Age group | Empiric regimen |
1 to 6 months | |
Bacterial (not Chlamydia trachomatis) | Infants <3 to 6 months of age with suspected bacterial pneumonia should be hospitalized |
C. trachomatis | Refer to UpToDate topic on C. trachomatis infections in the newborn |
6 months to 5 years | |
Typical bacterial* | Amoxicillin¶ 90 mg/kg per day in 2 or 3 divided doses (MAX 4 g/day), or |
Amoxicillin-clavulanate 90 mg/kg per day of the amoxicillin component in 2 or 3 divided doses (MAX 4 g/day amoxicillin component) | |
For children with mild reactions to a penicillin and no features of an IgE-mediated reactionΔ: | |
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For children with IgE-mediated or serious delayed reaction to a penicillin: | |
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In communities with a high rate of pneumococcal resistance to penicillin: | |
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≥5 years | |
Mycoplasma pneumoniae or Chlamydia pneumoniae | Azithromycin¶ 10 mg/kg on day 1 followed by 5 mg/kg daily for 4 more days (MAX 500 mg on day 1 and 250 mg thereafter), or |
Clarithromycin 15 mg/kg per day in 2 divided doses (MAX 1 g/day), or | |
Erythromycin 40 to 50 mg/kg per day in 4 divided doses (MAX 2 g/day as base, 3.2 g/day as ethylsuccinate), or | |
Doxycycline 4 mg/kg per day in 2 divided doses (MAX 200 mg/day), or | |
Levofloxacin◊ 8 to 10 mg/kg once daily for children 5 to 16 years (MAX 500 mg/day); 500 mg once daily for children ≥16 years, or | |
Moxifloxacin◊§ 400 mg once daily (≥18 years) | |
Typical bacterial* | Amoxicillin¶ 90 mg/kg per day in 2 or 3 divided doses (MAX 4 g/day) |
For children with mild reactions to a penicillin and no features of an IgE-mediated reactionΔ: | |
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For children with IgE-mediated or serious delayed reaction to a penicillin: | |
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In communities with a high rate of pneumococcal resistance to penicillin: | |
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Aspiration pneumonia | |
Community-acquired | Amoxicillin-clavulanate 40 to 50 mg/kg per day in 2 or 3 divided doses (MAX 1.75 g/day amoxicillin component) |
For children with mild reactions to a penicillin and no features of an IgE-mediated reactionΔ: | |
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For children with IgE-mediated or serious delayed reaction to amoxicillin: | |
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IgE: immunoglobulin E; MAX: maximum.
* For the infant or child who is suspected to have bacterial community-acquired pneumonia and is unable to tolerate liquids at the time of presentation, a single initial dose of ceftriaxone (50 to 75 mg/kg) may be administered intramuscularly or intravenously before starting oral antibiotics.
¶ Preferred agent.
Δ The choice is individualized according to the drug allergy history and the ability to safely conduct an oral challenge if necessary. Refer to UpToDate content on penicillin allergy.
◊ In the United States, fluoroquinolones (eg, levofloxacin and moxifloxacin) are approved by the US Food and Drug Administration for community-acquired pneumonia for patients ≥18 years of age. However, they may be used in younger children if other antibiotics are inappropriate (eg, due to hypersensitivity or local antimicrobial resistance patterns).
§ Also covers typical bacterial pathogens.Do you want to add Medilib to your home screen?