Pneumonia, community acquired (severe): complicated/empyema/with sepsis/admission to ITU
Review after 48 hours. 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): 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 |
Where atypical pneumonia is suspected: ADD azithromycin 10mg/kg (max 500mg) po (iv if po not tolerated) OD for 3 days
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