What is the recommended treatment for bacterial pneumonia in a pediatric patient with Impaired respiratory function, specifically a 5-year-old child?

From the Guidelines

For bacterial pneumonia in a 5-year-old child, amoxicillin is the first-line treatment, typically prescribed at 90 mg/kg/day divided into two doses for 5-7 days. For example, if the child weighs 20 kg, they would receive about 900 mg per day, or 450 mg twice daily 1. If there's concern for atypical pathogens or the child has an amoxicillin allergy, azithromycin can be used at 10 mg/kg on day 1 (maximum 500 mg) followed by 5 mg/kg (maximum 250 mg) once daily for days 2-5 1. For more severe cases or if there's concern for resistant organisms, amoxicillin-clavulanate or ceftriaxone may be appropriate 1.

Key Considerations

• The choice of antibiotic should be based on the severity of the pneumonia, the likelihood of resistant organisms, and the child's allergy history.
• Supportive care is also important, including ensuring adequate hydration, fever control with acetaminophen or ibuprofen, and rest.
• Parents should seek immediate medical attention if the child develops increased work of breathing, inability to drink fluids, or worsening symptoms despite antibiotics.

Antibiotic Options

• Amoxicillin: 90 mg/kg/day divided into two doses for 5-7 days 1
• Azithromycin: 10 mg/kg on day 1 (maximum 500 mg) followed by 5 mg/kg (maximum 250 mg) once daily for days 2-5 1
• Amoxicillin-clavulanate or ceftriaxone: for more severe cases or concern for resistant organisms 1

From the FDA Drug Label

Community-Acquired Pneumonia The recommended dose of azithromycin for oral suspension for the treatment of pediatric patients with 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.

PEDIATRIC DOSAGE GUIDELINES FOR OTITIS MEDIA, ACUTE BACTERIAL SINUSITIS AND COMMUNITY-ACQUIRED PNEUMONIA (Age 6 months and above, see PRECAUTIONS—Pediatric Use.) Based on Body Weight OTITIS MEDIA AND COMMUNITY-ACQUIRED PNEUMONIA: (5-Day Regimen)

• Dosing Calculated on 10 mg/kg/day Day 1 and 5 mg/kg/day Days 2 to 5.

For a 5 year old patient, the dose would be calculated based on their weight. Assuming an average weight for a 5 year old is around 18-20 kg (40 lbs), the dose would be around 200 mg on the first day and 100 mg on days 2-5.

For a 5 year old patient with bacterial pneumonia, the recommended dose of azithromycin is:

• 10 mg/kg as a single dose on the first day,
• followed by 5 mg/kg on Days 2 through 5. This would translate to approximately 200 mg on the first day and 100 mg on days 2-5, for a patient weighing around 18-20 kg (40 lbs) 2.

From the Research

Treatment Options for Bacterial Pneumonia in a 5-Year-Old

• The World Health Organization (WHO) recommends a 5-day Amoxicillin-based empiric treatment for community-acquired pneumonia (CAP) 3.
• A study published in the European Journal of Pediatrics found that a short course of Amoxicillin (5 days) is just as effective as a longer course (10 days) for uncomplicated CAP in children under 10 years old 3.
• Another study published in the Journal of the Pediatric Infectious Diseases Society found that a short course of antibiotic therapy (approximately 5 days) does not increase the odds of 30-day treatment failure compared with longer courses for hospitalized children with uncomplicated CAP 4.

Antibiotic Susceptibility

• Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are common causes of bacterial pneumonia in children 5, 6.
• Amoxicillin is effective against these bacteria, with susceptibility rates of 91.6% for S. pneumoniae, 70.2% for H. influenzae, and 11.2% for M. catarrhalis 5, 6.
• Other antibiotics, such as ceftriaxone, cefixime, and azithromycin, may also be effective against these bacteria, but their susceptibility rates vary 5, 6.

Clinical Management

• The first-line antibiotic options for the treatment of CAP in young children are amoxicillin (50 mg/kg/day, every 12 hours) among ambulatory patients and aqueous penicillin G (200,000 IU/kg/day, every 6 hours) or ampicillin (200 mg/kg/day, every 6 hours) for hospitalized children 7.
• Ceftriaxone can be considered in the treatment of very severe cases, and oxacillin or macrolide may be added in specific situations if Staphylococcus aureus or atypical bacteria are potential etiological agents 7.