First-Line Antibiotics for Pediatric Patients
Amoxicillin is the first-line antibiotic for most pediatric infections, particularly for children under 5 years, because it is effective against the majority of common pathogens, well-tolerated, and cost-effective. 1, 2
Age-Specific First-Line Recommendations
Children Under 5 Years
- Amoxicillin is the first-choice oral antibiotic therapy because it effectively treats the majority of common pediatric pathogens, has good tolerability, and is inexpensive 1
- Recommended dosing: 40-45 mg/kg/day divided into two doses for mild to moderate infections 2
- For severe infections or in areas with high prevalence of penicillin-resistant S. pneumoniae, high-dose amoxicillin (90 mg/kg/day) is recommended 2
Children 5 Years and Older
- Macrolide antibiotics (erythromycin, clarithromycin, azithromycin) may be used as first-line empirical treatment due to higher prevalence of mycoplasma pneumonia in this age group 1
- Amoxicillin should still be used if S. pneumoniae is the suspected pathogen, regardless of age 1
Infection-Specific First-Line Recommendations
Community-Acquired Pneumonia
- Oral amoxicillin for mild to moderate cases in previously healthy children 1, 3
- For hospitalized patients with severe pneumonia, appropriate intravenous options include co-amoxiclav, cefuroxime, and cefotaxime 1
Sepsis
- Combination therapy is recommended: amoxicillin/ampicillin/benzylpenicillin plus gentamicin 1
- Second choices include amikacin with cloxacillin, cefotaxime, or ceftriaxone 1
Upper Respiratory Tract Infections
- Amoxicillin for suspected bacterial infections, particularly in children under 5 years 1, 2
- For children who have received antibiotics in the previous 4-6 weeks, high-dose amoxicillin (90 mg/kg/day) should be used to overcome potential resistant organisms 1, 2
Special Considerations
Antibiotic Resistance
- In areas with high prevalence of penicillin-resistant S. pneumoniae or beta-lactamase producing H. influenzae, consider amoxicillin-clavulanate instead of amoxicillin alone 1, 2
- Recent antibiotic use (within 4-6 weeks) increases risk of resistant organisms and should guide therapy selection toward broader coverage 1, 2
Specific Pathogens
- For suspected Staphylococcus aureus infections, use a macrolide or combination of flucloxacillin with amoxicillin 1
- For suspected mycoplasma or chlamydia pneumonia, macrolide antibiotics are recommended 1
Route of Administration
- Oral antibiotics are safe and effective for most pediatric infections 1
- Intravenous antibiotics should be reserved for children who:
- Cannot absorb oral antibiotics (e.g., due to vomiting)
- Present with severe signs and symptoms
- Have sepsis or other serious infections 1
Clinical Monitoring
- Evaluate response to therapy after 48-72 hours; lack of improvement may indicate treatment failure requiring change in antibiotic or reevaluation 2
- If a child remains febrile or unwell 48 hours after starting antibiotics, reassessment is necessary to consider complications or alternative diagnoses 1
Antibiotic Stewardship Considerations
- Avoid unnecessary antibiotic use for viral infections to prevent development of resistance 1, 4
- Use the narrowest spectrum antibiotic effective against the most likely pathogen 4
- Prescribe appropriate duration of therapy to minimize adverse effects while ensuring clinical cure 1, 4
Common Pitfalls to Avoid
- Using broad-spectrum antibiotics (like azithromycin) as first-line when narrower options would be effective 1, 5
- Failing to adjust therapy based on local resistance patterns 2
- Continuing intravenous antibiotics when oral therapy would be appropriate after clinical improvement 1
- Not considering recent antibiotic exposure when selecting therapy 1, 2