Paediatric

Pneumonia, community acquired (severe): complicated/empyema/with sepsis/admission to ITU

If sepsis is suspected see Sepsis

 

  • Take blood cultures and appropriate samples (e.g. BAL or pleural culture) for culture. Review antibiotic choice when results are available.
  • Consider sending NPA multiplex PCR if atypical pneumonia is suspected. Review antibiotic choice when results are available.
Review empiric treatment after 48 hours (review the need for IV daily). Treat for 3-5 days.

Preferred

co-amoxiclav 30mg/kg (max 1.2g) iv TDS (BD if 1-2 months old)

Oral therapy (when able to tolerate): co-amoxiclav po, see dosing table below:

Age co-amoxiclav oral dose
1 month to 11 months

0.5mL/kg of 125mg/31mg/5mL suspension TDS
1 year to 5 years 

10mLs of 125mg/31mg/5mL suspension TDS
6 years to 17 years 

One 625mg tablet TDS

OR

10mLs of 250mg/62mg/5mL suspension TDS if patient cannot take tablets 

In case of empyema: ADD clindamycin 10mg/kg (max 600mg) iv QDS. Review at 48-72 hours. If antibiotics to continue, discuss with Paediatric ID.

For MRSA positive patients: ADD vancomycin iv

Alternative

For penicillin allergy (non-severe)

ceftriaxone 80mg/kg (max 4g) iv OD

 

For penicillin allergy (severe)

clarithromycin 7.5mg/kg (max 500mg) iv BD

 

If oral is tolerated:

Penicillin allergy (severe and non-severe): azithromycin 10mg/kg (max 500mg) po OD for 3 days 

Atypical pneumonia is suspected* AND admission to hospital is warranted for respiratory support

*Definition of suspected atypical pneumonia = over 5 years old, non-response to beta-lactams, duration of symptoms more than 6 days, low inflammatory markers AND admission to hospital is warranted for respiratory support

Preferred (including penicillin allergy (non-severe and severe)): clarithromycin 7.5mg/kg (max 500mg) iv BD

 

If oral is tolerated (including penicillin allergy (non-severe and severe): azithromycin 10mg/kg (max 500mg) po OD for 3 days

Additional information

  • Explain to parents or carers that after starting treatment their child's symptoms should steadily improve, although the rate of improvement will vary and some symptoms will persist after stopping antibiotics. For most children:

 • fever (without use of antipyretics) and difficulty breathing should have resolved within 3 to 4 days

• cough should gradually improve but may persist for up to 4 weeks after discharge and does not usually require further review if the child is otherwise well

  • Advise parents or carers of children with community-acquired pneumonia to seek further advice if there is persisting fever combined with:

• increased work of breathing, or,

• reduced fluid intake for children or poor feeding for infants, or,

• unresolving fatigue.

  • Give advice to people with community-acquired pneumonia (or their parents or carers, if appropriate) about:

• possible adverse effects of the antibiotic(s)

• seeking further advice (if the person is receiving treatment in the community or via hospital at home service) if:

      • symptoms worsen rapidly or significantly, or,
      • symptoms do not start to improve within 3 days, or,
      •  the person becomes systemically unwell.

Editorial Information

Last reviewed: 23 Jan 2026

Author(s): AMST.

Approved By: ASG