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.

·  Severity of illness.

·  Information about cultures if known.

·  CXR findings if known.

Antibiotic therapy for pneumonia

Under 5yrs

Streptococcus pneumoniae is the most likely pathogen. The causes of atypical pneumonia are Mycoplasma pneumoniae and Chlamydia tracho-matis

·  First-line treatment: amoxicillin

·  Alternatives: co-amoxiclav or cefaclor for typical pneumonia; erythromycin, clarithromycin, or azithromycin for atypical pneumonia Over 5yrs

Mycoplasma pneumoniae 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: if Staphylococcus aureus is suspected 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 cannulae 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.