Treatment for Pneumonia in Children

Initial Assessment and Treatment Selection

For a child with community-acquired pneumonia, the American Academy of Pediatrics recommends starting with high-dose oral amoxicillin 90 mg/kg/day divided into 2 doses as first-line therapy for presumed bacterial pneumonia 1
The Infectious Diseases Society of America suggests that this high dose is critical to overcome resistant Streptococcus pneumoniae strains 1
For presumed atypical pneumonia, the American Academy of Pediatrics recommends azithromycin: 10 mg/kg on day 1, followed by 5 mg/kg/day once daily on days 2-5 1
When diagnosis is uncertain, consider adding azithromycin to the beta-lactam therapy, as recommended by the Infectious Diseases Society of America 2, 4

For hospitalized children requiring parenteral therapy, the Infectious Diseases Society of America recommends ceftriaxone 50-100 mg/kg/day given every 12-24 hours OR cefotaxime at equivalent dosing 4, 5
Add vancomycin 40-60 mg/kg/day divided every 6-8 hours if community-associated MRSA is suspected, as recommended by the Infectious Diseases Society of America 4, 5

For penicillin allergy, the Infectious Diseases Society of America recommends a trial of amoxicillin under medical observation OR oral cephalosporin under medical supervision 2, 3, 4, 1
Alternative options include levofloxacin, linezolid, or clindamycin, as suggested by the Infectious Diseases Society of America 2, 3
For CA-MRSA coverage, add clindamycin 30-40 mg/kg/day in 3-4 doses OR vancomycin if CA-MRSA is suspected, as recommended by the Infectious Diseases Society of America 2, 4, 1, 5
If influenza is suspected, add oseltamivir or zanamivir, as recommended by the Infectious Diseases Society of America 2, 3, 4