Table 1. Open in new tab Summary Table...

Dehydration Management
Children without severe acute malnutrition
Dehydration	Country guidelines (the same as WHO-indicated treatment)
Severe (Plan C—facility)	Start IV fluid immediately (preferably Ringer’s lactate solution, 100 mL/kg). Reassess every 15–30 min. Give ORS (15 mL/kg/h) as soon as the child can drink. Reclassify dehydration after 6 h in infant and 3 h in child and continue with A, B, C plan.	Age <12 mo: 30 mL/kg^a in 1 h followed by 70 mL/kg over 5 h Age 12 mo–60 mo: 30 mL/kg^a in 30 min followed by 70 mL/kg over 2.5 h
Some (Plan B—facility)	Give recommended ORS in clinic over 4 hours. Reclassify dehydration after 4 h and continue with A, B, C plan.	Age* Up to 4 mo/weight <6 kg: 200–450 mL Age 4 mo up to 12 mo/weight 6 to <10 kg: 450–800 mL Age 12 mo up to 2 y/weight 10 to <12 kg: 800–960 mL Age 2 y up to 5 y/weight 12–19 kg: 960–1600 mL *Use the child's age only when you do not know the weight. The approximate amount of ORS required (in mL) can also be calculated by multiplying the child's weight (in kg) by 75.
None (Plan A—home)	Increase food and fluid intake to prevent dehydration
Children with severe acute malnutrition and no shock
Dehydration	Country guidelines (same as WHO-indicated treatment)
Severe (Plan C—facility)	Give ReSoMal (or half-strength standard low ORS with added potassium and glucose) 5 mL/kg every 30 min for the first 2 h, and 5–10 mL/kg/h for the next 4–10 h on alternate hours with F75. If rehydration still required at 10 h, give starter F75 instead of ReSoMal, at the same times.
Some (Plan B—facility)	Same as above
None (Plan A—home)	Not applicable (because child admitted in health facility)
Therapeutic zinc
Population	Country guidelines (the same as WHO-indicated treatment)
All children	Zinc supplementation for 10–14 d (age ≤6 mo: 10 mg/d; age >6 mo: 20 mg/d
Antibiotics
Population	Country guidelines (the same as WHO-indicated treatment)
Dysentery	Ciprofloxacin (15 mg/kg) twice daily for 3 d OR based on local sensitivity. IV/IM ceftriaxone at 50–80 mg/kg/d for 3 d (if child is severely ill or as second-line treatment)
Suspected cholera (age ≥2 y + severe dehydration + cholera present in area)	Erythromycin (12 mg/kg) 4 times a day for 3 d Ciprofloxacin 10–20 mg/kg twice a day for 5 d Cotrimoxazole: 4 mg/kg trimethoprim and 20 mg/kg sulfamethoxazole twice a day

Dehydration Management

Children without severe acute malnutrition

Dehydration

Country guidelines (the same as WHO-indicated treatment)

Severe (Plan C—facility)

Start IV fluid immediately (preferably Ringer’s lactate solution, 100 mL/kg). Reassess every 15–30 min. Give ORS (15 mL/kg/h) as soon as the child can drink. Reclassify dehydration after 6 h in infant and 3 h in child and continue with A, B, C plan.

Age <12 mo: 30 mL/kg^a in 1 h followed by 70 mL/kg over 5 h
Age 12 mo–60 mo: 30 mL/kg^a in 30 min followed by 70 mL/kg over 2.5 h

Some (Plan B—facility)

Give recommended ORS in clinic over 4 hours. Reclassify dehydration after 4 h and continue with A, B, C plan.

Age* Up to 4 mo/weight <6 kg: 200–450 mL
Age 4 mo up to 12 mo/weight 6 to <10 kg: 450–800 mL
Age 12 mo up to 2 y/weight 10 to <12 kg: 800–960 mL
Age 2 y up to 5 y/weight 12–19 kg: 960–1600 mL
*Use the child's age only when you do not know the weight. The approximate amount of ORS required (in mL) can also be calculated by multiplying the child's weight (in kg) by 75.

None (Plan A—home)

Increase food and fluid intake to prevent dehydration

Children with severe acute malnutrition and no shock

Dehydration

Country guidelines (same as WHO-indicated treatment)

Severe (Plan C—facility)

Give ReSoMal (or half-strength standard low ORS with added potassium and glucose) 5 mL/kg every 30 min for the first 2 h, and 5–10 mL/kg/h for the next 4–10 h on alternate hours with F75. If rehydration still required at 10 h, give starter F75 instead of ReSoMal, at the same times.

Some (Plan B—facility)

Same as above

None (Plan A—home)

Not applicable (because child admitted in health facility)

Therapeutic zinc

Population

Country guidelines (the same as WHO-indicated treatment)

All children

Zinc supplementation for 10–14 d (age ≤6 mo: 10 mg/d; age >6 mo: 20 mg/d

Antibiotics

Population

Country guidelines (the same as WHO-indicated treatment)

Dysentery

Ciprofloxacin (15 mg/kg) twice daily for 3 d OR based on local sensitivity. IV/IM ceftriaxone at 50–80 mg/kg/d for 3 d (if child is severely ill or as second-line treatment)

Suspected cholera (age ≥2 y + severe dehydration + cholera present in area)

Erythromycin (12 mg/kg) 4 times a day for 3 d
Ciprofloxacin 10–20 mg/kg twice a day for 5 d
Cotrimoxazole: 4 mg/kg trimethoprim and 20 mg/kg sulfamethoxazole twice a day

Dehydration Management
Children without severe acute malnutrition
Dehydration	Country guidelines (the same as WHO-indicated treatment)
Severe (Plan C—facility)	Start IV fluid immediately (preferably Ringer’s lactate solution, 100 mL/kg). Reassess every 15–30 min. Give ORS (15 mL/kg/h) as soon as the child can drink. Reclassify dehydration after 6 h in infant and 3 h in child and continue with A, B, C plan.	Age <12 mo: 30 mL/kg^a in 1 h followed by 70 mL/kg over 5 h Age 12 mo–60 mo: 30 mL/kg^a in 30 min followed by 70 mL/kg over 2.5 h
Some (Plan B—facility)	Give recommended ORS in clinic over 4 hours. Reclassify dehydration after 4 h and continue with A, B, C plan.	Age* Up to 4 mo/weight <6 kg: 200–450 mL Age 4 mo up to 12 mo/weight 6 to <10 kg: 450–800 mL Age 12 mo up to 2 y/weight 10 to <12 kg: 800–960 mL Age 2 y up to 5 y/weight 12–19 kg: 960–1600 mL *Use the child's age only when you do not know the weight. The approximate amount of ORS required (in mL) can also be calculated by multiplying the child's weight (in kg) by 75.
None (Plan A—home)	Increase food and fluid intake to prevent dehydration
Children with severe acute malnutrition and no shock
Dehydration	Country guidelines (same as WHO-indicated treatment)
Severe (Plan C—facility)	Give ReSoMal (or half-strength standard low ORS with added potassium and glucose) 5 mL/kg every 30 min for the first 2 h, and 5–10 mL/kg/h for the next 4–10 h on alternate hours with F75. If rehydration still required at 10 h, give starter F75 instead of ReSoMal, at the same times.
Some (Plan B—facility)	Same as above
None (Plan A—home)	Not applicable (because child admitted in health facility)
Therapeutic zinc
Population	Country guidelines (the same as WHO-indicated treatment)
All children	Zinc supplementation for 10–14 d (age ≤6 mo: 10 mg/d; age >6 mo: 20 mg/d
Antibiotics
Population	Country guidelines (the same as WHO-indicated treatment)
Dysentery	Ciprofloxacin (15 mg/kg) twice daily for 3 d OR based on local sensitivity. IV/IM ceftriaxone at 50–80 mg/kg/d for 3 d (if child is severely ill or as second-line treatment)
Suspected cholera (age ≥2 y + severe dehydration + cholera present in area)	Erythromycin (12 mg/kg) 4 times a day for 3 d Ciprofloxacin 10–20 mg/kg twice a day for 5 d Cotrimoxazole: 4 mg/kg trimethoprim and 20 mg/kg sulfamethoxazole twice a day

Table 1.

Open in new tab

Summary Table of Treatment Guidelines of Ministry of Health and Social Welfare, Republic of The Gambia

Dehydration Management
Children without severe acute malnutrition
Dehydration	Country guidelines (the same as WHO-indicated treatment)
Severe (Plan C—facility)	Start IV fluid immediately (preferably Ringer’s lactate solution, 100 mL/kg). Reassess every 15–30 min. Give ORS (15 mL/kg/h) as soon as the child can drink. Reclassify dehydration after 6 h in infant and 3 h in child and continue with A, B, C plan.	Age <12 mo: 30 mL/kg^a in 1 h followed by 70 mL/kg over 5 h Age 12 mo–60 mo: 30 mL/kg^a in 30 min followed by 70 mL/kg over 2.5 h
Some (Plan B—facility)	Give recommended ORS in clinic over 4 hours. Reclassify dehydration after 4 h and continue with A, B, C plan.	Age* Up to 4 mo/weight <6 kg: 200–450 mL Age 4 mo up to 12 mo/weight 6 to <10 kg: 450–800 mL Age 12 mo up to 2 y/weight 10 to <12 kg: 800–960 mL Age 2 y up to 5 y/weight 12–19 kg: 960–1600 mL *Use the child's age only when you do not know the weight. The approximate amount of ORS required (in mL) can also be calculated by multiplying the child's weight (in kg) by 75.
None (Plan A—home)	Increase food and fluid intake to prevent dehydration
Children with severe acute malnutrition and no shock
Dehydration	Country guidelines (same as WHO-indicated treatment)
Severe (Plan C—facility)	Give ReSoMal (or half-strength standard low ORS with added potassium and glucose) 5 mL/kg every 30 min for the first 2 h, and 5–10 mL/kg/h for the next 4–10 h on alternate hours with F75. If rehydration still required at 10 h, give starter F75 instead of ReSoMal, at the same times.
Some (Plan B—facility)	Same as above
None (Plan A—home)	Not applicable (because child admitted in health facility)
Therapeutic zinc
Population	Country guidelines (the same as WHO-indicated treatment)
All children	Zinc supplementation for 10–14 d (age ≤6 mo: 10 mg/d; age >6 mo: 20 mg/d
Antibiotics
Population	Country guidelines (the same as WHO-indicated treatment)
Dysentery	Ciprofloxacin (15 mg/kg) twice daily for 3 d OR based on local sensitivity. IV/IM ceftriaxone at 50–80 mg/kg/d for 3 d (if child is severely ill or as second-line treatment)
Suspected cholera (age ≥2 y + severe dehydration + cholera present in area)	Erythromycin (12 mg/kg) 4 times a day for 3 d Ciprofloxacin 10–20 mg/kg twice a day for 5 d Cotrimoxazole: 4 mg/kg trimethoprim and 20 mg/kg sulfamethoxazole twice a day

Dehydration Management
Children without severe acute malnutrition
Dehydration	Country guidelines (the same as WHO-indicated treatment)
Severe (Plan C—facility)	Start IV fluid immediately (preferably Ringer’s lactate solution, 100 mL/kg). Reassess every 15–30 min. Give ORS (15 mL/kg/h) as soon as the child can drink. Reclassify dehydration after 6 h in infant and 3 h in child and continue with A, B, C plan.	Age <12 mo: 30 mL/kg^a in 1 h followed by 70 mL/kg over 5 h Age 12 mo–60 mo: 30 mL/kg^a in 30 min followed by 70 mL/kg over 2.5 h
Some (Plan B—facility)	Give recommended ORS in clinic over 4 hours. Reclassify dehydration after 4 h and continue with A, B, C plan.	Age* Up to 4 mo/weight <6 kg: 200–450 mL Age 4 mo up to 12 mo/weight 6 to <10 kg: 450–800 mL Age 12 mo up to 2 y/weight 10 to <12 kg: 800–960 mL Age 2 y up to 5 y/weight 12–19 kg: 960–1600 mL *Use the child's age only when you do not know the weight. The approximate amount of ORS required (in mL) can also be calculated by multiplying the child's weight (in kg) by 75.
None (Plan A—home)	Increase food and fluid intake to prevent dehydration
Children with severe acute malnutrition and no shock
Dehydration	Country guidelines (same as WHO-indicated treatment)
Severe (Plan C—facility)	Give ReSoMal (or half-strength standard low ORS with added potassium and glucose) 5 mL/kg every 30 min for the first 2 h, and 5–10 mL/kg/h for the next 4–10 h on alternate hours with F75. If rehydration still required at 10 h, give starter F75 instead of ReSoMal, at the same times.
Some (Plan B—facility)	Same as above
None (Plan A—home)	Not applicable (because child admitted in health facility)
Therapeutic zinc
Population	Country guidelines (the same as WHO-indicated treatment)
All children	Zinc supplementation for 10–14 d (age ≤6 mo: 10 mg/d; age >6 mo: 20 mg/d
Antibiotics
Population	Country guidelines (the same as WHO-indicated treatment)
Dysentery	Ciprofloxacin (15 mg/kg) twice daily for 3 d OR based on local sensitivity. IV/IM ceftriaxone at 50–80 mg/kg/d for 3 d (if child is severely ill or as second-line treatment)
Suspected cholera (age ≥2 y + severe dehydration + cholera present in area)	Erythromycin (12 mg/kg) 4 times a day for 3 d Ciprofloxacin 10–20 mg/kg twice a day for 5 d Cotrimoxazole: 4 mg/kg trimethoprim and 20 mg/kg sulfamethoxazole twice a day

Source: WHO [21, 22].

Abbreviations: IM, intramuscular; IV, intravenous; ORS, oral rehydration solution; ReSoMal, rehydration solution for malnutrition; WHO, World Health Organization.

^aRepeat if the radial pulse is still very weak or not detectable.

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