In a hemodynamically stable 7‑year‑old boy with fever, cough, localized left‑lower‑lobe consolidation and oxygen saturation 94% on room air who can tolerate oral fluids, what is the most appropriate next step in management?

Management of Uncomplicated Pediatric Pneumonia in a Stable 7-Year-Old

Discharge this child on oral amoxicillin with clear safety-netting instructions (Option B).

Why Outpatient Management Is Appropriate

This 7-year-old meets all criteria for safe discharge:

• Oxygen saturation of 94% exceeds the <92% threshold that mandates hospital admission according to British Thoracic Society guidelines; values ≥92% do not require admission 1
• The ability to drink fluids indicates adequate hydration and supports outpatient care 1
• Absence of severe respiratory distress signs (no documented grunting, marked retractions, altered mental status, or inability to feed) further justifies outpatient management 1
• Age 7 years is well beyond the high-risk infant group (<3–6 months) that necessitates hospitalization 1

Admitting this hemodynamically stable child for IV antibiotics (Option A) constitutes overtreatment when oral intake is reliable and clinical parameters are reassuring 1.

First-Line Antibiotic Selection

Oral amoxicillin is the definitive first-line agent for community-acquired pneumonia in school-age children 1:

• Streptococcus pneumoniae remains the predominant bacterial pathogen across all pediatric age groups, and amoxicillin offers high efficacy, good tolerability, and low cost 1
• Prescribe amoxicillin at 45 mg/kg/day divided every 12 hours (or 40 mg/kg/day divided every 8 hours) for lower respiratory tract infections 1, 2
• Total treatment duration should be 5–7 days 1

Macrolides (Option C) should NOT be used as first-line therapy unless atypical organisms (Mycoplasma or Chlamydia) are specifically suspected; they are reserved for children ≥5 years with documented atypical pathogen infection 1.

Critical Safety-Netting Instructions

Families must receive explicit instructions to return immediately if any of the following occur 1:

• Increased work of breathing or respiratory distress
• Inability to maintain oral fluid intake
• Worsening fever despite antibiotics
• Lethargy, altered consciousness, or cyanosis

A mandatory follow-up visit within 48 hours is required if clinical improvement is not evident after initiating oral therapy 1.

Supportive Care Education

Parents should be counseled on 1:

• Use of antipyretics (acetaminophen or ibuprofen) for fever management
• Ensuring adequate hydration throughout the treatment course
• Completing the full 5–7 day antibiotic course even if symptoms improve earlier

Common Pitfalls to Avoid

• Do not order routine chest radiography for mild, uncomplicated cases when the clinical diagnosis is clear 1
• Do not prescribe broad-spectrum agents (co-amoxiclav, cephalosporins) as first-line therapy in uncomplicated pediatric pneumonia 1
• Do not base admission decisions solely on radiographic consolidation if clinical parameters (oxygen saturation, ability to drink, absence of severe distress) are reassuring 1
• Intravenous antibiotics are indicated only when oral intake is unreliable (persistent vomiting) or severe clinical features are present (SpO₂ <92%, marked respiratory distress, inability to feed) 1