Table 11.

Inpatient childhood pneumonia antibiotic treatment guidelines

Age/Category	Preferred/First-Line	Alternative/Second-Line
0–6 mo
Bacterial	IV penicillin derivative and third-generation cephalosporin	Aminoglycoside with PCN derivative; macrolide if suspect atypical organism
6 mo–5 y
Bacterial	IV penicillin derivative (PCN or ampicillin)	Third-generation cephalosporin
MRSA	Vancomycin or clindamycin (in addition to beta-lactam antibiotic)	Vancomycin or clindamycin (in addition to beta-lactam antibiotic)
Atypical bacterial infection	Macrolide	Macrolide (in addition to beta-lactam antibiotic)
Allergy to any of the above	Third-generation cephalosporin/clindamycin	Quinolone
5–16 y
Bacterial	IV penicillin derivative (PCN or ampicillin)	Third-generation cephalosporin
MRSA	Vancomycin or clindamycin (in addition to beta-lactam antibiotic)	Vancomycin or clindamycin (in addition to beta-lactam antibiotic); linezolid in children aged 12 y or older
Atypical bacterial infection	Macrolide	Macrolide (in addition to beta-lactam antibiotic)
Allergy to any of the above	Third-generation cephalosporin/clindamycin	Quinolone
Severe pneumonia/ICU admission	Third-generation cephalosporin and macrolide/vancomycin + third-gen ceph + macrolide	Third-generation cephalosporin and doxycycline/vancomycin + third-gen ceph + macrolide + (optional) Nafcillin + antiviral

Abbreviations: Ceph, cephalosporin; IV, intravenous; PCN, penicillin.

Adapted from Cincinnati Children’s Hospital Medical Center. Evidence-based care guideline. Community acquired pneumonia in children 60 days through 17 years of age. Available at: file:///C:/Users/sgrief/Downloads/Community%20Acquired%20Pneumona%20Great%20001.pdf. Accessed February 20, 2018; with permission.