Pneumonia is an acute inflammation of the lung parenchyma. Children typically present with cough, difficulty breathing, and fever. Clinical signs include bronchial breath sounds and focal crackles.
In infants <12 months, bronchiolitis is a more common cause of fast breathing and chest indrawing than pneumonia.
Antimicrobial
Infants under 3 months:
Admit to hospital.
Ampicillin 50mg/kg IV TID
PLUS
Gentamicin 5mg/kg IV OD
Infants and children over 3 months:
Mild:
Amoxicillin 40mg/kg (max 1g) PO BID
Moderate:
Ampicillin 50mg/kg (max 2g) IV TID
If atypical infection (Mycoplasma, Legionella, B. pertussis) is suspected ADD:
Azithromycin 10mg/kg IV/PO
Severe:
Ceftriaxone 50mg/kg (max 2g) IV OD
PLUS
Azithromycin 10mg/kg IV/PO OD
If a parapneumonic effusion is present, or Staphylococcus aureus is considered likely, add:
Cloxacillin 50mg/kg (max 2g) IV QID
(See Appendix H for neonatal dose intervals)
Comments and Duration of Therapy
Take blood cultures prior to antibiotics if systemically unwell.
If cough has been present for more than 3 weeks, or there is associated weight loss or a known TB contact, consider TB in the differential diagnosis.
Severe pneumonia in children is associated with grunting, chest indrawing, oxygen saturation <90% or danger signs including inability to feed, lethargy or convulsions. See Community acquired pneumonia (CAP) in adults below for when to suspect Staphylococcus aureus infection.
Duration:
Mild-Moderate: Treat for 3-5 days
Severe: Change to oral antibiotics when improving. Treat for a total of 5-7 days.
Azithromycin: Stop after 5 days.
See Community acquired pneumonia (CAP) in adults in Chapter 6: ENT / Respiratory Tract Infections, comments section for further work-up if there is failure to improve despite broad spectrum antibiotics.