From the Guidelines
Pediatric pneumonia should be treated based on the child's age, severity of illness, and likely pathogens, with amoxicillin as the first-line treatment at 90 mg/kg/day divided into two doses for 5-7 days for mild to moderate community-acquired pneumonia in previously healthy children over 3 months, as recommended by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America 1.
Key Considerations
- For children with penicillin allergy, azithromycin (10 mg/kg on day 1, then 5 mg/kg for 4 more days) or clarithromycin (15 mg/kg/day divided twice daily for 7-10 days) are appropriate alternatives 1.
- For more severe cases requiring hospitalization, ampicillin or ampicillin-sulbactam IV is recommended, with ceftriaxone reserved for more complicated cases 1.
- In children under 3 months, hospital admission with IV antibiotics is typically necessary 1.
- Atypical pneumonia, often caused by Mycoplasma pneumoniae, is more common in school-aged children and responds well to macrolides 2.
Supportive Care
- Supportive care including adequate hydration, fever control, and monitoring of respiratory status is essential 3.
- Chest radiographs are not routinely needed for mild cases but may be indicated for severe illness, treatment failure, or complications 4.
Prevention
- Vaccination against pneumococcus, Haemophilus influenzae type b, and annual influenza vaccines significantly reduces pneumonia risk and should be kept up to date 5.
Treatment Success
- Treatment success is indicated by clinical improvement within 48-72 hours, including decreased fever, improved appetite, and reduced respiratory symptoms 6.
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. The recommended pediatric dosage guideline for community-acquired pneumonia is:
- 10 mg/kg as a single dose on the first day
- 5 mg/kg on Days 2 through 5 Key points:
- The dosage is based on the patient's weight
- The treatment course is 5 days
- Safety and effectiveness in patients under 6 months of age have not been established 7
From the Research
Pediatric Pneumonia Guideline
- The World Health Organization (WHO) recommends a 5-day Amoxicillin-based empiric treatment for community-acquired pneumonia (CAP) in children 8.
- A systematic review of trials conducted in low- and middle-income countries found that a combination of penicillin/ampicillin and gentamicin is effective for managing very severe pneumonia in children between 2 and 59 months of age, and oral amoxicillin is equally efficacious as other parenteral antibiotics for managing severe pneumonia in this age group 9.
- Oral amoxicillin was also found to be effective in non-severe pneumonia, and a short 3-day course of antibiotics was found to be equally beneficial as a 5-day course for managing non-severe pneumonia in children between 2 and 59 months of age 9.
- A randomized controlled trial found that home treatment with high-dose oral amoxicillin is equivalent to hospitalization and parenteral ampicillin for treatment of severe pneumonia in children without underlying complications 10.
- Another study 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 8.
Antibiotic Treatment
- Ceftriaxone and ampicillin/sulbactam are recommended by various guidelines as the first-line antibiotics for community-acquired pneumonia (CAP) 11.
- A study found that ampicillin might be more effective in the early phase of treatment, but no significant difference in effectiveness was found between ampicillin/sulbactam and ceftriaxone at the end of treatment 11.
- A propensity-matched cohort study found that ampicillin and ceftriaxone (with the addition of macrolides for both arms) are comparable for the treatment of hospitalized adults due to CAP, with ampicillin associated with significantly lower rates of Clostridioides difficile infection (CDI) 12.
Treatment Duration
- A systematic review and meta-analysis 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 8.
- A randomized controlled trial found that a 3-day course of antibiotics is equally beneficial as a 5-day course for managing non-severe pneumonia in children between 2 and 59 months of age 9.