Assessment and management of bacterial infection and jaundice

Treatment options for the sick young infant when a referral is not possible.

First, you should ask the mother why she does not want to go to the hospital or health centre when her child is severely ill. The most frequent reasons to go to the hospital or health centre are:

• Hospital or health centre too far away.
• Costs related to transport, time, payment of medicines and staying in large towns.
• Cultural and religious belief preventing recently delivered women and newborn to go outside home and travel long distances.
• Inability to travel daily to and from health centre due to distance and time

You should discuss with the mother her situation and advise her to follow the referral option. Referral is the best option for a young infant with very severe disease; if a referral is not possible, start giving Amoxicillin and Gentamycin for at least seven days (see administration guidelines below).

Always advise the mother that the baby needs urgent referral If the young infant has any of these danger signs:

• Stopped breastfeeding.
• Convulsing or having abnormal movement or convulsing now.
• Not able to move even when simulated.

Oral antibiotic (Amoxicillin)

Age or weight	Amoxicillin. For very severe disease treatment gives two doses daily for seven days. For local bacterial infection give two doses daily for five days. For pre-referral give one dose before referral.
	Dispersible Tablet 125 mg	Dispersible Tablet 250 mg	Syrup 125 mg in 5 ml
<2000 gm	1/2	1/4	2.5 ml
2000 to <4500 gm	1	1/2	5 ml

Intramuscular antibiotic (Gentamycin)

Weight	Gentamycin For very severe disease treatment gives one dose daily for seven days. For very severe disease treatment give for weight <2000gm give one dose every 48 hours a total of 4 doses. For pre-referral give one dose before referral.
	20 mg/ml	80 mg/ml
<2000 gm	1 ml every 48 hour	0.3 ml every 48 hour
2000 to < 2500 gm	1 ml daily	0.3 ml daily
2500 gm to < 3500 gm	1.4 ml daily	0.4 ml daily
3500 gm to < 4500gm	2 ml daily	0.5 ml daily

Teach the mother to give oral drugs at home:

• Follow the instruction below for every oral drug to be given at home.
• Tell the mother the reason for giving the drug to the young infant.
• Determine the dose appropriately for the child's weight.
• Demonstrate how to measure a dose and watch the mother practice measure a dose by herself.
• Ask the mother to give the first dose to her baby explain carefully how to give the drug then label the drug.
• Explain that all the drugs must be used to finish the course of treatment (7 days) even if the baby looks better.
• Check the mother's understanding before you end the advice.