Paediatrics
LRTI in Infants (Viral and Bacterial)
بچوں میں سینے کا انفیکشن
Viral LRTI has a low-grade fever; bacterial LRTI has a high-grade fever. Both are graded mild, moderate or severe, and management depends on the grade. Severe cases go to tertiary care for admission.
- ICD-10
- —
- Source
- OPD handbook pp.172–176
- Status
- Draft
Not yet reviewed by a clinician. Check doses and brands against current national guidelines before use.
Symptoms
- Cough
- Fever (low grade in viral; high grade in bacterial)
- Chest crepitations on examination in moderate disease
Red flags Refer urgently if any are present
- Nasal flaring
- Intercostal / subcostal recessions
- Semi-conscious
- Reluctant to feed
Diagnosis
- Mild: chest clear, taking orally, no tachypnoea, fever and cough
- Moderate: chest crepts, taking orally, conscious, no chest recession
- Severe: nasal flaring, intercostal / subcostal recessions, semi-conscious, reluctant to feed
Treatment
Step 1 of 5
Mild
- Oral antibiotic
- Oral NSAIDs
- Expectorants
- Follow up if needed
Prescription
AzithromycinMacrolide antibiotic
Dose1 tsf OD (infant ~10 kg; sample for viral bronchiolitis)
Brand Syp Genthro 100 mg/5 mL
Also sold as Zithromax, Azomax, Azitma, Arzomic, Zyto, Genthro
Caution: QT prolongation; caution with other QT-prolonging drugs
Terbutaline (expectorant/bronchodilator syrup)Beta-2 agonist
Dose½+½+½ tsf (sample, 10 kg infant)
Brand Syp Britanyl
Also sold as Britanyl, Bricanyl, Muconyl
Step 2 of 5
Moderate
- IV antibiotics
- Oral NSAIDs
- Nebulization
- Expectorants
- Mother education
- Follow up
Prescription
Ceftriaxone3rd-generation cephalosporin
Dose1+1 (twice a day) for 3 days (sample, 1-year-old, 10 kg)
Brand Inj Ceftriaxone 250 mg
Also sold as Rocephin, Dayline, Oxidil
Resistance is widespread in Salmonella Typhi in Sindh and Punjab; use culture guidance.
Paracetamol (Acetaminophen)Analgesic / antipyretic
Dose1+1+1 (TDS)
Brand Syp Panadol 120 mg/5 mL
Also sold as Panadol, Calpol, Febrol, Pedrol, Calpol 6 Plus (250 mg/5 mL)
Caution: Do not exceed 4 g/day in adults or 60 mg/kg/day in children; Avoid in severe liver disease
Terbutaline (expectorant/bronchodilator syrup)Beta-2 agonist
Dose½+½+½ tsf
Brand Syp Britanyl
Also sold as Britanyl, Bricanyl, Muconyl
Normal saline nebulization (0.9%)Nebulization / mucolytic support
DoseNebulization with N/S four times a day for 10–15 minutes each
Brands Generic / hospital supply
Step 3 of 5
Severe
- Refer to tertiary care / consultant for admission
- IV antibiotics
- Oxygen
- Blood culture
- IV fluid
- Prop-up position
- Nebulization
- Chest physiotherapy
Step 4 of 5
Viral bronchiolitis (sample)
- Nebulization, steam; keep warm clothes on the child; return to the doctor if breathing is fast or the child is distressed (Urdu note)
Prescription
AzithromycinMacrolide antibiotic
Dose1 tsf OD (10 kg infant)
Brand Syp Genthro 100 mg/5 mL
Also sold as Zithromax, Azomax, Azitma, Arzomic, Zyto, Genthro
Caution: QT prolongation; caution with other QT-prolonging drugs
Ibuprofen + PseudoephedrineNSAID + decongestant
Dose1 tsf 1+1+1 (TDS)
Brand Syp Arinac Forte
Also sold as Arinac Forte, Arinac syrup
BetamethasoneCorticosteroid
Dose½+½ (morning, evening)
Brand Tab Betnisol 0.5 mg
Also sold as Betnisol, Betnelan
Terbutaline (expectorant/bronchodilator syrup)Beta-2 agonist
Dose½+½+½ tsf
Brand Syp Britanyl
Also sold as Britanyl, Bricanyl, Muconyl
Step 5 of 5
Home care and counselling (Urdu notes)
- Dress the child in warm clothes
- Give boiled eggs
- Use nebulization at home as taught; chest physiotherapy by patting the back after nebulization
- Review after 3 days
Paediatric dose reference from the book (TSF = teaspoonful = 5 mL)
- Syp Novidat 125 mg/5 mL (ciprofloxacin), 20 mg/kg in two divided doses: 1 y, 10 kg → 1+1 tsf; 4–5 y, 13–14 kg → 1½+1½; 6–7 y, 18–20 kg → 2+2.
- Syp Augmentin 312.5 mg/5 mL, 30 mg/kg TDS: 1 y, 10 kg → 1+1+1; 3–4 y, 13–14 kg → 1½+1½+1½; 6–7 y, 18–20 kg → 2+2+2.
- Syp Caricef 100 mg/5 mL (cefixime), 10 mg/kg OD: 1 y, 10 kg → 1 tsf daily; 3–4 y, 14–15 kg → 1½ tsf daily; 6–7 y, 18–20 kg → 2 tsf daily.
- Syp Genthro 100 mg/5 mL (azithromycin), 10 mg/kg OD: same as Caricef.
- Syp Brufen 100 mg/5 mL, 10 mg/kg TDS: same as Caricef but TDS (1 y, 10 kg → 1+1+1).
- Syp Tercica 100 mg/5 mL (dexibuprofen), 5–10 mg/kg TDS: 10 kg / 1 y → 1+1+1.
Sample prescription from the book (patient details removed)
- Infant, 17 months, 10 kg, fever and cough for 1 day, took oral; T 101 °F, pulse 124; chest crepitations +: Inj Ceftriaxone 250 mg 1+1 for 3 days; Syp Panadol 120 mg/5 mL 1+1+1; Syp Britanyl ½+½+½ tsf; nebulization with N/S four times a day for 10–15 minutes; chest physiotherapy; review after 3 days; warm clothes, boiled eggs.