Table 5. Antimicrobial Regimens for ABRS in Children Indication
First Line (daily dose)
Initial empirical therapy Amoxicillin-clavulanate (45 mg/kg/day PO bid)
β-lactam allergy Type I hypersensitivity
Non-type I hypersensitivity
Risk for antibiotic resistance or
Second Line (daily dose)
> Amoxicillin-clavulanate (90 mg/kg/day PO bid)
> Levofloxacin (10-20 mg/kg/day PO q12-24h)
> Clindamycina (30-40 mg/kg/day PO tid) plus cefixime (8 mg/kg/day PO bid) or cefpodoxime (10 mg/kg/day PO bid)
> Amoxicillin-clavulanate (90 mg/kg/day PO bid)
Failed initial therapy
> Clindamycina (30-40 mg/kg/day PO tid) plus cefixime (8 mg/kg/day PO bid) or cefpodoxime (10 mg/kg/day PO bid)
Severe infection requiring hospitalization
> Ampicillin/sulbactam (200-400 mg/kg/day IV q6h)
> Ceftriaxone (50 mg/kg/day IV q12h)
> Cefotaxime (100-200 mg/kg/day IV q6h)
> Levofloxacin (10-20 mg/kg/day IV q12-24h)
a Resistance to clindamycin (~31%) is found frequently among S. pneumoniae serotype 19A isolates in different parts of the USA.
> Levofloxacin (10-20 mg/kg/day PO q12-24h)
