Table 3.
Empiric antimicrobial strategies for pediatric community-acquired pneumonia
| Population | Bacterial Pneumonia | Atypical Pneumonia | |
|---|---|---|---|
| Outpatient | |||
| Neonates — 3 mo | |||
| Preschool (<5 y) | Preferred | Amoxicillin | Azithromycin |
| Alternative(s) | Amoxiciilin/clavulanate | Clarithromycin or erythromycin | |
| 5–17 y | Preferred | Amoxicillin | Azithromycin |
| Alternative(s) | Amoxicillin/clavulanate | Clarithromycin or erythromycin Doxycycline if >7 y | |
| Inpatient | |||
| Neonates | Preferred | Ampicillin + gentamicin | N/A |
| Alternative(s) | Ampicillin + cefotaxime | ||
| 1–3 mo | Preferred | Cefotaxime | N/A |
| Alternative(s) | Azithromycin if suspect C trachomatis or B pertussis | ||
| 3 mo–17 y, fully immunized, local epidemiology indicates low prevalence of penicillin nonsusceptible Streptococcus pneumoniae | Preferred | Ampicillin or penicillin G | Azithromycin |
| Alternative(s) | Ceftriaxone or cefotaxime Antistaphylococcal coverage for suspected S aureus, including clindamycin or vancomycin in methicillin-resistant S aureus–prevalent regions | Clarithromycin or erythromycin Doxycycline if >7 y Levofloxacin for those who have reached skeletal maturity | |
| 3 mo–17 y, not fully immunized, or local epidemiology indicates moderate to high prevalence of penicillin nonsusceptible Streptococcus pneumoniae | Preferred | Ceftriaxone or cefotaxime | Azithromycin |
| Alternative(s) | Levofloxacin Antistaphylococcal coverage for suspected S aureus, including clindamycin or vancomycin in methicillin-resistant S aureus–prevalent regions |
Clarithromycin or erythromycin Doxycycline if >7 y Levofloxacin for those who have reached skeletal maturity | |
Adapted from Bradley JS, Byington CL, Shah SS, et al. Empiric therapy for pediatric community-acquired pneumonia (CAP). The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis 2011;53:e34. Table 7; with permission.