What is the recommended treatment for pneumonia in children?

Treatment of Pneumonia in Children

Amoxicillin is the first-line antibiotic treatment for community-acquired pneumonia in children under 5 years, while macrolide antibiotics are recommended as first-line treatment for children aged 5 and above. 1

Age-Based Treatment Approach

• For children under 5 years:

  • Oral amoxicillin is the first-choice antibiotic as it effectively targets the most common pathogens in this age group, particularly Streptococcus pneumoniae 1, 2
  • Recommended dosage: 90 mg/kg/day in two divided doses for 5-7 days 1, 3
  • For non-severe pneumonia, a 5-day course is typically sufficient 1, 2

• For children 5 years and older:

  • Macrolide antibiotics (erythromycin, clarithromycin, or azithromycin) are recommended due to higher prevalence of Mycoplasma pneumoniae in this age group 1, 4
  • Azithromycin dosing for community-acquired pneumonia: 10 mg/kg as a single dose on day 1, followed by 5 mg/kg on days 2-5 5

Severity-Based Treatment Approach

• Mild pneumonia (outpatient management):

  • Young children with mild symptoms may not need antibiotics if viral etiology is suspected 1, 2
  • For bacterial pneumonia, oral amoxicillin is the first-line treatment 6, 1
  • Follow-up within 48-72 hours to ensure clinical improvement 3

• Severe pneumonia (requiring hospitalization):

  • Intravenous antibiotics should be used when the child is unable to absorb oral medications or presents with severe symptoms 1, 7
  • Appropriate IV antibiotics include co-amoxiclav, cefuroxime, and cefotaxime 1
  • For very severe cases, penicillin/ampicillin plus gentamicin is superior to chloramphenicol 7
  • In areas where referral is not possible, injectable antimicrobials such as ceftriaxone, penicillin/gentamicin, or chloramphenicol should be used 6

Special Considerations

• HIV-infected children:

  • For children living in areas of high HIV prevalence or with suspected/diagnosed HIV infection who present with non-severe pneumonia, amoxicillin is still recommended regardless of co-trimoxazole prophylaxis status 6
  • If first-line therapy fails, refer to hospital for management including HIV testing and broad-spectrum parenteral antibiotics 6

• Malaria-endemic regions:

  • Children presenting with rapid breathing should be assessed for severe anemia 6
  • Any child with pneumonia who also has severe anemia should be referred to hospital 6

Supportive Care

• Maintain oxygen saturation above 92% in hypoxic children 1, 3
• Ensure adequate hydration 3
• Use antipyretics and analgesics to keep the child comfortable and help with coughing 1, 3
• Chest physiotherapy is not beneficial and should not be performed 1, 3

Treatment Monitoring and Follow-up

• Patients should be re-evaluated if they remain febrile or unwell 48 hours after starting treatment 1, 3
• Repeated chest radiographs are not routinely required in children who recover uneventfully 3, 8
• If improvement does not occur, consider complications such as empyema or lung abscess 8

Common Pitfalls to Avoid

• Unnecessary use of broad-spectrum antibiotics for non-severe pneumonia 2, 7
• Failure to reassess after 48-72 hours if no clinical improvement is observed 3
• Unnecessary chest radiographs for follow-up in clinically improving children 3, 8
• Underestimating the importance of supportive care alongside antibiotic therapy 3