Antibiotic choices for adult and children pneumonia

Antibiotic choices for common infection 

Antibiotic choices for adult pneumonia 

Management

Chest x-ray is not routinely recommended, however, it may be appropriate when the diagnosis is unclear, there is dullness to percussion or other signs of an effusion or collapse, and when the likelihood of malignancy is increased, such as in a smoker aged over 50 years.

Patients with one or more of the following features: age > 65 years, confusion, respiratory rate >30/min, systolic BP < 90 mmHg, diastolic BP <60 mmHg, have a predicted increased mortality rate and admission to hospital should be considered.

Patients can generally be adequately treated with an agent that covers S. pneumoniae. Ciprofloxacin should not be used as it does not reliably treat infections due to S. pneumoniae. 

Common pathogens

Respiratory viruses, Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydophilia pneumonia, Legionella pneumophila, Staphylococcus aureus

Respiratory

Antibiotic treatment

Pneumonia – adult

First choice
Amoxicillin

Adult: 500 mg – 1 g, three times daily, for five to seven days

If M. pneumoniae, C. pneumoniae or L. pneumophila are suspected or if the patient has not improved after 48 hours, add either roxithromycin 300 mg, once daily, for seven days or doxycycline 200 mg, twice daily*, on day one, followed by 100 mg, twice daily, from days two to seven

Alternatives

Monotherapy with roxithromycin or doxycycline is acceptable for people with a history of penicillin allergy

Antibiotic treatment of

Pneumonia – child

Management

Referral to hospital should be considered for any child with one or more of the following factors: aged less than six months, drinking less than half their normal amount, oxygen saturation ≤92% on pulse oximetry, severe tachypnoea, decreased respiratory effort, temperature < 35°C or > 40°C, decreased breath sounds or dullness to percussion, difficult to rouse.

In addition, if there is no response to treatment in 24 – 48 hours, review diagnosis and consider referral to hospital.

Common pathogens

Respiratory viruses, Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, Staphylococcus 

First choice
Amoxicillin

Child: 25 – 30 mg/kg/dose, three times daily, for five to seven days (maximum 500 mg/dose age three months to five years, 1000 mg/dose age > five years)

Alternatives

Erythromycin

Child: 10 – 12.5 mg/kg/dose, four times daily, for seven days

N.B. Can be first-line in school-aged children where the likelihood of atypical pathogens is higher.

Roxithromycin

Child: 4 mg/kg/dose, twice daily, for seven to ten days

N.B. Only available in tablet form, therefore only if the child can swallow