Initial Antibiotic Treatment for Pediatric Community-Acquired Pneumonia

Age-Based Treatment Recommendations

For children under 5 years with presumed bacterial pneumonia, the American Academy of Pediatrics recommends oral amoxicillin 90 mg/kg/day in 2 doses 1
For children 5 years and older with presumed bacterial pneumonia, the American Academy of Pediatrics recommends oral amoxicillin 90 mg/kg/day in 2 doses (maximum 4 g/day) 1
For hospitalized children with bacterial pneumonia, the Infectious Diseases Society of America recommends intravenous ampicillin (150-200 mg/kg/day every 6 hours) or ceftriaxone (50-100 mg/kg/day every 12-24 hours) 2, 3
For hospitalized children with atypical pneumonia, the Infectious Diseases Society of America recommends intravenous azithromycin (10 mg/kg on days 1 and 2 of therapy) 2, 4

For penicillin-susceptible Streptococcus pneumoniae strains, the American Academy of Pediatrics recommends oral amoxicillin (90 mg/kg/day in 2 doses) 1
For Mycoplasma pneumoniae/Chlamydophila pneumoniae, the American Academy of Pediatrics recommends oral azithromycin (10 mg/kg on day 1, followed by 5 mg/kg/day once daily on days 2-5) 1
For Haemophilus influenzae β-lactamase negative strains, the Infectious Diseases Society of America recommends amoxicillin (75-100 mg/kg/day in 3 doses) 2
For Haemophilus influenzae β-lactamase producing strains, the Infectious Diseases Society of America recommends amoxicillin-clavulanate (amoxicillin component, 45 mg/kg/day in 3 doses or 90 mg/kg/day in 2 doses) 2, 5

Children should demonstrate clinical improvement within 48-72 hours of starting appropriate therapy, according to the American Academy of Pediatrics 1, 5
If no improvement is seen within this timeframe, reevaluation is necessary, as recommended by the American Academy of Pediatrics 1, 5

For children with non-serious allergic reactions to amoxicillin, the American Academy of Pediatrics recommends considering oral cephalosporins with substantial activity against S. pneumoniae (cefpodoxime, cefprozil, or cefuroxime) under medical supervision 1
For children with severe reactions, the American Academy of Pediatrics recommends considering macrolides, though resistance rates may be higher 1
If community-associated MRSA is suspected, the Infectious Diseases Society of America recommends considering adding clindamycin (30-40 mg/kg/day in 3-4 doses) 1
For confirmed MRSA pneumonia, the Infectious Diseases Society of America recommends vancomycin (40-60 mg/kg/day every 6-8 hours) or linezolid 2, 3

The Infectious Diseases Society of America recommends limiting antibiotic exposure to prevent resistance development 2
The Infectious Diseases Society of America recommends using the narrowest spectrum antibiotic effective against the presumed pathogen 2
The Infectious Diseases Society of America recommends proper dosing to achieve minimal effective concentration at the infection site 2
The American Academy of Pediatrics recommends completing the full prescribed course of antibiotics, even if symptoms improve before completion 5

The Infectious Diseases Society of America recommends empiric combination therapy with a macrolide in addition to a β-lactam antibiotic for hospitalized children when atypical pathogens are suspected 6
Azithromycin is specifically indicated when atypical pathogens (Mycoplasma pneumoniae or Chlamydophila pneumoniae) are significant considerations in hospitalized or outpatient children with CAP 6