Medicines recommended to prevent and manage the priority diseases at the community and health facility level

Transcription

1 s recommended to prevent and manage the priority diseases at the community and health facility level Shamim Qazi Department of Child and Adolescent Health and Development

2 Global Causes of Child Deaths Black et al. Lancet, 2010 WHO. The World Health Statistics 2010 Black et al. Lancet, % of under five deaths are associated with undernutrition

3 Background Main burden of infective diseases in children Pneumonia Diarrhoea Malaria Neonatal infections HIV TB

4 Diarrhoea ORS As specified (low osmolarity) 1 litre, 500 and 200 ml According to the dehydration status/guidelines Zinc Sulphate 10 or 20 mg FSOD 10 of each Once daily for 10

5 Pneumonia Low HIV setting Pneumonia (Fast breathing) Oral amoxicillin Oral cotrimoxazole 250 or 500 mg FSOD TMP 80+SMX 400mg; TMP 20+SMX 100 mg 10 of either Twice daily, 5 50mg/kg/day (3?) 8mg/kg/day (3?) Severe pneumonia (Chest Indrawing) Oral amoxicillin 250 or 500 mg FSOD 10 of either Twice daily, 5 Very severe pneumonia (danger signs) Oxygen, Ampicillin + gentamicin or ceftriaxone Cylinder/oxygen concentrators -500 mg or 1 G -20 mg or 40 mg/ml 500 mg or 1 G Variable Pack?? Single dose As needed Variable daily x mg/day 5

6 Pneumonia High HIV setting Pneumonia (Fast breathing) Oral amoxicillin 250 or 500 mg FSOD 10 of either Twice daily, 5 Severe pneumonia (Chest Indrawing) Ampicillin + gentamicin or ceftriaxone + cotrimoxazole -500 mg or 1 G -20 mg or 40 mg/ml -500 mg or 1 G Pack?? Single dose Variable daily x mg/day 5 Very severe pneumonia (danger signs) Oxygen, Ampicillin + gentamicin or ceftriaxone + cotrimoxazole Cylinder/oxygen concentrators -500 mg or 1 G -20 mg or 40 mg/ml -500 mg or 1 G Variable Pack?? Single dose As needed Variable daily x mg/day 5

7 Malaria Malaria (uncomplicated) Artemeter +Lumefantrine (FDC) Artesunate + amodiaquine (FDC) Variable FSOD For 3 day treatment 6x1 & 6x2 (30 blisters per box) 3 (25 blisters per box) Daily or twice daily x 3 Malaria (severe or pre-referral) Artesunate Quinine hydrochloride 60 mg Injection 152 mg/ml injection?50/pack 100 ampoules/pack 2.4 mg/kg iv, 3 doses, then daily; 20mg infusion then 10mg/kg 8 hourly Artesunate rectal 50, 100, 200 mg Suppositories 6 per pack 10 mg/kg dose

8 HIV HIV treatment AZT+3TC+NVP (< 3 years) AZT+3TC+EFV (>3 years) mg+50 mg FDC tablet, scored 2nd one not yet available 30 Once or twice daily HIV - Prophylaxis Isoniazid Cotrimoxazole 100 mg TMP 80+SMX 400mg; mg/kg mg TMP /day age related doses TMP 20+SMX 100 mg AZT or ZDV: Zidovudine NVP: Nevirapine 3TC: Lamivudine EFV:Efavirenz

9 HIV ARV Prophylaxis Breastfeeding population NVP Available: 10mg/ml/liquid &50 and 200 mg tablet Need 20 mg scored tablet 30 Variable according to weight and age Daily from birth until one week after all exposure to breastmilk Non breastfeeding population AZT or NVP AZT: 10mg/ml/liquid & 60/300 mg tablet, 100/250 mg cap 15? 45 Variable according to weight and age For 4-6 weeks All exposed infants AZT or NVP 15? 45 Variable according to weight and age For 4-6 weeks

10 Neonates Neonatal sepsis Ampicillin + gentamicin or ceftriaxone Procaine penicillin? -500 mg or 1 G -20 mg /ml 500 mg or 1 G?? Single dose Single dose -50 mg/kg x2 doses for 1 week and x3 doses for 2-4 wk mg/kg/day in 0-6 and mg/kg in 7-59 x mg/kg /day -40,000-60,000 units/kg/day Neonatal care Chlorhexidine 4% solution 500 ml Topical application Vitamin K Caffeine Hydrate 1 mg/1 ml, 10 mg/ml 20mg/ml injection or oral liquid?? Variable Variable mg x 1 at birth; 5mg/kg/day

11 Miscellaneous Child survival Vitamin A 100,000 units capsule variable 100,000 units every 6 months Pain Paracetamol Variable FSOD 5-10 supply 15 mg/kg 4-6 hours Tab mg Morphine 10 mg oral dosage form 5 Variable every 6 hours 10m/ml injection

12 TB Treatment intensive phase, 2 months Isoniazid Rifampicin Pyrazinamide ethambutol 4 component FDC, flexible oral solid dosage form containing Or product with same ratio 30 In this dose, weight based dosing, once daily Treatment, continuation phase, 4 months Isoniazid Rifampicin Pyrazinamide 3 component FDC, flexible oral solid dosage form containing Or 2 component FDC, flexible oral solid dosage form