What is the recommended antibiotic treatment for pediatric pneumonia?

From the Guidelines

The recommended antibiotic treatment for pediatric pneumonia is amoxicillin for mild to moderate community-acquired pneumonia in previously healthy children over 3 months of age, with alternatives such as azithromycin or clarithromycin for those with penicillin allergies. When considering the treatment of pediatric pneumonia, several factors must be taken into account, including the severity of the illness, the age of the child, and whether the pneumonia is community-acquired or hospital-acquired. According to the guidelines provided by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America 1, the choice of antibiotic should target the most likely pathogens by age group, with Streptococcus pneumoniae being the most common bacterial cause across all pediatric age groups. Some key points to consider when selecting an antibiotic for pediatric pneumonia include:

• For Streptococcus pneumoniae with MICs for penicillin >2.0 μg/mL, ampicillin or penicillin are preferred, with alternatives including ceftriaxone or cefotaxime 1.
• For S. pneumoniae resistant to penicillin, with MICs ≥4.0 μg/mL, ceftriaxone is preferred, with alternatives including ampicillin, levofloxacin, or linezolid 1.
• For Group A Streptococcus, intravenous penicillin or ampicillin are preferred, with alternatives including ceftriaxone or cefotaxime 1.
• For Staphylococcus aureus, methicillin-susceptible, cefazolin or semisynthetic penicillin are preferred, with alternatives including clindamycin or vancomycin 1. It is essential to note that the treatment should be adjusted based on clinical response within 48-72 hours and that atypical pneumonia, often caused by Mycoplasma pneumoniae, particularly in school-aged children, responds better to macrolides like azithromycin. In terms of dosage, amoxicillin is typically given at 90 mg/kg/day divided into two doses for 5-7 days, while azithromycin is given at 10 mg/kg on day 1, then 5 mg/kg daily for 4 more days 1. Overall, the choice of antibiotic for pediatric pneumonia should be guided by the most recent and highest-quality evidence, with consideration of the child's individual needs and circumstances.

From the FDA Drug Label

Community-Acquired Pneumonia The recommended dose of azithromycin for oral suspension for the treatment of pediatric patients with community-acquired pneumonia is 10 mg/kg as a single dose on the first day followed by 5 mg/kg on Days 2 through 5.

The recommended antibiotic treatment for pediatric pneumonia is azithromycin. The dosage is as follows:

• 10 mg/kg as a single dose on the first day
• 5 mg/kg on Days 2 through 5 This treatment is for community-acquired pneumonia due to Chlamydophila pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, or Streptococcus pneumoniae in patients appropriate for oral therapy 2.

Key points:

• The treatment is for pediatric patients with community-acquired pneumonia.
• The dosage is based on the patient's weight.
• Azithromycin should not be used in pediatric patients with pneumonia who are judged to be inappropriate for oral therapy because of moderate to severe illness or risk factors such as any of the following: patients with cystic fibrosis, patients with nosocomially acquired infections, patients with known or suspected bacteremia, patients requiring hospitalization, or patients with significant underlying health problems that may compromise their ability to respond to their illness (including immunodeficiency or functional asplenia) 2.

From the Research

Antibiotic Treatment for Pediatric Pneumonia

• The optimal dose and duration of oral amoxicillin for children with community-acquired pneumonia (CAP) are unclear, but studies suggest that lower-dose amoxicillin is noninferior to higher dose and 3-day treatment is noninferior to 7 days 3, 4.
• A randomized clinical trial found that among children with CAP discharged from an emergency department or hospital ward, lower-dose outpatient oral amoxicillin was noninferior to higher dose, and 3-day duration was noninferior to 7 days, with regard to need for antibiotic re-treatment 4.
• Another study found that a short course of antibiotic therapy (approximately 5 days) does not increase the odds of 30-day treatment failure compared with longer courses for hospitalized children with uncomplicated CAP 5.

Comparison of Broad Spectrum vs Low Spectrum Antibiotics

• A study compared the efficacy of sequential injectable crystalline penicillin and gentamicin combination followed by oral amoxicillin with sequential IV and oral amoxicillin-clavulanate in treatment of severe or very severe hypoxemic pneumonia, and found that both treatments were equally effective 6.
• Another study compared injectable amoxicillin with injectable ampicillin plus gentamicin in the treatment of severe pneumonia in children, and found that parenteral amoxicillin is an effective alternative to ampicillin, with a longer half-life and broader coverage 7.

Recommendations for Antibiotic Treatment

• The World Health Organization (WHO) guidelines recommend parenteral ampicillin every 6 hours and once-daily parenteral gentamicin for 5 to 7 days for the standard management of severe pneumonia 7.
• However, studies suggest that shorter durations of therapy and lower doses of antibiotics may be effective and noninferior to traditional treatments, which could improve adherence and reduce costs 3, 4, 5.