Is amoxicillin (amoxicillin) effective for treating pediatric pneumonia?

Amoxicillin for Pediatric Pneumonia

Amoxicillin is the first-line antibiotic for treating community-acquired pneumonia in children and should be used for previously healthy, appropriately immunized infants, preschool children, school-aged children, and adolescents with mild to moderate bacterial pneumonia. 1

Age-Specific Recommendations

Infants and Preschool Children (Under 5 Years)

• Amoxicillin is the first choice for oral antibiotic therapy because it is effective against the majority of pathogens causing community-acquired pneumonia in this age group, particularly Streptococcus pneumoniae, is well tolerated, and inexpensive 1
• The recommended dose is 90 mg/kg/day divided into 2 doses for outpatient management 2
• Treatment duration should be 5-7 days for uncomplicated cases 3, 4

School-Aged Children and Adolescents (5 Years and Older)

• Amoxicillin remains first-line therapy for S. pneumoniae, the most prominent invasive bacterial pathogen 1
• However, macrolide antibiotics should be considered as first-line empirical treatment in this age group because Mycoplasma pneumoniae is more prevalent 1
• If atypical pathogens (Mycoplasma or Chlamydia) are suspected based on clinical presentation, macrolides should be used 1

Important Clinical Caveats

When NOT to Use Antibiotics

• Antimicrobial therapy is not routinely required for preschool-aged children with community-acquired pneumonia because viral pathogens are responsible for the great majority of clinical disease 1
• Young children presenting with mild symptoms of lower respiratory tract infection need not be treated with antibiotics 1

Route of Administration

• Oral amoxicillin is safe and effective for children presenting with community-acquired pneumonia 1
• Oral amoxicillin has been shown to be equivalent to injectable penicillin even for severe pneumonia (with lower chest indrawing) in controlled settings 5
• 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

Treatment Duration Evidence

Shorter vs. Longer Courses

• A 3-day course of amoxicillin is equally effective as a 5-day course for non-severe pneumonia, with treatment failure rates of 21% vs. 20% respectively 6
• A 5-day course is as effective as a 10-day course for uncomplicated community-acquired pneumonia in children under 10 years old 3
• However, 7-day treatment resulted in faster resolution of cough (10 days vs. 12 days) compared to 3-day treatment, though other symptoms resolved at similar rates 7
• Treatment should not exceed 7 days for uncomplicated cases 4

Risk Factors for Treatment Failure

• Non-adherence to treatment is the most important risk factor for treatment failure 6
• Other predictors include: age younger than 12 months, illness duration of 3 days or longer before treatment, respiratory rate more than 10 breaths/min above age-specific cut-off, vomiting, and hypoxia 6, 5

Hospitalized Patients

Inpatient Antibiotic Selection

• Ampicillin or penicillin G should be administered to fully immunized infants or school-aged children admitted to a hospital ward when local epidemiology documents lack of substantial high-level penicillin resistance 1
• Third-generation parenteral cephalosporins (ceftriaxone or cefotaxime) should be prescribed for hospitalized infants and children who are not fully immunized, in regions with high-level penicillin resistance, or for life-threatening infections including empyema 1
• Transition to oral antibiotics should occur when there is clear evidence of clinical improvement 1

Alternatives to Amoxicillin

For Penicillin Allergy

• Alternative agents include co-amoxiclav, cefaclor, erythromycin, clarithromycin, and azithromycin 1

For Specific Pathogens

• If Staphylococcus aureus is suspected, a macrolide or combination of flucloxacillin with amoxicillin is appropriate 1
• Macrolide antibiotics should be prescribed for children with findings compatible with atypical pathogens 1

Monitoring and Follow-Up

• Children cared for at home should be reviewed if deteriorating or if not improving after 48 hours on treatment 1
• Chest radiography should be ordered if the diagnosis is uncertain, if patients have hypoxemia or significant respiratory distress, or if patients fail to show clinical improvement within 48-72 hours after initiation of antibiotic therapy 4