point midway between systolic and diastolic pressure for 5 minutes

Positive test: 20 or more petechiae per 1 inch² (6.25 cm²)

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Classify DENGUE HEMORRHAGIC FEVER

bleeding from the nose or gums Bleeding in the vomitus or stoolsSkin petechiaeCold clammy extremitiesCapillary refill more than 3 secondsabdominal pain or Vomiting orPositive torniquet test

SEVERE DENGUE HEMORRHAGIC

FEVER

If skin petechiae or abdominal pain or vomiting or positive torniquet test are the only positive signs, give ORSIf any other signs of bleeding are present, give fluids rapidly as in Plan CTreat the child to prevent low blood sugarRefer all chioldren URGENTLY to the hospitalDO NOT GIVE ASPIRIN

No signs of severe dengue hemorrhagic fever

FEVER; DENGUE HEMORRHAIC FEVER

UNLIKELY

Advise mother when to return immediatelyFollow up in 2 days if fever persists or child shows signs of bleeding.DO NOT GIVE ASPIRIN

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Dengue Hemorrhagic Fever

A child with dengue hemorrhagic fever or dengue shock syndrome may present severely hypotensive with disseminated intravascular coagulation (DIC), as this severely ill PICU patient did. Crystalloid fluid resuscitation and standard DIC treatment are critical to the child's survival.

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Delayed capillary refill may be the first sign of intravascular volume depletion. Hypotension usually is a late sign in children. This child's capillary refill at 6 seconds was delayed well beyond a normal duration of 2 seconds.

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Session 4-d

Ear Problem

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Assess EAR PROBLEM

A child with ear problem is assessed for:

– Ear pain– Ear discharge

If present, how long has the child has had ear discharge

– Tender swelling behind the ear, a sign of mastoiditis

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Assess EAR PROBLEM

Then Ask: Does the child have an ear problem?

If YES, ASK: Is there ear pain? Is there ear discharge? If yes, for how long?

LOOK and FEEL: Look for pus draining from the ear. Feel for tender swelling behind the ear.

Ask about ear problem in ALL sick children.

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Classify EAR PROBLEM

Tender swelling behind the ear

MASTOIDITIS Give the first dose of an appropriate antibioticsGive first dose of Paracetamol for painRefer URGENTLY to hospital

Pus is seen draining from the ear and discharge is reported for less than 14 days, orEar pain

ACUTE EAR INFECTION

Give an antibiotic for 5 days. (Amoxicillin)*Give Paracetamol for pain.Dry the ear by wicking.Follow up in 5 days.

Pus is seen draining from the ear and discharge is reported for 14 days or more.

CHRONIC EAR INFECTION

topical quinolone ear drops for at least two weeks Dry the ear by wicking.Follow up in 5 days.

No ear pain and no pus is seen draining from the ear.

NO EAR INFECTION No additional treatment.

*Oral amoxicillin is a better choice for the management of suppurative otitis media in countries where antimicrobial resistance to cotrimoxazole is high.

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TECHNICAL UPDATES: Chronic Suppurative Otitis Media

TECHNICAL BASIS: aural toilet combined with antimicrobial

treatment is more effective than aural toilet alone

topical antibiotics were found to be better than systemic antibiotics in resolving otorrhea and eradicating middle ear bacteria

topical quinolones were found to be better than topical non-quinolones

– topical ofloxacin or ciprofloxacin vs intramuscular gentamicin, topical gentamicin, tobramycin or neomycin-polymyxin

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TECHNICAL UPDATES: Acute Otitis Media

TECHNICAL BASIS: oral amoxicillin as the better choice for the

management of acute ear infection in countries where antimicrobial resistance to cotrimoxazole is high.

reduces the risk of mastoiditis in populations where it is more common

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TREAT THE CHILD: Dry the Ear by Wicking

Dry the ear at least 3 times daily.– Roll a clean absorbent cotton or soft tissue

paper into a wick.– Place the wick in the child’s ear.– Remove the wick when wet.– Replace the wick with a clean one and

repeat these steps until the ear is dry. Do not use a cotton-tipped applicator, a stick

or a flimsy paper that will fall apart in the ear.

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TREAT THE CHILD: Dry the Ear by Wicking

Wick the ear 3 times daily. Use this treatment for as many days as it

takes until the wick no longer gets wet when put in the ear and no pus drains from the ear.

Do not place anything (oil, foil or other substances) in the ear between wicking treatments.

Do not allow the child to go into swimming.

IMCI SEssion 4 - Main Symptoms

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Transcript of IMCI SEssion 4 - Main Symptoms