What is the first line treatment for pneumonia in children?

First-Line Treatment for Pneumonia in Children

Amoxicillin is the first-choice antibiotic for treating community-acquired pneumonia (CAP) in children under 5 years of age, while macrolide antibiotics are recommended as first-line empirical treatment for children aged 5 and above. 1

Age-Based Treatment Approach

Children Under 5 Years:

• Oral amoxicillin is the first-line treatment because it is effective against the majority of pathogens causing CAP in this age group, is well-tolerated, and inexpensive 1
• The recommended dosage for 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 2
• Alternative options include co-amoxiclav, cefaclor, erythromycin, clarithromycin, and azithromycin 1

Children 5 Years and Older:

• Macrolide antibiotics (erythromycin, clarithromycin, or azithromycin) are recommended as first-line empirical treatment due to the higher prevalence of Mycoplasma pneumonia in this age group 1
• Azithromycin dosing for children with community-acquired pneumonia is based on weight, with typical regimens being 10 mg/kg on day 1 followed by 5 mg/kg on days 2-5 2

Pathogen-Specific Considerations

• If Streptococcus pneumoniae is the suspected pathogen, amoxicillin should be used as first-line treatment at any age 1
• For suspected Mycoplasma or Chlamydia pneumonia, macrolide antibiotics should be used 1
• If Staphylococcus aureus is the likely pathogen, a macrolide or combination of flucloxacillin with amoxicillin is appropriate 1

Treatment Duration

• Recent evidence suggests that shorter courses (3-5 days) of amoxicillin are as effective as longer courses (7-10 days) for uncomplicated CAP in children 3, 4
• The British Thoracic Society guidelines recommend a 5-day course for most cases of pediatric CAP 1

Severity-Based Treatment Approach

Mild Cases:

• Young children presenting with mild symptoms of lower respiratory tract infection may not need antibiotics 1
• Outpatient management with oral antibiotics is appropriate for children without respiratory distress who can tolerate oral medications 4

Moderate to Severe Cases:

• Intravenous antibiotics should be used when the child is unable to absorb oral antibiotics (e.g., due to vomiting) or presents with severe signs and symptoms 1
• Appropriate IV antibiotics for severe pneumonia include co-amoxiclav, cefuroxime, and cefotaxime 1
• If clinical or microbiological data suggest S. pneumoniae is the causative organism, amoxicillin, ampicillin, or penicillin alone may be used 1
• Patients on IV antibiotics should be transitioned to oral treatment when there is clear evidence of improvement 1, 4

Special Considerations

• In areas with high HIV prevalence, amoxicillin is still recommended for non-severe pneumonia, regardless of co-trimoxazole prophylaxis status 1
• Patients should be re-evaluated if they remain pyrexial or unwell 48 hours after starting treatment 1
• Children treated at home should be reviewed by a healthcare provider if their condition deteriorates or does not improve after 48 hours of treatment 1

Supportive Care

• Maintain oxygen saturation above 92% in children with pneumonia who are hypoxic 1
• Antipyretics and analgesics can help keep the child comfortable and help with coughing 1
• Chest physiotherapy is not beneficial and should not be performed in children with pneumonia 1

By following these evidence-based recommendations, healthcare providers can optimize outcomes for children with community-acquired pneumonia while minimizing unnecessary antibiotic use and potential adverse effects.