Paediatrics: Pneumonia treatment

Pneumonia: treatment

Oral antibiotics are safe and effective in the treatment of community-acquired pneumonia. IV antibiotics are used in children who cannot absorb oral antibiotics or in those with severe symptoms. The specific choice of antibiotic is based on the following:

• Age of the child.
• Host factors.
• The severity of illness.
• Information about cultures if known.
• CXR findings if known.

Antibiotic therapy for pneumonia

Under 5yrs

Streptococcus pneumonia is the most likely pathogen. The causes of atypical pneumonia are Mycoplasma pneumonia and Chlamydia trachomatis

• First-line treatment: amoxicillin
• Alternatives: co-amoxiclav or cefaclor for typical pneumonia; erythromycin, clarithromycin, or azithromycin for atypical pneumonia Over 5yrs

Mycoplasma pneumonia is more common in this age group

• First-line treatment: amoxicillin is effective against the majority of pathogens, but consider macrolide antibiotics if mycoplasma or chlamydia is suspected
• Alternatives: staphylococcus aureus is suspected to consider using a macrolide, or a combination of flucloxacillin with amoxicillin

Severe pneumonia

Co-amoxiclav, cefotaxime, or cefuroxime IV

Supportive therapies

Consider whether any of the following are needed:

• Antipyretics for fever.
• IV fluids: consider if dehydrated or not drinking.
• Supplemental oxygen: administer oxygen via headbox or nasal cannula so that SpO₂ is maintained >92%.
• Chest drain: for fluid or pus collections in the chest, as in empyema.

Physiotherapy

Chest physiotherapy is generally not beneficial in children with pneumonia and should not be performed.