Table 6. Empiric Therapy for Pediatric CAP (continued) (For children with drug allergy to recommended therapy, please see full text Guidelinesa
) Site of Care
Fully immunized with conjugate vaccines for H. influenzae type b and S. pneumoniae; local penicillin resistance in invasive strains of pneumococcus is minimal
Not fully immunized for
Empiric Therapy for Presumed Bacterial Pneumonia
Ampicillin or penicillin G
Alternatives: • Ceftriaxone or cefotaxime
(Add vancomycin or clindamycin for suspected CA-MRSA)
Empiric Therapy for Presumed Atypical Pneumonia
Inpatient (all ages) see Table 4 for dosages
Azithromycin (in addition to β-lactam, if diagnosis in doubt)
Alternatives: • Clarithromycin or erythromycin
• Doxycycline for children > 7 y
• Levofloxacin for children who have reached growth maturity or those who cannot tolerate macrolides
H. influenzae type b, and S. pneumoniae; local penicillin resistance in invasive strains of pneumococcus is significant
Ceſtriaxone or cefotaxime (Add vancomycin or clindamycin for suspected CA-MRSA)
Alternative: • Levofloxacin
(Add vancomycin or clindamycin for suspected CA-MRSA)
Azithromycin (in addition to β-lactam, if diagnosis in doubt)
Alternatives: • Clarithromycin or erythromycin;
• Doxycycline for children > 7 y
• Levofloxacin for children who have reached growth maturity or those who cannot tolerate macrolides
a For those children with a history of possible, nonserious allergic reactions to amoxicillin, treatment is not well defined and should be individualized. Options include: a trial of amoxicillin under medical observation; a trial of an oral cephalosporin that has substantial activity against S. pneumoniae, such as cefpodoxime, cefprozil, or cefuroxime, provided under medical supervision; treatment with levofloxacin; treatment with linezolid; treatment with clindamycin (if susceptible); or treatment with a macrolide (if susceptible). For those children with bacteremic pneumococcal pneumonia, particular caution should be exercised in selecting alternatives to amoxicillin, given the potential for secondary sites of infection including meningitis.
b See full text Guidelines for discussion of dosage recommendations based on local susceptibility data. Twice daily dosing of amoxicillin or amoxicillin/clavulanate may be effective for pneumococci that are susceptible to penicillin.
c Not evaluated prospectively for safety. 19
Oseltamivir or zanamivir (for children ≥ 7 y)
Alternatives: • IV peramivir, IV oseltamivir and IV zanamivir are under clinical investigation in children
(IV zanamivir is available for compassionate use)
As above
Empiric Therapy for Presumed Influenza Pneumonia
(see Table 5 for dosages)
