From the Guidelines
For bacterial pneumonia in a 6-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 a typical 6-year-old weighing about 20 kg, this would be approximately 900 mg twice daily 1. If there's concern for atypical pathogens or the child has significant allergies to penicillins, azithromycin at 10 mg/kg on day 1 (maximum 500 mg) followed by 5 mg/kg (maximum 250 mg) daily for days 2-5 is an alternative 1.
Key Considerations
- The choice of antibiotic should be based on the severity of the pneumonia, the likelihood of bacterial versus atypical pathogens, and local resistance patterns.
- For more severe cases requiring hospitalization, ampicillin or ampicillin-sulbactam IV may be needed 1.
- It's essential to ensure the child stays well-hydrated, gets plenty of rest, and takes the full course of antibiotics even if symptoms improve quickly.
- Fever reducers like acetaminophen can help manage fever and discomfort.
- Amoxicillin is preferred because Streptococcus pneumoniae remains the most common bacterial cause of pneumonia in this age group, and this medication provides excellent coverage while minimizing unnecessary broad-spectrum exposure 1.
Follow-Up
- Close follow-up is essential, and if the child doesn't show improvement within 48-72 hours, reassessment and possibly a change in antibiotic therapy may be necessary 1.
- Reassessment should include monitoring for the expected improvements in presenting findings, such as fever, respiratory rate, and hypoxemia, as well as the child's global response in terms of activity, appetite, and hydration status 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 6-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. To determine the dose, the patient's weight in kilograms or pounds should be used in the provided dosage guidelines table 2.
From the Research
Treatment Options for Bacterial Pneumonia in a 6-Year-Old
- Amoxicillin/clavulanate is a commonly prescribed antibiotic for community-acquired pneumonia, including in children 3, 4, 5, 6.
- Azithromycin is also an effective treatment option for community-acquired pneumonia in children, with a shorter treatment course compared to amoxicillin/clavulanate 4, 5, 6.
- The choice of antibiotic should be based on the severity of the pneumonia, the child's medical history, and the likelihood of antibiotic resistance 6.
Efficacy of Antibiotics
- Amoxicillin/clavulanate has been shown to be effective in eradicating Streptococcus pneumoniae and Haemophilus influenzae in children with acute otitis media 3.
- Azithromycin has been shown to be effective in treating community-acquired pneumonia in children, with a clinical success rate of 92.6% 4.
- A study comparing amoxicillin/clavulanate and azithromycin for non-severe respiratory exacerbations in children with bronchiectasis found that both antibiotics were effective, but amoxicillin/clavulanate had a higher relative risk for resolution by day 14 5.
Safety and Tolerability
- Both amoxicillin/clavulanate and azithromycin are generally well-tolerated in children, with common adverse events including gastrointestinal symptoms 3, 4, 5.
- A study evaluating the safety and efficacy of azithromycin for community-acquired pneumonia in adults found that the overall incidence of adverse events was 25.0% 4.