Pediatric Pneumonia Treatment Guidelines

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 3, 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) 3, 1
For children with presumed atypical pneumonia, the Infectious Diseases Society of America recommends oral azithromycin 10 mg/kg on day 1, followed by 5 mg/kg/day once daily on days 2-5 1, 5, 4

For Streptococcus pneumoniae, the Infectious Diseases Society of America recommends oral amoxicillin (90 mg/kg/day in 2 doses) 5, 1
For Mycoplasma pneumoniae/Chlamydophila pneumoniae, the Infectious Diseases Society of America recommends oral azithromycin (10 mg/kg on day 1, followed by 5 mg/kg/day once daily on days 2-5) 5, 4
For Haemophilus influenzae, the Infectious Diseases Society of America recommends amoxicillin (75-100 mg/kg/day in 3 doses) for β-lactamase negative strains and amoxicillin-clavulanate for β-lactamase producing strains 5, 4, 2
For Staphylococcus aureus, the Infectious Diseases Society of America recommends oral cephalexin (75-100 mg/kg/day in 3-4 doses) for methicillin-susceptible S. aureus and oral clindamycin (30-40 mg/kg/day in 3-4 doses) for methicillin-resistant S. aureus 5, 4

For uncomplicated pneumonia, the American Academy of Pediatrics recommends a 5-day course of antibiotics 1
For pneumonia with complications, the American Academy of Pediatrics recommends longer treatment (2-4 weeks) 1

Children should demonstrate clinical improvement within 48-72 hours of starting appropriate therapy, according to the American Academy of Pediatrics 1, 2
If no improvement is seen within this timeframe, reevaluation is necessary, including consideration of alternative diagnoses, resistant pathogens, or complications, as recommended by the American Academy of Pediatrics 1, 2

For children with non-serious allergic reactions to amoxicillin, the Infectious Diseases Society of America recommends considering oral cephalosporins with substantial activity against S. pneumoniae under medical supervision 3
For children with severe penicillin allergies, the Infectious Diseases Society of America recommends considering macrolides or linezolid/clindamycin 5, 3
For influenza pneumonia, the Infectious Diseases Society of America recommends considering oseltamivir or zanamivir based on age appropriateness 3