Respiratory tract (lower)

Review previous microbiology results: If resistant target organisms previously isolated (e.g. MRSA, ESBL, known resistance to empirical antibiotic choices), discuss antibiotic choice with Paediatric and/or Microbiology Consultant.

User guide: for further advice regarding antimicrobial prescribing good practice, oral switch, penicillin allergy, dosing, and safety considerations: HERE

Community acquired pneumonia (non-severe)

<5 years OLD ** or S. pneumoniae likely pathogen

First line

PO/IV amoxicillin

TOTAL duration 5 days

Penicillin allergy

PO azithromycin^#

TOTAL duration 3 days

>5 years OLD OR chlamydia / mycoplasma suspected

PO azithromycin^#

TOTAL duration 3 days

Comments

** If <1 months, treat as per Neonatal: Late onset, >72 hours of age
^# PO/IV clarithromycin (5 days) is an alternative

Community acquired pneumonia (severe)

First line*

IV co-amoxiclav
add PO/IV clarithromycin^# if atypical (chlamydia/mycoplasma) infection suspected
consider IV gentamicin if septic

Oral switch: co-amoxiclav +/- clarithromycin^#

Penicillin allergy (non-severe)*

IV cefUROXime
add PO/IV clarithromycin^# if atypical (chlamydia/mycoplasma) infection suspected
consider IV gentamicin if septic

Oral switch: discuss with Microbiology

Penicillin allergy (SEVERE)*

IV vancomycin
and IV ciprofloxacin

Oral switch: discuss with Microbiology

TOTAL duration

5 - 10 days

Comments

* If <1 months old: treat as per Neonatal: Late onset, >72 hours of age
^# PO azithromycin (3 - 5 days) is an alternative

Pneumonia complicating influenza (possible Staphylococcal pneumonia)

Public Health Scotland guidance on treatment/prophylaxis of seasonal influenza can be accessed HERE.

First line

IV/PO co-amoxiclav

Penicillin allergy

Discuss with microbiology

TOTAL duration (IV + PO)

7 - 14 days

Aspiration pneumonia

Mild aspiration pneumonia usually represents a pneumonitis i.e. chemical inflammation / irritation of airways. No antibiotic is required.

First line

IV/PO amoxicillin

Penicillin allergy

IV/PO clindamycin

TOTAL duration (IV + PO)

5 days

Last reviewed: 20/02/2024

Next review date: 20/02/2026

Author(s): Dr Jon van Aartsen (Consultant Microbiologist), Dr Jed Bamber (Consultant Paediatrician).

Version: v1.0

Approved By: AMT (20.02.2024) and ADTC (28.02.2024)

Reviewer name(s): Dr Jed Bamber (Consultant Paediatrician), AMS Team.

Community acquired pneumonia (non-severe)

Community acquired pneumonia (severe)

Pneumonia complicating influenza (possible Staphylococcal pneumonia)

Aspiration pneumonia

Editorial Information