| Pulse oximetry for detection of hypoxaemia | |||
| Pulse oximetry is recommended to determine the presence of hypoxaemia and to guide administration of oxygen therapy in infants and children with hypoxaemia. | Strong | Low | |
| Clinical signs for detection of hypoxaemia in children | |||
| a) Use pulse oximetry wherever possible for the detection of hypoxaemia in children with severe, lower respiratory infections. If oximetry is not available, then the following clinical signs could be used to guide the need for oxygen therapy: — central cyanosis — nasal flaring — inability to drink or feed (where this is due to respiratory distress) — grunting with every breath — depressed mental state (i.e. drowsy, lethargic) | Strong | Low | |
| b) In some situations and depending on the overall clinical condition, children with the following less-specific signs may also need oxygen: — severe lower chest wall indrawing — respiratory rate of 70/min or above — head nodding | Strong | Very Low | |
| Oxygen therapy in treatment of hypoxaemia | |||
| a) Children with hypoxaemia should receive appropriate oxygen therapy. | Strong | Low | |
| b) Effective oxygen delivery systems should be a universal standard of care, and should be made more widely available. | Strong | expert opinion | |
| Thresholds for administering oxygen therapy | |||
| a) Administering oxygen therapy should be guided by pulse oximetry where available and thresholds for giving oxygen may vary depending on the altitude. | Strong | Very Low | |
| b) Children living at ≤ 2500 m above sea level should receive oxygen therapy if their oxygen saturation is ≤ 90%, as measured by pulse oximetry. | Strong | Very Low | |
| c) In children living at high altitude (> 2500m above sea level), the normal oxygen saturation is lower than those living at sea level. At these altitudes, a lower level of saturation, such as SpO2 ≤ 87%, could be used as a threshold for giving oxygen. | Strong | Very Low | |
| Oxygen delivery methods | |||
| a) Nasal prongs are the preferred method for delivering oxygen in infants and children under 5 years of age with hypoxaemia who require oxygen therapy. | Strong | Moderate | |
| b) Where nasal prongs are not available, nasal or nasopharyngeal catheters could be used as alternative delivery methods. Face masks or head-boxes are not recommended. | Strong | Moderate | |
| Criteria for starting and stopping oxygen therapy | |||
| a) Children with hypoxaemia should be closely monitored using pulse oximetry. | Strong | Very Low | |
| b) Oxygen therapy should be discontinued when oxygen saturation remains stable above recommended levels of 90% (≤ 2500M above sea level) or 87% (> 2500M above sea level) for at least 15 minutes on room air in a clinically stable child. | Strong | Very Low |
Common causes of fever
| Antibiotics for treatment of acute bacterial meningitis | |||
| a) Children with acute bacterial meningitis should be treated empirically with 3rd generation cephalosporins. — Ceftriaxone: 50mg/kg per dose IV every 12 hours or 100 mg/kg once daily, or — Cefotaxime: 50mg/kg per dose every 6 hours for 10–14 days. | Strong | Moderate | |
| b) Where it is known that there is no significant resistance to chloramphenicol and beta lactam antibiotics among bacteria-causing meningitis follow national guidelines or choose any of the following two regimens: — Chloramphenicol: 25 mg/kg IM (or IV) every 6 hours plus ampicillin: 50 mg/ kg IM (or IV) every 6 hours OR — Chloramphenicol: 25 mg/kg IM (or IV) every 6 hours plus benzyl penicillin: 60 mg/kg (100 000 units/kg) every 6 hours IM (or IV). | Conditional | Moderate | |
| 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 | Low | |
| 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 | Low | |
| Topical antibiotics for treatment of chronic suppurative otitis media (CSOM) | |||
| a) Children with chronic suppurative otitis media (CSOM) should, in addition to aural toilet by dry wicking, be treated with instillation of drops containing quinolones (such as ciprofloxacin, norfloxacin, ofloxacin) three times daily for two weeks. | Strong | Low | |
| b) Children who fail to respond to treatment should be referred for further evaluation for other causes of CSOM, especially tuberculosis. | Strong | expert opinion | |
| Topical antiseptics for treatment of chronic suppurative otitis media | |||
| Topical antiseptics and steroids should not be used for the treatment of CSOM in children. | Strong | Low | |
| Topical steroids for treatment of chronic suppurative otitis media | |||
| Topical steroids should not be used in treating CSOM. | Weak | Very Low | |
| Antibiotics for treatment of Typhoid Fever | |||
| a) Children with typhoid fever should be treated with a fluoroquinolone (i.e. Ciprofloxacin, Gatifloxacin, Ofloxacin, and Perfloxacin) as a first line treatment for 7–10 days. — Ciprofloxacin: orally 15 mg/kg/dose twice daily for 7–10 days. | Strong | Moderate | |
| b) If the response to treatment is poor, consider drug-resistant typhoid, and treat with a second line antibiotic like 3rd generation cephalosporins or azithromycin. — Cetriaxone (IV): 80 mg/kg per day for 5–7 days, OR — Azithromycin: 20 mg/kg per day for 5–7 days. | Strong | Moderate | |
| c) Where drug resistance to antibiotics among salmonella isolates is known, follow the national guidelines according to local susceptibility data. | Strong | Moderate |
Dysentery
| Antibiotics for treatment of dysentery | |||
| a) Children with diarrhoea and blood in stool (i.e. dysentery) should be treated with ciprofloxacin as a first line treatment. Ceftriaxone should be given as a second line treatment in severely ill children where local antimicrobial sensitivity is not known. — Ciprofloxacin: 15 mg/kg/dose twice daily for 3 days — Ceftriaxone: 50–80 mg/kg daily for 3 days | Strong | Low | |
| b) Where local antimicrobial sensitivity is known, local guidelines should be followed. | Strong | Low |
