What is the recommended treatment for pneumonia in a 3-year-old child?

Treatment of Pneumonia in a 3-Year-Old Child

Amoxicillin is the first-line treatment for community-acquired pneumonia in a 3-year-old child, administered at 90 mg/kg/day in 2 doses or 45 mg/kg/day in 3 doses for 5 days. 1, 2

Outpatient Management

First-line therapy:

• For mild to moderate community-acquired pneumonia (CAP) in previously healthy, fully immunized children:
  • Oral amoxicillin 90 mg/kg/day divided in 2 doses or 45 mg/kg/day in 3 doses for 5 days 1, 2, 3
  • A 5-day course is as effective as longer 10-day courses for uncomplicated pneumonia 3, 4

Alternative therapy (for penicillin-allergic patients):

• Oral clindamycin 30-40 mg/kg/day divided in 3 doses 5, 2
• For suspected atypical pneumonia (Mycoplasma or Chlamydophila):
  • Azithromycin 10 mg/kg on day 1, followed by 5 mg/kg/day once daily on days 2-5 1, 2, 6

Inpatient Management

For hospitalized patients with non-severe pneumonia:

• Ampicillin 150-200 mg/kg/day divided every 6 hours 1, 2
• For areas with high prevalence of resistant pneumococci or incomplete immunization:
  • Ceftriaxone 50-100 mg/kg/day every 12-24 hours or cefotaxime 150 mg/kg/day every 8 hours 1, 2

For suspected atypical pneumonia requiring hospitalization:

• Add a macrolide (e.g., azithromycin) to β-lactam therapy 1, 2
• Intravenous azithromycin 10 mg/kg on days 1 and 2 of therapy 1

Pathogen-Specific Considerations

Streptococcus pneumoniae:

• For penicillin-susceptible strains: amoxicillin as described above 1, 2
• For penicillin-resistant strains: higher dose amoxicillin (90 mg/kg/day) or alternative agents based on susceptibility 1, 2

Mycoplasma pneumoniae/Chlamydophila:

• Azithromycin as the preferred agent 1, 2

Staphylococcus aureus:

• For methicillin-susceptible S. aureus: cefazolin (150 mg/kg/day) or oxacillin (150-200 mg/kg/day) if hospitalized 1, 2
• For methicillin-resistant S. aureus: vancomycin or clindamycin based on susceptibility 1, 5

Haemophilus influenzae:

• Amoxicillin (75-100 mg/kg/day) for β-lactamase negative strains 1, 2
• Amoxicillin-clavulanate for β-lactamase producing strains 1, 2

Treatment Duration

• 5 days for uncomplicated CAP treated as outpatient 2, 3, 4
• Longer courses may be needed for complicated pneumonia or specific pathogens like S. aureus 2

Important Clinical Considerations

• Recent studies show that shorter antibiotic courses (5 days) are as effective as longer courses (10 days) for uncomplicated pneumonia, which helps reduce antibiotic resistance 3, 4
• Treatment failure is more likely in children younger than 12 months, those with symptoms lasting 3 days or longer before presentation, and those with higher respiratory rates 7
• Non-adherence to prescribed treatment is a significant risk factor for treatment failure 7
• Empiric therapy should be adjusted based on local resistance patterns and the child's vaccination status 2
• For children with uncomplicated lower respiratory tract infections where pneumonia is not clinically suspected, antibiotics may not provide significant benefit 8