Condition Major First Choice Therapy Alternative Therapy Comments

Pathogens
Community-acquired
pneumonia, 3 Majority: Antimicrobial therapy Non-severe penicillin allergy: Duration for beta lactam
months-5 years old, respiratory is not routinely Cefdinir 7mg/kg/dose PO BID therapy (not Azithromycin)
outpatient therapy
viruses indicated unless (max 600mg/day) 7 days
suspected bacterial
Streptococcus *Click here for guidance on
etiology
pneumoniae Amoxicillin maximum dosin
Haemophilus If suspected typical Severe penicillin allergy: formulations
influenzae bacterial etiology: Azithromycin 10mg/kg/dose
PO x 1 on day 1 then
Amoxicillin
5mg/kg/dose PO daily on days
45mg/kg/dose PO BID
2-5
(max 1000mg/dose)*

Note: Atypical
pneumonia is rare in
this age group

Community-acquired
pneumonia, > 5 years Typical, lobar: If typical bacterial Non-severe penicillin allergy: Duration for beta lactam
old, outpatient etiology suspected: Replace Amoxicillin with therapy (not Azithromycin
therapy Streptococcus
Amoxicillin Cefdinir 7mg/kg/dose PO BID 7 days
pneumoniae
45mg/kg/dose PO BID (max 600mg/day) Blood cultures are not usua
Atypical,
(max 1000mg/dose)* indicated for outpatients wit
bilateral
community-acquired pneum
interstitial
If atypical bacterial Severe penicillin allergy: *Click here for guidance on
infiltrates:
etiology suspected: Replace Amoxicillin with Amoxicillin maximum dosing

Azithromycin Azithromycin 10mg/kg/dose and formulations

Respiratory
viruses 10mg/kg/dose PO on PO on day 1 (max 500mg/dose)
day 1 (max then 5mg/kg/dose PO daily on
Mycoplasma 500mg/dose) then days 2-5 (max 250mg/dose)
pneumoniae 5mg/kg/dose PO daily
on days 2-5 (max
250mg/dose)

Community-acquired Ceftriaxone
pneumonia, < 3 Streptococcus 50mg/kg/dose IV q24h Corrected gestational age < Initial inpatient therapy is
months old pneumoniae if corrected gestational 44 weeks: recommended
age > 44 weeks
Haemophilus Use Cefotaxime per Neonatal
Blood culture is recommende
influenzae Dosing Guideline in place of
 Respiratory Ceftriaxone Consider evaluation and emp
viruses therapy for Pertussis especial
for infants with apnea, signif
post-tussive emesis,
lymphocytosis or older conta
Also consider:
with prolonged cough
Bordetella
pertussis
Chlamydia
trachomatis
Community-acquired Similar to
pneumonia, > 3 outpatient Suspected typical Non-severe penicillin allergy: Duration for beta lactam
months old and up, etiologies bacterial etiology: Replace Ampicillin with therapy (not Azithromycin
inpatient therapy but
not complicated Ampicillin Ceftriaxone 50mg/kg/dose IV Levofloxacin):
(empyema, 50mg/kg/dose IV q6h q24h (max 2g/dose) Mild: 7 days
necrotizing
pneumonia) (max 2g/dose)
Moderate: 10 days

Strong suspicion for Severe beta lactam allergy: Consider blood culture for
atypical etiology: Levofloxacin 10mg/kg/dose IV patients with moderate to sev
Azithromycin q24h if >= 5 years old, q12h if
illness, young age, incomplet
10mg/kg/dose PO on < 5 years old (max 750mg/day) vaccines, or
day 1 (max (provides both typical and immunocompromised
500mg/dose) then atypical bacterial activity)
5mg/kg/dose PO daily Consider therapy for Influenz
OR patient admitted during active
on days 2-5 (max
250mg/dose) Influenza season.
Azithromycin 10mg/kg/dose
PO on day 1 (max 500mg/dose)
Note: Atypical
then 5mg/kg/dose PO daily on
pneumonia is rare in
days 2-5 (max 250mg/dose) if
children < 5 years old
strong suspicion for atypical
etiology with low suspicion for
If no distinguishing
typical bacterial etiology
features for typical
vs. atypical bacterial
etiology and
especially if > 5 years
old:
Consider combination
of Ampicillin +
 Azithromycin (doses
as above)

Community-acquired
pneumonia, Streptococcus Ceftriaxone Severe beta lactam allergy:
complicated pneumoniae 50mg/kg/dose IV q24h Replace Ceftriaxone with
(empyema,
necrotizing Staphylococcus (max 2g/dose) Levofloxacin 10mg/kg/dose IV
pneumonia) aureus q24h if >= 5 years old, q12h if
AND
< 5 years old (max 750m

One of the following

agents with
MRSAactivity:
Clindamycin
10mg/kg/dose IV q8h
(max 900mg/dose) for
clinically stable
patients

OR

Vancomycin
15mg/kg/dose IV q6-
8h (initial max
1g/dose) for critically
ill/clinically unstable
patients