What is the treatment for pneumonia in a pediatric patient?

From the Guidelines

Treatment for Pediatric Pneumonia

For pediatric patients with pneumonia, antimicrobial therapy is the cornerstone of treatment, with the choice of antibiotic depending on the suspected or confirmed pathogen, the age of the child, and the severity of the disease 1.

• Outpatient treatment for children under 5 years old with presumed bacterial pneumonia typically involves amoxicillin at a dose of 90 mg/kg/day in 2 doses, with azithromycin (10 mg/kg on day 1, followed by 5 mg/kg/day once daily on days 2–5) being an alternative for presumed atypical pneumonia 1.
• For children 5 years old and above, amoxicillin (90 mg/kg/day in 2 doses to a maximum of 4 g/day) is recommended for presumed bacterial pneumonia, while azithromycin (10 mg/kg on day 1, followed by 5 mg/kg/day once daily on days 2–5 to a maximum of 500 mg on day 1, followed by 250 mg on days 2–5) is used for presumed atypical pneumonia 1.
• Inpatient treatment may involve ampicillin or penicillin G for fully immunized children with minimal local penicillin resistance, while ceftriaxone or cefotaxime are alternatives, especially if there's significant penicillin resistance or suspicion of CA-MRSA 1.
• The duration of antimicrobial therapy is typically 7-10 days but can vary based on the pathogen, severity of disease, and clinical response, with some cases requiring longer treatment courses 1.
• Transition to oral therapy can occur once the child shows significant improvement, usually after 2-3 days of parenteral therapy, allowing for earlier discharge and reduced risk of nosocomial infections 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.

The treatment for pneumonia in a pediatric patient is azithromycin for oral suspension at a dose of 10 mg/kg as a single dose on the first day followed by 5 mg/kg on Days 2 through 5 2.

• Key points:
  • The dose is based on the patient's weight.
  • The treatment is for community-acquired pneumonia.
  • The patient should be at least 6 months old.
• Important consideration: Azithromycin should not be used in pediatric patients with pneumonia who are judged to be inappropriate for oral therapy because of moderate to severe illness or risk factors such as any of the following: patients with cystic fibrosis, patients with nosocomially acquired infections, patients with known or suspected bacteremia, patients requiring hospitalization, or patients with significant underlying health problems that may compromise their ability to respond to their illness (including immunodeficiency or functional asplenia) 2.

From the Research

Treatment Options for Pediatric Pneumonia

• The treatment for pneumonia in pediatric patients typically involves the use of antibiotics, with the specific medication and duration of treatment depending on the severity and cause of the infection 3, 4, 5, 6, 7.
• Amoxicillin is a commonly used antibiotic for the treatment of community-acquired pneumonia in children, with studies suggesting that a 5-day course may be as effective as a 10-day course for uncomplicated cases 4, 6.
• For very severe community-acquired pneumonia, treatment with oxacillin plus ceftriaxone or amoxicillin plus clavulanic acid may be effective, with the latter potentially resulting in faster improvement of tachypnea and shorter hospital stays 7.
• The choice of antibiotic and duration of treatment should be guided by clinical judgment and consideration of factors such as the child's age, symptoms, and response to treatment 3, 5, 6.

Duration of Treatment

• Studies have compared the efficacy of shorter (3-5 days) versus longer (7-10 days) courses of amoxicillin for the treatment of community-acquired pneumonia in children, with some suggesting that shorter courses may be as effective as longer courses for uncomplicated cases 3, 4, 6.
• However, the optimal duration of treatment may depend on the severity of the infection and the child's response to treatment, with longer courses potentially being necessary for more severe cases 5, 7.

Antibiotic Choices

• Amoxicillin is a commonly used antibiotic for the treatment of community-acquired pneumonia in children, with a broad spectrum of activity against typical bacterial causes of pneumonia 3, 4, 5, 6.
• Other antibiotics, such as cefixime and amoxicillin-clavulanate, may also be effective for the treatment of community-acquired pneumonia in children, with the choice of antibiotic depending on the severity and cause of the infection, as well as the child's age and symptoms 5, 7.