Bronchitis & Pneumonia Protocols

Clinical pathways for primary care management in adults and children.

Vitals & Physical Exam Filter

Evaluate for the presence of vital sign abnormalities or signs of consolidation/effusion.

Abnormal Vitals Checklist:

Tachycardia (HR > 100 beats/min)
Tachypnea (RR > 24 breaths/min)
Fever (Temperature > 38°C)
Hypoxemia (SpO₂ < 95%)

🟢 No Abnormal Vitals & Normal Exam

Acute Bronchitis Likely:

Antibiotics are NOT needed.
The majority of cases are self-limiting and viral.
Provide symptomatic treatment.
Consider bronchodilators if wheezing is present.

🔴 Any Vital Abnormality OR Exam Signs

Pneumonia Pathway:

Treat empirically as Pneumonia.
Perform a chest X-ray (CXR) as a baseline if available.
If CXR is unavailable and the patient is unstable, refer out.

📊 Interactive CRB-65 Calculator

Used to determine severity and need for hospitalization in adult pneumonia cases.

Confusion (New onset) Tachypnea (RR ≥ 30 breaths/min) Hypotension (SBP < 90 or DBP ≤ 60 mmHg) Age ≥ 65 years old

Other considerations for hospitalization: SpO₂ < 95%, significant comorbidities, or an inability to maintain oral intake.

💊 Recommended Adult Outpatient Dosage

Without Comorbidities

Antibiotic	Dosing	Duration	Status
Amoxicillin	500mg – 1000mg PO q8h	5 – 7 Days	Preferred
Doxycycline	100mg PO q12h	5 – 7 Days	Alternative

With Comorbidities*

Antibiotic	Dosing	Duration	Status
Amoxicillin/Clavulanate	625mg PO q8h	5 – 7 Days	Preferred
Doxycycline	100mg PO q12h	5 – 7 Days	Alternative
Azithromycin	500mg PO q24h	3 Days	Add if atypical suspected**

*Comorbidities: chronic heart, lung, liver or kidney disease, diabetes, alcoholism, malignancy or asplenia.

**Suspect atypical pathogens if extrapulmonary manifestations and diffuse infiltrations radiologically are present.

🦠 Outbreak & Pathogen Considerations

Influenza Outbreak

Suspect if acute fever and myalgia are present.

Oseltamivir 75mg PO q12h for 5 days is indicated for high-risk* patients regardless of symptom duration.

*High risk: Age <2 or ≥65, pregnant, immunosuppressed, chronic medical illness, or morbid obesity (BMI ≥ 40 kg/m²).

Pertussis Outbreak

Suspect if cough ≥ 2 weeks, paroxysms, post-tussive vomiting, or an inspiratory whoop are present.

Erythromycin Ethylsuccinate 800mg PO q12h for 14 days.

Always consider ruling out COVID-19 alongside these workflows.

👶 Pneumonia Diagnostic Criteria

Pneumonia in children is diagnosed based on the presence of fast breathing for age and/or chest indrawing.

Age-Specific Tachypnea Cut-offs:

< 2 months old: > 60 breaths/min
2 to 12 months old: > 50 breaths/min
12 months to 5 years old: > 40 breaths/min

Children with a runny nose and cough but no signs of severity or tachypnea do not have pneumonia and should receive home care advice without antibiotics.

🔍 Severity Stratification

Mild Pneumonia (2mo – 5yr)

Tachypnea present for age group.
NO chest indrawing.
Suitable for oral outpatient treatment.

Severe / Very Severe

Severe: Severe chest indrawing or tachypnea (if <2mo).
Very Severe: Not feeding/drinking, convulsions, drowsiness/abnormally sleepy, fever, or hypothermia.

🧮 Interactive Pediatric Weight-Band Selector

Select the child’s weight category to view streamlined WHO-endorsed outpatient dosing configurations.

Preferred Therapy (Amoxicillin)

250 mg q12h PO

Standard duration is 5 days. Capped at a maximum of 1g/dose or 3g/day.

Alternative Therapy (Erythromycin Ethylsuccinate)

40 – 50 mg/kg/day split q12h

Indicated if mycoplasma or chlamydia pneumonia is suspected. Max 800mg/dose.

🚨 Criteria for Immediate Pediatric Hospitalization

Infants aged 3 months and below (whatever the severity)
Fever more than 38.5°C with refusal to feed or vomiting
Fast breathing with cyanosis or severe chest indrawing
Systemic manifestations (convulsions, lethargic or reduced consciousness)
Failure of previous outpatient antibiotic therapy or recurrent history
Severe underlying disorders (e.g., immunodeficiency)

Safety Net: Caregivers must be advised to return in 2 days for reassessment, or earlier if condition gets worse.