What is the recommended treatment for pediatric pneumonia?

From the Guidelines

The recommended treatment for pediatric pneumonia is amoxicillin at a dose of 90 mg/kg/day divided into two doses for 5-7 days for mild to moderate community-acquired pneumonia in otherwise healthy children. For children with suspected atypical pneumonia (often caused by Mycoplasma pneumoniae), azithromycin at 10 mg/kg on day 1 followed by 5 mg/kg for 4 more days is recommended 1. The choice of antibiotic and duration of treatment depend on the child's age, severity of illness, and likely causative organism.

Key Considerations

• For outpatient treatment, oral antibiotics are typically appropriate for mild to moderate community-acquired pneumonia in otherwise healthy children.
• Children with severe pneumonia, those under 3 months of age, or those with underlying conditions may require hospitalization for intravenous antibiotics, typically ampicillin or ceftriaxone, along with supportive care including oxygen therapy if needed.
• Supportive measures for all children with pneumonia include adequate hydration, fever control with acetaminophen or ibuprofen, and rest.
• Parents should monitor for worsening symptoms such as increased work of breathing, inability to drink, or persistent high fever, which would warrant immediate medical attention.

Treatment Duration

• A treatment duration of 5-10 days for non-severe, bacterial pneumonia in the outpatient setting is recommended 1.
• A shorter course may be justified as sufficient, but the effectiveness of shorter courses may vary depending on the specific circumstances, such as the causative organism and the child's overall health.

Antibiotic Choices

• Amoxicillin is the first-line treatment for mild to moderate community-acquired pneumonia in otherwise healthy children.
• Azithromycin is recommended for children with suspected atypical pneumonia.
• Other antibiotics, such as ampicillin, ceftriaxone, and clindamycin, may be used in certain situations, such as severe pneumonia or suspected methicillin-resistant Staphylococcus aureus (MRSA) infection 1.

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.

The recommended treatment for pediatric pneumonia is azithromycin for oral suspension. The dose is 10 mg/kg as a single dose on the first day, followed by 5 mg/kg on Days 2 through 5. The dosage guidelines are based on the patient's weight, as shown in the table. 2

• For patients weighing 5-10 kg (approximately 11-22 lbs), the dose is 2.5 mL (½ tsp) on Day 1 and 1.25 mL (¼ tsp) on Days 2-5.
• For patients weighing 11-20 kg (approximately 24-44 lbs), the dose is 5 mL (1 tsp) on Day 1 and 2.5 mL (½ tsp) on Days 2-5.
• For patients weighing 21-30 kg (approximately 46-66 lbs), the dose is 7.5 mL (1½ tsp) on Day 1 and 3.75 mL (¾ tsp) on Days 2-5.
• For patients weighing 31-40 kg (approximately 68-88 lbs), the dose is 10 mL (2 tsp) on Day 1 and 5 mL (1 tsp) on Days 2-5.
• For patients weighing 41 kg or more (approximately 90 lbs or more), the dose is 12.5 mL (2½ tsp) on Day 1 and 6.25 mL (1¼ tsp) on Days 2-5.

From the Research

Pediatric Pneumonia Medication

The recommended treatment for pediatric pneumonia involves the use of antibiotics, with amoxicillin being a commonly prescribed medication.

• The optimal dose and duration of amoxicillin treatment for community-acquired pneumonia in children have been studied in several trials 3, 4, 5.
• A study published in 2021 found that a 3-day course of amoxicillin was non-inferior to a 7-day course in terms of clinical efficacy and safety in children with uncomplicated community-acquired pneumonia 3.
• Another study published in 2002 compared the clinical efficacy of 3-day and 5-day courses of amoxicillin in children with non-severe pneumonia and found that the 3-day course was equally effective as the 5-day course 4.
• A systematic review and meta-analysis published in 2022 found that a 5-day course of amoxicillin was as effective as a 10-day course in treating uncomplicated community-acquired pneumonia in children 5.

Amoxicillin Dosage

The dosage of amoxicillin for pediatric pneumonia has also been studied.

• A study published in 2003 compared the pharmacokinetics of amoxicillin given twice or three times per day to children with pneumonia and found that a twice-daily regimen was a feasible alternative to a three-times-daily regimen 6.
• The World Health Organization recommends a dose of 15-20 mg/kg per dose, given three times a day, for the treatment of pneumonia in children 4, 6.

Treatment Duration

The duration of treatment for pediatric pneumonia has been a topic of debate.

• A study published in 2008 found that a 5-day course of high-dose oral amoxicillin was equivalent to a 5-day course of parenteral ampicillin in treating severe pneumonia in children 7.
• The American Academy of Pediatrics recommends a treatment duration of 10 days for community-acquired pneumonia in children, but some studies suggest that a shorter course of treatment may be effective in certain cases 5.