Pediatric Pneumonia Treatment Guidelines

Introduction to Treatment

The American Academy of Pediatrics recommends oral amoxicillin at 90 mg/kg/day in 2 doses for children with presumed bacterial pneumonia, and azithromycin for children with presumed atypical pneumonia 1

For children under 5 years with presumed bacterial pneumonia, the Infectious Diseases Society of America recommends oral amoxicillin 90 mg/kg/day in 2 doses 2, 1
For children under 5 years 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 2, 1
For children 5 years and older with presumed bacterial pneumonia, the Infectious Diseases Society of America recommends oral amoxicillin 90 mg/kg/day in 2 doses (maximum 4 g/day) 2, 1
For children 5 years and older 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 (maximum 500 mg on day 1, followed by 250 mg on days 2-5) 2, 1

For Streptococcus pneumoniae, the Infectious Diseases Society of America recommends oral amoxicillin (90 mg/kg/day in 2 doses) 5, 1
For Mycoplasma pneumoniae or 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, 1

For uncomplicated pneumonia, the Infectious Diseases Society of America recommends 5-7 days of antibiotics 7
For pneumonia with parapneumonic effusion, the Infectious Diseases Society of America recommends 2-4 weeks of antibiotics, depending on drainage adequacy and clinical response 7

For small effusions (<10mm rim), the Infectious Diseases Society of America recommends treatment with antibiotics alone, no drainage needed unless respiratory compromise is high 7, 3
For moderate to large effusions, the Infectious Diseases Society of America recommends consideration of drainage options based on respiratory compromise 7, 3

Patients should show clinical improvement within 48-72 hours of starting appropriate antibiotics, according to the Infectious Diseases Society of America 7, 1

The Infectious Diseases Society of America recommends discharge when there is documented overall clinical improvement, including level of activity, appetite, and decreased fever for at least 12-24 hours 7
The Infectious Diseases Society of America also recommends consistent pulse oximetry measurements >90% in room air for at least 12-24 hours 7

The American Academy of Pediatrics warns against underdosing amoxicillin, using standard doses (40-45 mg/kg/day) rather than the recommended higher doses (90 mg/kg/day) for pneumonia, which may lead to treatment failure due to resistant pneumococci 1
The Infectious Diseases Society of America advises against inappropriate use of macrolides as first-line therapy for presumed bacterial pneumonia in young children 1
The Infectious Diseases Society of America recommends reassessing children not improving within 48-72 hours 7, 1