From the Guidelines
For simple pneumonia in a 5-year-old child weighing 19 kg, the first-line treatment is oral amoxicillin, prescribed at a dose of 90 mg/kg/day in 2 doses, which translates to approximately 850 mg twice daily for 5-7 days, as recommended by the most recent and highest quality study 1. This high-dose amoxicillin regimen is effective against Streptococcus pneumoniae, the most common bacterial cause of community-acquired pneumonia in children. Some key points to consider when treating this patient include:
- Ensuring the child stays well-hydrated and gets plenty of rest
- Using acetaminophen or ibuprofen for fever and discomfort as needed
- Monitoring the child's symptoms and breathing; if there's no improvement within 48-72 hours or if symptoms worsen, reassess and consider alternative antibiotics or hospitalization
- This outpatient treatment is appropriate for mild to moderate cases without complications The high dose of amoxicillin is used to overcome potential resistance in S. pneumoniae strains, while the twice-daily dosing improves compliance compared to three times daily regimens, as supported by 1. It's also important to note that the treatment guidelines may vary depending on the specific circumstances of the patient, such as allergy to recommended therapy or suspected infection with other pathogens, as discussed in 1, but the recommended dose and duration of amoxicillin therapy remain the cornerstone of treatment for community-acquired pneumonia in children.
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.
PEDIATRIC DOSAGE GUIDELINES FOR OTITIS MEDIA, ACUTE BACTERIAL SINUSITIS AND COMMUNITY-ACQUIRED PNEUMONIA (Age 6 months and above, see PRECAUTIONS—Pediatric Use.)
Based on Body Weight OTITIS MEDIA AND COMMUNITY-ACQUIRED PNEUMONIA: (5-Day Regimen) * Dosing Calculated on 10 mg/kg/day Day 1 and 5 mg/kg/day Days 2 to 5.
Weight100 mg/5 mL200 mg/5 mLTotal mL per Treatment CourseTotal mg per Treatment Course KgLbs. Day 1Days 2–5Day 1Days 2–5
20445 mL (1 tsp) 2.5 mL (½ tsp) 15 mL600 mg
30667.5 mL (1½ tsp) 3.75 mL (¾ tsp) 22. 5 mL900 mg
408810 mL (2 tsp) 5 mL (1 tsp) 30 mL1200 mg
For a 5-year-old child weighing 19 kg, the first-line treatment for community-acquired pneumonia (CAP) with azithromycin is:
- 10 mg/kg as a single dose on the first day, which is approximately 190 mg (19 kg x 10 mg/kg)
- Followed by 5 mg/kg on Days 2 through 5, which is approximately 95 mg (19 kg x 5 mg/kg) per day 2
From the Research
First-Line Treatment for Community-Acquired Pneumonia (CAP) in Children
- The first-line treatment for community-acquired pneumonia (CAP) in children is amoxicillin 3, 4.
- The recommended dosage of amoxicillin is 90 mg/kg/day divided into three doses, although two doses could be considered to improve compliance 3.
- For a 5-year-old child weighing 19 kg, the calculated dosage would be approximately 1710 mg/day (90 mg/kg/day x 19 kg) 3.
- The duration of therapy is recommended to be 5 days, with clinical monitoring and re-assessment approximately 72 hours after the start of antibiotic treatment to evaluate symptom resolution 3, 5.
- Macrolides may be considered in addition to amoxicillin in children over 5 years old, if symptoms persist and the clinical condition remains good after 48 hours of therapy 3.
Considerations for Treatment
- The choice of antibiotic treatment should take into account the child's immunization status, particularly against Haemophilus influenzae type b and Streptococcus pneumoniae 3.
- Amoxicillin-clavulanate or second- or third-generation cephalosporins may be prescribed for children who are unimmunized or have incomplete immunization coverage for both H. influenzae type b and S. pneumoniae 3.
- The treatment regimen may vary depending on the severity of the disease, with ceftriaxone considered for very severe cases 4.