Management of Lower Respiratory Tract Infections

Community acquired pneumonia (CAP) is an important cause of morbidity and mortality in children in developing countries. In most cases clinical assessment suffices for diagnosis of CAP. Chest radiology and tests to determine microbial etiology should be done only in severe cases/complicated cases/ non responding cases or in those with comorbidities. Young infants below the age of 3 months should preferably be treated as inpatients. For children older than 3 months amoxicillin in standard doses of 40 mg/Kg/day is satisfactory first line therapy for non severe pneumonia. The use of broad spectrum drugs such as oral third generation cephalosporins for these children should be discouraged owing to fear of antibiotic resistance. For second line therapy/inpatients, IV coamoxyclav, ceftriaxone, cefotaxime are good options. If infection with mycoplasma is suspected, macrolides should be added or substituted. The treatment recommendations discussed in this article may change overtime depending on the evolution of antimicrobial drug resistance in India. Supportive care including administration of oxygen where indicated is as important as antimicrobial therapy in management of CAP.