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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.
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
Co-amoxiclav, cefotaxime, or cefuroxime IV
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.
Chest physiotherapy is generally not beneficial in children with pneumonia and should not be performed.
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