What is the treatment for pneumonitis in children?

Treatment of Pneumonitis in Children

Amoxicillin is the first-line antibiotic for children under 5 years with community-acquired pneumonia, while macrolide antibiotics (azithromycin, clarithromycin, or erythromycin) are first-line for children 5 years and older. 1

Age-Based Antibiotic Selection

Children Under 5 Years

• Oral amoxicillin at 90 mg/kg/day divided into 2 doses is the recommended first-line treatment because it effectively covers Streptococcus pneumoniae, the most common bacterial pathogen in this age group 1, 2
• Treatment duration should be 5-7 days for uncomplicated cases 1, 3
• Amoxicillin is preferred because it is well-tolerated, inexpensive, and targets the majority of causative pathogens 1

Children 5 Years and Older

• Macrolide antibiotics are first-line empirical treatment due to higher prevalence of Mycoplasma pneumoniae in this age group 1
• Options include erythromycin, clarithromycin, or azithromycin 1
• For azithromycin specifically: 500 mg on Day 1, followed by 250 mg once daily on Days 2-5 for community-acquired pneumonia 4

Severity-Based Treatment Approach

Outpatient Management (Mild Cases)

• Children with mild symptoms and no respiratory distress can be managed as outpatients with oral antibiotics 1, 3
• Young children with very mild lower respiratory tract symptoms may not require antibiotics at all 1
• Re-evaluate within 48 hours if the child is not improving 1, 2

Inpatient Management (Severe Cases)

Hospitalization criteria include: 5, 2

• Oxygen saturation <92% or cyanosis
• Respiratory rate >50 breaths/min
• Difficulty breathing or grunting
• Signs of dehydration
• Family unable to provide appropriate observation

Intravenous antibiotic options for severe pneumonia: 5, 1, 2

• Co-amoxiclav (amoxicillin-clavulanate)
• Cefuroxime
• Cefotaxime
• Ampicillin or penicillin G (if S. pneumoniae suspected)
• Add vancomycin or clindamycin if MRSA is suspected 2

Transition to oral antibiotics when the child shows clear clinical improvement and can tolerate oral intake 5, 3

Pathogen-Specific Considerations

• If Streptococcus pneumoniae is suspected: Use amoxicillin at any age 1
• If Mycoplasma or Chlamydia pneumonia is suspected: Use macrolide antibiotics 1
• If Staphylococcus aureus is suspected: Use a macrolide or combination of flucloxacillin with amoxicillin 1

Supportive Care Measures

Oxygen Therapy

• Provide supplemental oxygen to maintain saturation >92% via nasal cannulae, head box, or face mask 5, 1, 2
• Perform pulse oximetry to assess hypoxemia 5

Hydration and Monitoring

• Administer intravenous fluids at 80% of basal levels with serum electrolyte monitoring in severely ill children 5
• Ensure adequate hydration and avoid nasogastric tubes if possible, as they may compromise breathing 5, 2

Symptomatic Relief

• Antipyretics and analgesics help keep the child comfortable and assist with coughing 1
• Avoid chest physiotherapy—it is not beneficial and should not be performed 5, 1

Special Populations

HIV-Endemic Areas

• Amoxicillin remains the recommended treatment for non-severe pneumonia regardless of co-trimoxazole prophylaxis status 1
• If first-line therapy fails, refer to hospital for HIV testing and broad-spectrum parenteral antibiotics 1
• Children with pneumonia and severe anemia should be referred to hospital 1

Aspiration Pneumonia

• Oral amoxicillin at 90 mg/kg/day in 2 doses for 7-14 days is first-line for outpatient management 2
• For severe cases requiring hospitalization, use IV ampicillin, penicillin G, ceftriaxone, or cefotaxime 2

Pediatric Dosing Guidelines for Azithromycin

For community-acquired pneumonia (5-day regimen): 4

• Day 1: 10 mg/kg as a single dose
• Days 2-5: 5 mg/kg once daily

Weight-based dosing examples using 200 mg/5 mL suspension: 4

• 10 kg (22 lbs): 5 mL Day 1, then 2.5 mL Days 2-5
• 20 kg (44 lbs): 5 mL Day 1, then 2.5 mL Days 2-5 (total 600 mg)
• 30 kg (66 lbs): 7.5 mL Day 1, then 3.75 mL Days 2-5 (total 900 mg)

Common Pitfalls to Avoid

• Do not delay antibiotic therapy in bacterial pneumonia while awaiting diagnostic test results 5
• Do not use chest physiotherapy—it provides no benefit 5, 1
• Do not routinely order chest radiography unless the diagnosis is uncertain, hypoxemia is present, or the patient fails to improve within 48-72 hours 3
• Do not continue antibiotics beyond 5-7 days for uncomplicated cases 1, 3
• Do not use nasogastric tubes in severely ill children as they may compromise breathing 5, 2

Monitoring and Follow-Up

• Review the child within 48 hours if not improving on treatment 1, 2
• Re-evaluate for possible complications if the child remains febrile or unwell after 48 hours of appropriate treatment 2
• Monitor for signs of respiratory distress, dehydration, and adequate oral intake 5, 2