Recommended Antibiotic Treatment for Pediatric Pneumonia
Amoxicillin is the first-line antibiotic treatment for pediatric community-acquired pneumonia, with a recommended dosage of 90 mg/kg/day in 2-3 divided doses for 5-7 days. 1
Age-Based Treatment Recommendations
Infants and Children Under 5 Years
- First-line treatment: Amoxicillin 90 mg/kg/day in 2 divided doses 1
- Duration: 5-7 days for uncomplicated pneumonia 1
- Alternative: Amoxicillin-clavulanate if unimmunized against Haemophilus influenzae type b or in areas with high resistance 1, 2
Children 5 Years and Older
- First-line treatment: Amoxicillin 90 mg/kg/day in 2 divided doses (maximum 4 g/day) 1
- Consider adding: Macrolide (azithromycin or clarithromycin) if atypical pneumonia is suspected or if symptoms persist after 48 hours of amoxicillin therapy 1, 2
- Azithromycin dosing: 10 mg/kg on day 1, followed by 5 mg/kg on days 2-5 3
Treatment Based on Severity
Mild to Moderate Pneumonia (Outpatient)
- First choice: Oral amoxicillin 90 mg/kg/day in 2-3 divided doses 1, 2, 4
- Duration: 5 days with reassessment at 72 hours 1, 2
Severe Pneumonia (Inpatient)
- First choice: Intravenous ampicillin or penicillin G 1, 4
- Alternatives: Ceftriaxone or cefotaxime if not fully immunized or in areas with high resistance 1
- For suspected Staphylococcus aureus: Add vancomycin (40-60 mg/kg/day) or clindamycin (40 mg/kg/day) 1
Special Considerations
Penicillin Allergy
- Non-anaphylactic reactions: Cefuroxime (30 mg/kg/day) or cefpodoxime-proxetil 1
- Severe allergic reactions: Clindamycin (10-20 mg/kg/day in 3 divided doses) 1
Atypical Pathogens
- For suspected Mycoplasma or Chlamydia (especially in children >5 years): Add a macrolide such as azithromycin 1, 5
- Azithromycin dosing for CAP: 10 mg/kg (max 500 mg) on day 1, followed by 5 mg/kg (max 250 mg) on days 2-5 3
Monitoring and Follow-up
- Assess for clinical improvement within 48-72 hours 1
- Signs of improvement include: decreased respiratory rate, reduced work of breathing, improved oxygen saturation, decreased fever, and improved feeding 1
- If no improvement within 48-72 hours, reassess and consider alternative treatment 1
- For patients on oxygen therapy, check oxygen saturation at least every 4 hours 1
Common Pitfalls to Avoid
- Overuse of broad-spectrum antibiotics: Studies show inappropriate use of broad-spectrum antibiotics like ceftriaxone and amoxicillin-clavulanate when narrow-spectrum options would suffice 6, 7
- Inadequate dosing: Standard dosing may be inadequate in areas with high prevalence of resistant organisms 1
- Inappropriate duration: Treating longer than necessary (evidence supports 5-7 days for uncomplicated pneumonia) 1, 2
- Failure to consider age-specific pathogens: Streptococcus pneumoniae is common at all ages, while Mycoplasma pneumoniae becomes more prevalent from age 5 years onward 5
The evidence strongly supports amoxicillin as first-line therapy for pediatric CAP, with consideration for age, immunization status, and local resistance patterns guiding specific treatment decisions.