Treatment Guidelines for Pediatric Pneumonia of Moderate Risk

Outpatient Management

The Infectious Diseases Society of America recommends oral amoxicillin at 90 mg/kg/day divided in 2 doses as the first-line treatment for presumed bacterial pneumonia in outpatient settings for pediatric patients with moderate-risk community-acquired pneumonia (CAP) 1
For children <5 years old with presumed bacterial pneumonia, the American Academy of Pediatrics suggests amoxicillin oral (90 mg/kg/day in 2 doses) as the first-line treatment 1
For children ≥5 years old with presumed bacterial pneumonia, the Infectious Diseases Society of America recommends oral amoxicillin (90 mg/kg/day in 2 doses to a maximum of 4 g/day) 1
The American Academy of Pediatrics recommends adding a macrolide to a β-lactam antibiotic for children with presumed bacterial CAP without clear distinction from atypical CAP 1

For fully immunized pediatric patients with conjugate vaccines for H. influenzae type b and S. pneumoniae, the Infectious Diseases Society of America suggests ampicillin or penicillin G as empiric therapy, with alternatives being ceftriaxone or cefotaxime 1
The Infectious Diseases Society of America recommends adding vancomycin or clindamycin for suspected CA-MRSA in fully immunized pediatric patients 1
For not fully immunized pediatric patients, the Infectious Diseases Society of America suggests ceftriaxone or cefotaxime as empiric therapy, with the addition of vancomycin or clindamycin for suspected CA-MRSA 1

The American Academy of Pediatrics recommends amoxicillin at 90 mg/kg/day in 2 doses (maximum 4 g/day) for pediatric patients with moderate-risk pneumonia 1
The Infectious Diseases Society of America suggests ceftriaxone at 50-100 mg/kg/day given once daily or divided every 12-24 hours for moderate-risk pneumonia 1, 3
For pneumococcal pneumonia with penicillin resistance, the Infectious Diseases Society of America recommends ceftriaxone at 100 mg/kg/day given every 12-24 hours 3
The American Academy of Pediatrics recommends azithromycin at 10 mg/kg on day 1, followed by 5 mg/kg/day once daily on days 2–5 for pediatric patients with atypical pneumonia 1
The Infectious Diseases Society of America suggests ampicillin at 150-200 mg/kg/day divided every 6 hours for pediatric patients with moderate-risk pneumonia 2
For penicillin-resistant S. pneumoniae, the Infectious Diseases Society of America recommends ampicillin at 300-400 mg/kg/day every 6 hours 2
The Infectious Diseases Society of America recommends clindamycin at 40 mg/kg/day divided every 6-8 hours (IV) or 30-40 mg/kg/day in 3 doses (oral) for suspected MRSA 2
The Infectious Diseases Society of America suggests vancomycin at 40-60 mg/kg/day divided every 6-8 hours for suspected MRSA 2

For penicillin-susceptible S. pneumoniae, the Infectious Diseases Society of America recommends amoxicillin at 90 mg/kg/day in 2 doses or 45 mg/kg/day in 3 doses 2
For penicillin-resistant S. pneumoniae, the Infectious Diseases Society of America suggests ceftriaxone at 100 mg/kg/day every 12-24 hours 2
The American Academy of Pediatrics recommends empiric combination therapy with a macrolide in addition to a β-lactam antibiotic when atypical pathogens are suspected 2

The Infectious Diseases Society of America recommends monitoring pediatric patients for clinical and laboratory signs of improvement within 48-72 hours 1
For pediatric patients whose condition deteriorates after admission and initiation of antimicrobial therapy or who show no improvement within 48-72 hours, the Infectious Diseases Society of America suggests further investigation 1

The American Academy of Pediatrics recommends modifying treatment options for pediatric patients with drug allergies to recommended therapy 1
The Infectious Diseases Society of America suggests exercising particular caution in selecting alternatives to amoxicillin for pediatric patients with bacteremic pneumococcal pneumonia 1
The Infectious Diseases Society of America recommends identifying parapneumonic effusions using chest radiography and managing them appropriately 1