What are the treatment options for pneumonia in pediatric patients?

From the Guidelines

Pneumonia in pediatric patients should be treated with antibiotics, with amoxicillin being the first-line treatment for mild to moderate community-acquired pneumonia in otherwise healthy children over 3 months of age, at a dose of 90 mg/kg/day divided into two doses for 5-7 days, as recommended by the most recent guidelines 1. The treatment options for pneumonia in pediatric patients depend on the child's age, severity of illness, and likely causative organism.

• For outpatient treatment of children under 5 years old, amoxicillin (90 mg/kg/day in 2 doses) or azithromycin (10 mg/kg on day 1, followed by 5 mg/kg/day once daily on days 2–5) are recommended 1.
• For children 5 years and older, oral amoxicillin (90 mg/kg/day in 2 doses to a maximum of 4 g/day) or azithromycin (10 mg/kg on day 1, followed by 5 mg/kg/day once daily on days 2–5 to a maximum of 500 mg on day 1, followed by 250 mg on days 2–5) are recommended 1.
• For inpatient treatment, ampicillin or penicillin G are recommended, with the addition of vancomycin or clindamycin for suspected community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) 1.
• Supportive care, including ensuring adequate hydration, fever control with acetaminophen or ibuprofen, and rest, is equally important in the treatment of pneumonia in pediatric patients.
• Parents should monitor for warning signs such as increased difficulty breathing, bluish discoloration of lips or face, inability to drink, or decreased responsiveness, which warrant immediate medical attention. The guidelines from the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America 1 provide the most recent and comprehensive recommendations for the treatment of pneumonia in pediatric patients.
• These guidelines prioritize the use of amoxicillin as the first-line treatment for mild to moderate community-acquired pneumonia in otherwise healthy children over 3 months of age.
• The guidelines also recommend the use of azithromycin as an alternative for children with penicillin allergies or for the treatment of atypical pneumonia.
• The use of intravenous antibiotics, such as ampicillin or ceftriaxone, is recommended for more severe cases of pneumonia that require hospitalization 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.

The treatment option for pneumonia in pediatric patients is azithromycin oral suspension, with a recommended dose of 10 mg/kg on Day 1, followed by 5 mg/kg on Days 2 through 5.

• This dosage is applicable for pediatric patients with community-acquired pneumonia.
• The safety and effectiveness of azithromycin in pediatric patients under 6 months of age have not been established.
• Azithromycin is effective against certain strains of bacteria that cause pneumonia, including Chlamydophila pneumoniae, Mycoplasma pneumoniae, and Streptococcus pneumoniae 2.
• It is essential to note that 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

Treatment Options for Pneumonia in Pediatric Patients

The treatment options for pneumonia in pediatric patients vary depending on the severity of the disease and the causative pathogen.

• Empirical antibiotic therapy remains the cornerstone of treatment in community-acquired pneumonia (CAP) 3.
• The choice of antibiotics for ambulatory treatment of CAP is oral amoxicillin with a duration of 3-5 days 3, 4.
• Children with CAP with lower chest retractions but no hypoxia can be treated with oral amoxicillin 3.
• Severe pneumonia can be treated with intravenous antibiotics consisting of penicillin/ampicillin with or without an aminoglycoside 3.
• Several new drugs have been developed and approved for use in CAP caused by multidrug-resistant organisms, but these should be used judiciously to avoid emergence of further resistance 3.

Antibiotic Duration and Dose

• A study compared the efficacy, safety, and impact on antimicrobial resistance of shorter (3-day) and longer (7-day) treatment with amoxicillin at both a lower and a higher dose in children with uncomplicated community-acquired pneumonia 5.
• The results showed that 3-day and 7-day treatments with amoxicillin were non-inferior to each other in terms of clinically indicated systemic antibacterial treatment prescribed for respiratory tract infection 5.
• Another study found that treatment with oral amoxicillin for 3 days was equally as effective as treatment for 5 days in children with non-severe pneumonia 4.

Clinical Management

• The clinical management of community-acquired pneumonia in young children involves the use of antibiotics, with amoxicillin being the first-line option for ambulatory patients and aqueous penicillin G or ampicillin for hospitalized children 6.
• Ceftriaxone can be considered in the treatment of very severe cases, and oxacillin or macrolide may be added in specific situations if Staphylococcus aureus or atypical bacteria are potential etiological agents 6.
• Penicillins remain the first-line choice of antibiotic for the treatment of CAP in young children 6.