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ARI CONTROL PROGRAME

Dr.Vinu A Thomas

INTRODUCTION
Commonest

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

years.

are intended for use in children under 5

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 criteria


Respiratory

rate fast breathing


Chest 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 criteria


Chest 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
Very

pneumonia

severe disease

No pneumonia
No

fast breathing
No chest indrawing
Feeding 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 indrawing
Child 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 pneumonia

Fast breathing
Chest indrawing
No 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 disease


Young

infants < 2 months


Suspect 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
Admission
Oxygen
Choloramphenicol

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 present
Reassess twice daily.

Thank you