Community Acquired Pneumonia in Children - LRTI

Doses are oral and for adults unless otherwise stated. Visit the Health Products Regulatory Authority (HPRA) website for detailed drug information (summary of product characteristics and patient information leaflets). Dosing details, contraindications and drug interactions can also be found in the Irish Medicines Formulary (IMF) or other reference sources such as British National Formulary (BNF) / BNF for children (BNFC). See guidance on dosing in children for quick reference dosage/weight guide. Refer to drug interactions table for detailed drug interactions for all antimicrobials. Note extensive drug interactions for clarithromycin, fluoroquinolones, azole antifungals and rifampicin. Many antibiotics increase the risk of bleeding with anticoagulants.

Note additional warnings for clarithromycin and fluoroquinolones

Comments from Expert Advisory Committee

  • Bacterial pneumonia should be considered in children when there is persistent or repetitive fever >38.5°C together with chest recession and a raised respiratory rateD
  • Pneumonia in children age ≤2 years is usually caused by viruses, and should not be routinely treated with antibioticsA
  • Streptococcus pneumoniae (“pneumococcus”) is the commonest cause of bacterial pneumonia in children. Penicillin and amoxicillin remain the most active antibiotics against pneumococcus (amoxicillin is preferred, due to better oral bioavailability)A
  • Macrolides (e.g. erythromycin, clarithromycin, azithromycin) and cephalosporins (e.g. cefaclor, cefuroxime, cefixime) are less effective against pneumococcal pneumonia in children, compared to amoxicillinA
  • Influenza antiviral therapy should be administered as soon as possible to children with moderate to severe pneumonia consistent with influenza virus infection during widespread local circulation of influenza virusesB
  • Consider referring to hospital for assessment if:
    • Tachypnoea
      • RR >70 breaths/minute in infants
      • RR >50 breaths/minute in older child
    • Significant respiratory distress ± grunting
    • Sa02 <92%
    • Symptoms not improving despite treatment (consider empyema)
    • Acute bronchitis in children is caused by viruses, and should not be treated with antibioticsA
  • Antibiotic therapy is not recommended as part of the management of acute asthmatic attacks in childrenB

Community Acquired Pneumonia in Children LRTI

*Resistance to macrolides, such as clarithromycin, is becoming increasingly common among strains of pneumococcus. Only use these agents to treat bacterial pneumonia if documented penicillin allergy, or if treating suspected Mycoplasma or other “atypical” pathogen

Reviewed Dec 2019