When the child improves (after at least 7 days of IV or IM antibiotics), continue cloxacillin orally four times a day for a total course of 3 weeks. Treat with cloxacillin (50 mg/kg IM or IV every 6 h) and gentamicin (7.5 mg/kg IM or IV once a day). The presence of septic skin pustules supports the diagnosis. aureus in cultured sputum or empyema fluid. This is suggested if there is rapid clinical deterioration despite treatment, by a pneumatocoele or pneumothorax with effusion on chest X-ray, numerous Gram-positive cocci in a smear of sputum or heavy growth of S. The commonest other possible diagnoses are: If the child has not improved after 2 days or if the child's condition has worsened, look for complications (see section 4.3) or alternative diagnoses. Nurses should check every 3 h that the nasal prongs are not blocked with mucus and are in the correct place and that all connections are secure. Discontinue oxygen if the saturation remains stable at > 90% (at least 15 min on room air). Remove oxygen for a trial period each day for stable children while continuing to use a pulse oximeter to determine oxygen saturation. If a pulse oximeter is not available, continue oxygen until the signs of hypoxia (such as inability to breastfeed or breathing rate ≥ 70/min) are no longer present. Give oxygen to all children with oxygen saturation 90%). Hyper-resonance on percussion of one side of the chest –Ģ–6-month-old child with central cyanosis –Ĭhest X-ray changes, but chest clear on auscultation –Įnsure continuous oxygen supply, either as cylinders or oxygen concentrator, at all times. Sudden onset, usually after major chest trauma – Sudden onset of stridor or respiratory distress –įocal areas of wheeze or reduced breath sounds Paroxysms of cough followed by whoop, vomiting, cyanosis or apnoea – Known or family history of allergy or asthmaĭiagnostic chest X-ray may show primary complex or miliary TB – Night cough or cough and wheeze with exercise – Recurrent episodes of shortness of breath or wheeze – Stony dullness to percussion (over the effusion) – Reduced movement on affected side of chest – Coarse crackles or bronchial breath sounds or dullness to percussion –

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