Pediatric Care: Asthma, Infections, and Common Illnesses

Posted on Jan 12, 2025 in Agriculture

Asthma Management and Medication in Children

Medication Treatment:

  • Beclomethasone dipropionate 100 µg, 200 µg
  • Budesonide
  • Fluticasone propionate 100 µg

Monitoring and Dose Adjustment:

  • Asthma not controlled by fast-acting β-agonists: Follow up from initial visit to 1-3 months.
  • Asthma not controlled with low doses of inhaled glucocorticoids: Start to double the low dose, consider the use of leukotriene modifiers.
  • Asthma not controlled with low-dose, double-inhaled glucocorticoids: Consult a specialist.
  • Well-controlled asthma: Follow up every 3 months.
  • Exacerbations: Follow up every 2 weeks to 1 month.

Managing Exacerbations:

  • Home: Treatment with fast-acting β2-agonists, 1 puff with a spacer every 6 hours.
  • Hospital:
    • 24% oxygen by mask, aiming for O2 saturation of about 94%.
    • Salbutamol 2 puffs with a spacer or 2.5 mg with a nebulizer every 20 minutes for 1 hour.
    • In severe cases, 5 µg/kg bolus over 5 minutes followed by 5 µg/kg/hour continuous infusion.
    • Ipratropium bromide 2 puffs with a spacer every 20 minutes for 1 hour.
    • Oral prednisone 1-2 mg/kg/day for 5 days.
    • Intravenous methylprednisolone: Day 1: 1 mg/kg every 6 hours; Day 2: 1 mg/kg every 12 hours; Day 3 and beyond: 1 mg/kg per day.
    • Aminophylline loading dose: 6-10 mg/kg of lean body mass.
    • Maintenance dose: Adjust according to 0.9 mg/kg/hour.

Note: Avoid sedatives, mucolytics, physiotherapy, epinephrine, and intravenous magnesium sulfate.

Urinary Tract Infection (UTI) Treatments

Dosage (mg/kg):

  • Ceftriaxone 75 mg/kg IV every 12-24 hours
  • Cefotaxime 150 mg/kg IV every 6-8 hours
  • Ceftazidime 150 mg/kg IV every 6-8 hours
  • Gentamicin* 5-7.5 mg/kg IV every 8 hours
  • Cotrimoxazole 40/8 mg/kg (sulfa/TMP) orally every 12 hours
  • Nitrofurantoin 5-7 mg/kg orally every 8 hours
  • Amoxicillin 50 mg/kg orally every 8 hours
  • Cefadroxil 50 mg/kg orally every 8 hours
  • Cephalexin 50 mg/kg orally every 6 hours
  • Cefixime 8 mg/kg orally every 12 hours

UTI Prophylaxis

Dosage (mg/kg):

  • Nitrofurantoin 1-2 mg/kg orally every 24 hours
  • Cotrimoxazole 5-10 mg/kg (sulfa) / 1-2 mg/kg (TMP) orally every 24 hours
  • Cefadroxil* 10 mg/kg orally every 24 hours

*For infants under 6 months.

Diarrhea Treatment

Oral Rehydration: Glucose regulates sodium transport in the small intestine. Use a glucose-electrolyte hydration solution (mmol/L):

  • Na 90
  • K 20
  • Sodium citrate 30
  • Cl 80
  • Glucose 111

In children under 2 years with acute diarrhea unrelated to Vibrio cholerae, use a solution with:

  • Na 50-60
  • K 20-30
  • Sodium citrate 30
  • Cl 30-50
  • Glucose 111

Parenteral Rehydration: For the most severe cases of dehydration, especially when associated with malnutrition.

Antimicrobial Treatment for Acute Diarrhea:

  • Salmonella: Chloramphenicol, Cotrimoxazole, Cefotaxime
  • Shigella: Chloramphenicol, Quinolones, Cefixime
  • Vibrio cholerae: Tetracycline (for children over 8 years), Cotrimoxazole
  • Escherichia coli: Cotrimoxazole
  • Amebiasis: Metronidazole
  • Giardiasis: Metronidazole

Note: Do not use antiemetics or antidiarrheals like loperamide, kaolin-pectin, or pipenzolate. Avoid antispasmodics like domperidone and papaverine.

Vaccines

Rotavirus: A live attenuated vaccine of human origin, administered orally. Up to 100% efficacy against severe diarrhea. Administer 2 doses at 2 and 4 months of age. Protects 85% of infants against severe rotavirus and 100% efficacy against episodes of severe rotavirus gastroenteritis.

Common Childhood Illnesses

Measles: Symptomatic treatment and isolation.

Scarlet Fever: Treatment for eradication includes benzathine penicillin (600,000 to 1,200,000 UI) + a single dose of sodium penicillin. Macrolides orally for 10 days.

Rubella: Symptomatic treatment and isolation.

Chickenpox: Symptomatic treatment includes antipyretics and antihistamines. Acyclovir within the first 24 hours of rash initiation:

  • Children under 40 kg: 20 mg/kg orally 4 times a day for 5 days
  • Children over 40 kg: 800 mg orally 4 times a day for 5 days
  • Paracetamol: 10 mg/kg every 6 hours for children under 12 years; 650 mg every 6 hours for children over 12 years or over 40 kg (maximum dose 4 g per day)

Impetigo: Antibiotic treatment for eradication.

Herpetic Gingivostomatitis: Treatment with acetaminophen and acyclovir.

Parotitis: Symptomatic treatment.

Common Cold: Symptomatic treatment includes antipyretics and nasal saline irrigation. The use of antihistamines and vasoconstrictors is debated.

Pharyngitis: Bacterial eradication and alleviation of symptoms.