Community Acquired Pneumonia
S. pneumoniae, S. pyogenes, MSSA/MRSA, H. influenza, M. catarrhalis
Atypical Pneumonia:
M. pneumoniae, C. pneumoniae
Amoxicillin 90mg/kg/day PO div q12h (max 2000mg/dose)
OR
Ampicillin 200mg/kg/day IV div q6h (max 3000mg/dose)
If received Amoxicillin w/in prior 30 days:
Amoxicillin/Clavulanate† 90mg/kg/day (amox component) PO div q12h (max 2000mg of Amox/dose)
Beta-lactam Allergic Patients:
Clindamycin 40mg/kg/day IV/PO div q8h (max 600mg/dose)
OR
Levofloxacin
6 months to <5 years of age:
20mg/kg/day IV/PO div q12h (max 375 mg/dose)
5 years of age or older:
10mg/kg/day IV/PO div q24h (max 750 mg/dose)
If concern for atypical pathogens, ADD:
Azithromycin Day 1: 10mg/kg/day IV/PO q24h (max 500mg/dose); Day 2-5 5mg/kg PO q24h (max 250mg/dose)
OR
Levofloxacin monotherapy (see dosing above for beta-lactam allergic patients)⁸
Empiric Therapy & Alternative Regimens
Duration of Therapy & Clinical Pearls
Chest Radiographs (AP + Lateral):
-
CXR should NOT be obtained for patients with clinical CAP who are well enough to be treated as an outpatient
-
CXR should be obtained in patients with hypoxemia or significant respiratory distress, in those that fail initial antibiotic therapy in the outpatient setting, and in those patients requiring hospitalization for management of CAP to assess for parenchymal infiltrates and to identify any associated complications.
Blood Cultures:
-
Blood cultures should NOT be performed in nontoxic children w/CAP managed in the outpatient setting
-
Blood cultures should be considered for bacterial CAP that is moderate to severe in severity and requiring hospitalization and should be obtained in patients with a complicated pneumonia.8
Length of Therapy:
5 days⁹
†Amoxicillin-Clavulanate Dosing
Should use 14:1 Amoxicillin-Clavulanate formulation for Pneumonia.
For additional information regarding amoxicillin-clavulanate dosing and proper formulations, please see Bugs & Drugs Section.