From the Guidelines
For pediatric pneumonia, the recommended antibiotics depend on the child's age, severity of illness, and whether treatment is outpatient or inpatient, with amoxicillin being the first-line treatment at 90 mg/kg/day divided into two doses for 5-7 days for mild community-acquired pneumonia in previously healthy children over 3 months. The choice of antibiotic is guided by the suspected causative organism, with considerations for penicillin resistance and the potential for atypical pathogens. For children with penicillin allergy, alternatives include azithromycin (10 mg/kg on day 1, then 5 mg/kg daily for 4 days) or clarithromycin (15 mg/kg/day divided twice daily for 7-10 days) 1. In more severe cases requiring hospitalization, ampicillin or penicillin G intravenously is often used, sometimes with the addition of azithromycin if atypical pathogens are suspected, as outlined in the guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America 1. Key considerations include:
- The child's age and severity of illness
- The suspected causative organism and its antibiotic resistance profile
- The need for broader coverage in certain cases, such as with Staphylococcus aureus or in children under 3 months
- The importance of completing the full course of antibiotics to prevent recurrence or resistance development, as emphasized in the guidelines 1. In cases where Staphylococcus aureus is a concern, clindamycin or vancomycin may be added to the treatment regimen, as recommended in the guidelines for the management of community-acquired pneumonia in infants and children older than 3 months of age 1. For children under 3 months, broader coverage is typically needed with a combination of ampicillin and gentamicin or a third-generation cephalosporin, as outlined in the evidence summary for section V of the guidelines 1. These recommendations target the most common causative organisms in pediatric pneumonia, including Streptococcus pneumoniae, Mycoplasma pneumoniae, and respiratory viruses, and are based on the most recent and highest quality evidence available 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 recommended antibiotic 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 2
From the Research
Recommended Antibiotics for Pediatric Pneumonia
- Amoxicillin is recommended as the first-line antibiotic for pediatric pneumonia, with a duration of treatment not exceeding 7 days 3.
- A 5-day course of Amoxicillin is considered effective for uncomplicated community-acquired pneumonia in children under 10 years old 4.
- High-dose Amoxicillin may still be required to treat pediatric pneumonia, especially if using CLSI breakpoints 5.
- Oral Amoxicillin is equally efficacious as other parenteral antibiotics for managing severe pneumonia in children between 2 and 59 months of age 6.
Duration of Antibiotic Treatment
- A 3-day course of antibiotics is equally beneficial as a 5-day course for managing non-severe pneumonia in children between 2 and 59 months of age 6.
- A 5-day course of Amoxicillin is considered effective for uncomplicated community-acquired pneumonia in children under 10 years old 4.
- A 7-day course of Amoxicillin is recommended for school-aged children with community-acquired pneumonia 3.
Special Considerations
- Parenteral penicillin G and oral Amoxicillin are recommended as treatment for pediatric community-acquired pneumonia 5.
- Combination of penicillin/ampicillin and gentamicin is effective for managing very severe pneumonia in children between 2 and 59 months of age 6.
- Oral Amoxicillin is effective in non-severe pneumonia and is a suitable option for low- and middle-income countries where parenteral drug administration is an issue 6.