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.
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 11 years |
10mLs of 250mg/62mg/5mL suspension TDS |
| 12 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):
Under 6 months: clarithromycin po, see dosing table below, for 3-5 days.
| Weight | clarithromycin oral dose |
| Under 8kg | 7.5mg/kg BD |
| 8-11kg | 62.5mg BD |
| 12-19kg | 125mg BD |
6 months and over: 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:
Under 6 months: clarithromycin po, see dosing table below, for 3 days
| Weight | clarithromycin oral dose |
| Under 8kg | 7.5mg/kg BD |
| 8-11kg | 62.5mg BD |
| 12-19 kg | 125mg BD |
6 months and over: 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.
-