Treatment
Anti-infective Outpatient
ÎAntimicrobial therapy is not routinely required for preschool-aged children with CAP, since viral pathogens are responsible for the great majority of clinical disease. (SR-H)
ÎAmoxicillin should be used as first-line therapy for previously healthy, appropriately immunized infants and preschool aged children with mild to moderate CAP suspected to be of bacterial origin. (SR-M)
Note: Amoxicillin provides appropriate coverage for Streptococcus pneumoniae, the most prominent invasive bacterial pathogen. Table 4 lists preferred agents and alternative agents for children allergic to amoxicillin.
ÎAmoxicillin should be used as first-line therapy for previously healthy, appropriately immunized school-aged children and adolescents with mild to moderate CAP due to S. pneumoniae, the most prominent invasive bacterial pathogen. (SR-M)
Note: Atypical bacterial pathogens (eg, M. pneumoniae) and less common lower respiratory tract bacterial pathogens should also be considered in management decisions.
ÎMacrolide antibiotics should be prescribed for treatment of children (primarily school-aged children and adolescents) evaluated in an outpatient setting with findings compatible with CAP caused by atypical pathogens. (WR-M)
Note: Table 4 lists preferred and alternative agents for atypical pathogens.
ÎInfluenza antiviral therapy (Table 5) should be administered as soon as possible to children with moderate to severe CAP consistent with influenza virus infection during widespread local circulation of influenza viruses, particularly for those with clinically worsening disease documented at the time of an outpatient visit. (SR-M)
• Since early antiviral treatment has been shown to provide maximal benefit, treatment should NOT be delayed while awaiting confirmation of positive influenza test results.
Inpatient
ÎAmpicillin or penicillin G should be administered to the fully immunized infant or school-aged child admitted to a hospital ward with CAP when local epidemiologic data document lack of substantial high-level penicillin-resistance for invasive S. pneumoniae. (SR-M)
Note: Other antimicrobial agents for empiric therapy are provided on Table 6. 11
• Negative influenza diagnostic tests do not conclusively exclude influenza disease. Treatment after 48 hours of symptomatic infection may still provide clinical benefit to those with more severe disease.
