Table 1.
WHO criteria for presumptive antimicrobial treatment in children admitted to hospital
| WHO criteria | Recommended antimicrobial | Chapter, page of guidelines for care at first referral level8 |
|---|---|---|
| Sick young infant—any infant aged <2 months admitted to hospital (not included in this study) | Ampicillin plus gentamicin IV/IM or penicillin plus gentamicin IV/IM | 6.1, 75 |
| Meningo-encephalopathy—BCS<3 or stiff neck or bulging fontanelle or >2 convulsions in preceding 24 hours | Chloramphenicol plus ampicillin IV/IM or chloramphenicol plus penicillin IV/IM | 5.2, 62 |
| Malaria with shock*—positive slide for malaria plus shock† or BCS<3 or bulging fontanelle or >2 convulsions in preceding 24 hours | Chloramphenicol plus penicillin IV/IM | 5.1.1, 59† |
| Very severe pneumonia—cough/difficulty breathing plus multiple convulsions or coma or lethargy or vomiting everything or inability to drink or cyanosis or severe respiratory distress‡ | Chloramphenicol IV/IM or gentamicin plus penicillin IV/IM§ | 3.1.1, 30 |
| Severe pneumonia—cough/difficulty breathing plus lower chest indrawing or nasal flaring or grunting | Benzyl penicillin IV/IM | 3.1.2, 32 |
| Non-severe pneumonia—cough/difficulty breathing plus raised respiratory rate for age | Amoxycillin PO or co-trimoxazole PO | 3.1.3, 32 |
| Septicaemia—negative slide for malaria plus axillary temperature ≥37.5°C plus inability to drink/feed or lethargy or >2 convulsions in preceding 24 hours or vomiting everything | Chloramphenicol plus penicillin IV/IM | 5.4, 67 |
| Severe acute malnutrition—bilateral oedema or severe wasting or weight for height z-score <−3 | Co-trimoxazole PO or amoxycillin plus gentamicin¶ IM/IV | 7.2.5, 84 |
Where categories were used in analysis, children were assigned to one diagnostic category with priority to those higher in list.
BCS=Blantyre coma score; IM=intramuscular; IV=intravenous; PO=oral.
*“Malaria with shock or signs of meningitis” defined in WHO guidelines8; however, children with malaria and signs of meningitis will already be included in category above.
†Shock defined as capillary refill >3 seconds or cool peripheries or systolic blood pressure <50 mm Hg (WHO Pocket Book of Hospital Care for Children 6.2.1, 142).
‡Defined as oxygen saturation <90% or respiratory rate ≥70 breaths/minute.
§Recommended if chloramphenicol is not available.
¶Recommended if hypoglycaemia or hypothermia present or if child seems lethargic or “sickly.”