Technical updates of the guidelines on the IMCI: Evidence and recommendations for further adaptations

Since the IMCI guidelines were first introduced, new evidence has become available from research, including studies coordinated by the Department of Child and Adolescent Health and Development (CAH/HQ), which has led to new IMCI recommendations. The updates concern the following topics:

1. Antibiotic treatment of severe and non-severe pneumonia (frequency of administration of amoxicillin and duration of amoxicillin and cotrimoxazole treatment of non-severe pneumonia; use of oral amoxicillin versus injectable penicillin in severe pneumonia; use of gentamicin plus ampicillin versus chloramphenicol for very severe pneumonia; trial of rapid-acting bronchodilators in children with wheeze and fast breathing and/or lower chest wall indrawing);
2. Management of diarrhoeal diseases (use of low osmolarity ORS, use of Zinc as an adjunct to oral rehydration salts, and antibiotic treatment for bloody diarrhoea);
3. Antimalarials for treatment of malaria;
4. Treatment of ear infections (acute and chronic suppurative otitis media);
5. Infant feeding (exclusive and complementary feeding, management of severe malnutrition where referral is not possible, HIV and infant feeding); and
6. Management of helminth infestations in children below 24 months.

Of relevance to public health programme managers in countries already implementing IMCI is the process to introduce the proposed recommendations in the existing guidelines, which requires reaching a consensus, a change in policies, the adaptation of guidelines and training materials, orientations or refresher training courses for health personnel already trained in IMCI, and involvement of professional and academic institutions and key partners, as described in the document.