ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﺻﻔﺤﻪ ﻗﺒﻠﯽ
خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
نسخه الکترونیک
medimedia.ir

Initial oral empiric antibiotics for outpatient treatment of pediatric community-acquired pneumonia

Initial oral empiric antibiotics for outpatient treatment of pediatric community-acquired pneumonia
Age group Empiric regimen
1 to 6 months
Bacterial (not Chlamydia trachomatis) Infants <3 to 6 months of age with suspected bacterial pneumonia should be hospitalized
C. trachomatis Refer to UpToDate topic on C. trachomatis infections in the newborn
6 months to 5 years
Typical bacterial* Amoxicillin 90 mg/kg per day in 2 or 3 divided doses (MAX 4 g/day), or
Amoxicillin-clavulanate 90 mg/kg per day of the amoxicillin component in 2 or 3 divided doses (MAX 4 g/day amoxicillin component)
For children with mild reactions to a penicillin and no features of an IgE-mediated reactionΔ:
  • Amoxicillin 90 mg/kg per day in 2 or 3 divided doses (MAX 4 g/day), or
  • Amoxicillin-clavulanate 90 mg/kg per day of the amoxicillin component in 2 or 3 divided doses (MAX 4 g/day amoxicillin component), or
  • An extended-spectrum cephalosporin, such as cefuroxime axetil 20 to 30 mg/kg per day in 2 divided doses (MAX 1 g/day), cefpodoxime 10 mg/kg per day in 2 divided doses (MAX 400 mg/day) cefdinir 14 mg/kg per day in 2 divided doses (MAX 600 mg/day) in communities with a low rate of pneumococcal resistance to penicillin
For children with IgE-mediated or serious delayed reaction to a penicillin:
  • Levofloxacin 16 to 20 mg/kg per day in 2 divided doses (MAX 750 mg/day), or
  • Clindamycin 30 to 40 mg/kg per day in 3 or 4 divided doses (MAX 1.8 g/day), or
  • Linezolid 30 mg/kg per day in 3 divided doses (MAX 1.8 g/day)
In communities with a high rate of pneumococcal resistance to penicillin:
  • Levofloxacin 16 to 20 mg/kg per day in 2 divided doses (MAX 750 mg/day), or
  • Linezolid 30 mg/kg per day in 3 divided doses (MAX 1.8 g/day)
≥5 years
Mycoplasma pneumoniae or Chlamydia pneumoniae Azithromycin 10 mg/kg on day 1 followed by 5 mg/kg daily for 4 more days (MAX 500 mg on day 1 and 250 mg thereafter), or
Clarithromycin 15 mg/kg per day in 2 divided doses (MAX 1 g/day), or
Erythromycin 40 to 50 mg/kg per day in 4 divided doses (MAX 2 g/day as base, 3.2 g/day as ethylsuccinate), or
Doxycycline 4 mg/kg per day in 2 divided doses (MAX 200 mg/day), or
Levofloxacin 8 to 10 mg/kg once daily for children 5 to 16 years (MAX 500 mg/day); 500 mg once daily for children ≥16 years, or
Moxifloxacin◊§ 400 mg once daily (≥18 years)
Typical bacterial* Amoxicillin 90 mg/kg per day in 2 or 3 divided doses (MAX 4 g/day)
For children with mild reactions to a penicillin and no features of an IgE-mediated reactionΔ:
  • Amoxicillin 90 mg/kg per day in 2 or 3 divided doses (MAX 4 g/day), or
  • An extended-spectrum cephalosporin, such as cefuroxime axetil 20 to 30 mg/kg per day in 2 divided doses (MAX 1 g/day), cefpodoxime 10 mg/kg per day in 2 divided doses (MAX 400 mg/day), or cefdinir 14 mg/kg per day in 2 divided doses (MAX 600 mg/day) in communities with a low rate of pneumococcal resistance to penicillin
For children with IgE-mediated or serious delayed reaction to a penicillin:
  • Levofloxacin 8 to 10 mg/kg once daily for children 5 to 16 years (MAX 750 mg/day); 750 mg once daily for children ≥16 years, or
  • Clindamycin 30 to 40 mg/kg per day in 3 or 4 divided doses (MAX 1.8 g/day), or
  • Linezolid 30 mg/kg per day in 3 divided doses (MAX 1.8 g/day) for children <12 years; 20 mg/kg per day divided in 2 doses (MAX 1.2 g/day) for children ≥12 years
In communities with a high rate of pneumococcal resistance to penicillin:
  • Levofloxacin 8 to 10 mg/kg once daily for children 5 to 16 years (MAX 750 mg/day); 750 mg once daily for children ≥16 years, or
  • Linezolid 30 mg/kg per day divided in 3 doses (MAX 1.8 g/day) for children <12 years; 20 mg/kg per day divided in 2 doses (MAX 1.2 g/day) for children ≥12 years
Aspiration pneumonia
Community-acquired Amoxicillin-clavulanate 40 to 50 mg/kg per day in 2 or 3 divided doses (MAX 1.75 g/day amoxicillin component)
For children with mild reactions to a penicillin and no features of an IgE-mediated reactionΔ:
  • Amoxicillin-clavulanate 40 to 50 mg/kg per day in 2 or 3 divided doses (MAX 1.75 g/day amoxicillin component)
For children with IgE-mediated or serious delayed reaction to amoxicillin:
  • Clindamycin 30 to 40 mg/kg per day divided in 3 or 4 doses (MAX 1.8 g/day)
  • Moxifloxacin 400 mg once daily (for ≥18 years)

IgE: immunoglobulin E; MAX: maximum.

* For the infant or child who is suspected to have bacterial community-acquired pneumonia and is unable to tolerate liquids at the time of presentation, a single initial dose of ceftriaxone (50 to 75 mg/kg) may be administered intramuscularly or intravenously before starting oral antibiotics.

¶ Preferred agent.

Δ The choice is individualized according to the drug allergy history and the ability to safely conduct an oral challenge if necessary. Refer to UpToDate content on penicillin allergy.

◊ In the United States, fluoroquinolones (eg, levofloxacin and moxifloxacin) are approved by the US Food and Drug Administration for community-acquired pneumonia for patients ≥18 years of age. However, they may be used in younger children if other antibiotics are inappropriate (eg, due to hypersensitivity or local antimicrobial resistance patterns).

§ Also covers typical bacterial pathogens.
Data from:
  1. McIntosh K. Community-acquired pneumonia in children. N Engl J Med 2002; 346:429.
  2. Bradley JS, Byington CL, Shah SS, et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: Clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis 2011; 53:e25.
  3. American Academy of Pediatrics. Tables of antibacterial drug dosages. In: Red Book: 2021-2024 Report of the Committee on Infectious Diseases, 32nd ed, Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH (Eds), American Academy of Pediatrics, Itasca, IL 2021. p.876.
Graphic 80561 Version 29.0

آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟