Treatment of Pneumonia in Children with Asthma

Age-Based Antibiotic Selection

The American Thoracic Society recommends oral amoxicillin 90 mg/kg/day divided into 2-3 doses as the first-line treatment for children under 5 years with pneumonia, because it effectively covers Streptococcus pneumoniae and other common bacterial pathogens in this age group, is well-tolerated, and inexpensive 1, 2
Alternative agents include co-amoxiclav, cefaclor, erythromycin, clarithromycin, or azithromycin if amoxicillin cannot be used 1
A 5-day course is recommended for most cases 2

The British Thoracic Society recommends hospital admission for children with oxygen saturation <92% on room air, respiratory rate >70 breaths/min (infants) or >50 breaths/min (older children), difficulty breathing, grunting, or respiratory distress 1, 2, 3
The American Academy of Pediatrics recommends hospital admission for children who are unable to tolerate oral medications or have poor feeding, signs of dehydration, or failure to respond to oral antibiotics within 48-72 hours 1, 2, 3

The American Thoracic Society recommends maintaining oxygen saturation >92% using nasal cannulae, head box, or face mask, and administering intravenous fluids at 80% basal levels if needed, with electrolyte monitoring 1, 2, 3
The British Thoracic Society recommends using antipyretics and analgesics to keep the child comfortable, and minimizing handling in severely ill children to reduce metabolic and oxygen requirements 1, 3

The American Academy of Pediatrics recommends re-evaluating the child at 48-72 hours and considering broader-spectrum antibiotics such as amoxicillin-clavulanate, ceftriaxone, or cefuroxime if there is no clinical improvement 2
The American Thoracic Society recommends adding macrolide coverage if atypical pathogens (Mycoplasma or Chlamydophila) are suspected, particularly in children over 5 years 1, 2