From the Guidelines
For pediatric chest infections, the recommended first-line antibiotic is amoxicillin at a dose of 90 mg/kg/day in 2 doses, as stated in the guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America 1. This dose is recommended for outpatient treatment of children with presumed bacterial pneumonia. For children with penicillin allergy, azithromycin at 10 mg/kg on day 1, followed by 5 mg/kg/day once daily on days 2–5, is an appropriate alternative 1. In cases of suspected atypical pneumonia, clarithromycin at 15 mg/kg/day in 2 doses for 7-14 days may be used 1. For more severe infections requiring hospitalization, ampicillin-sulbactam at 150-200 mg/kg/day divided every 6 hours or ceftriaxone at 50-100 mg/kg/day once daily may be necessary 1. Dosing should be adjusted based on the child's weight, and treatment duration may be extended if clinical improvement is slow. These antibiotics target the common bacterial pathogens in pediatric respiratory infections, including Streptococcus pneumoniae, Haemophilus influenzae, and Mycoplasma pneumoniae. Always assess for improvement within 48-72 hours of starting therapy, and consider changing antibiotics if there's no clinical response. Some key points to consider when selecting an antibiotic include:
- The severity of the infection
- The suspected pathogen
- The child's age and weight
- Any allergies or sensitivities to antibiotics
- Local resistance patterns It's also important to note that treatment for the shortest effective duration will minimize exposure of both pathogens and normal microbiota to antimicrobials and minimize the selection for resistance 1.
From the FDA Drug Label
Table 1 Lower Respiratory Tract Mild/ Moderate or Severe 875 mg every 12 hours or 500 mg every 8 hours 45 mg/kg/day in divided doses every 12 hours or 40 mg/kg/day in divided doses every 8 hours
The recommended pediatric dose for a chest infection (Lower Respiratory Tract) is:
- Mild/Moderate or Severe: 45 mg/kg/day in divided doses every 12 hours or 40 mg/kg/day in divided doses every 8 hours 2
- Alternatively, for patients who can take the adult dose: 875 mg every 12 hours or 500 mg every 8 hours 2
From the Research
Pediatric Dosing for Chest Infections
The following information is based on studies regarding antibiotic treatment for chest infections in children:
- The dosage of amoxicillin for uncomplicated lower respiratory tract infections in children is typically 50 mg/kg per day, divided into three doses orally for 7 days 3, 4.
- A study comparing different doses and durations of amoxicillin for community-acquired pneumonia in children found that a dose of 35-50 mg/kg/day was non-inferior to a higher dose of 70-90 mg/kg/day, and a 3-day treatment was non-inferior to a 7-day treatment 5.
- For community-acquired pneumonia caused by atypical agents, macrolides, fluoroquinolones, doxycycline, and ketolides are effective treatment options 6.
- A study on antibiotic choice and clinical outcomes in ambulatory children with community-acquired pneumonia found that macrolide monotherapy was the most commonly prescribed antibiotic, and was associated with lower odds of subsequent hospitalization and severe pneumonia compared to narrow-spectrum antibiotics 7.
Key Findings
- Amoxicillin is a commonly prescribed antibiotic for chest infections in children, with a typical dose of 50 mg/kg per day.
- The duration of amoxicillin treatment can vary, but 3-7 days is a common range.
- Macrolides are effective treatment options for community-acquired pneumonia caused by atypical agents.
- Macrolide monotherapy is associated with lower odds of subsequent hospitalization and severe pneumonia in ambulatory children with community-acquired pneumonia.