Table 110-1 Etiologic Agents and Empirical Antimicrobial Therapy for Pneumonia in Patients without History of Recent Antibiotic Therapy AGE GROUP COMMON PATHOGENS* (IN APPROXIMATE ORDER OF FREQUENCY) LESS COMMON PATHOGENS OUTPATIENTS† (7–10 DAYS TOTAL DURATION OF TREATMENT) PATIENTS REQUIRING HOSPITALIZATION‡ (10–14 DAYS TOTAL DURATION OF TREATMENT) PATIENTS REQUIRING INTENSIVE CARE*,‡ (10–14 DAYS TOTAL DURATION OF TREATMENT) 1 to 3 months
Amoxicillin or ampicillin if fully immunized for age for S. pneumoniae and H. influenzae type b. Alternatives: cefotaxime or ceftriaxone if not fully immunized or local
S. pneumoniae penicillin resistance is significant, with clindamycin if MRSA suspected Cefotaxime or ceftriaxone plus nafcillin, oxacillin, clindamycin, or vancomycin 3 months to 5 Respiratory syncytial years virus, other respiratory viruses (parainfluenza viruses, influenza viruses, human metapneumovirus adenoviruses), S. pneumoniae,
H. influenzae (type b,§ nontypable) C. trachomatis, Mycoplasma Amoxicillin plus pneumoniae, Chlamydophila erythromycin, azithromycin, pneumoniae, group A or clarithromycin if atypical streptococcus, Staphylococcus pneumonia suspected aureus, Mycobacterium tuberculosis Ampicillin Alternatives: Cefuroxime or ceftriaxone plus cefotaxime or ceftriaxone if azithromycin, erythromycin or not fully immunized or local clarithromycin with or without
S. pneumoniae penicillin clindamycin or vancomycin resistance is significant, with clindamycin if MRSA suspected; Add erythromycin, azithromycin, or clarithromycin if atypical pneumonia suspected
MRSA, Methicillin-resistant Staphylococcus aureus.
*Severe pneumonia, from S. pneumoniae, S. aureus, group A streptococcus, H. influenzae, or M. pneumoniae requiring admission to an intensive care unit. Antipseudomonal agents should be added if Pseudomonas is suspected.
†Oral administration.
‡Intravenous administration for inpatients except for the macrolides (erythromycin, azithromycin, and clarithromycin), which are given orally. §H. influenzae type b infection is uncommon with universal H. influenzae type b immunization. ǁFluoroquinolones are contraindicated for children younger than 18 years of age and pregnant or lactating women. Tetracyclines are not recommended for children younger than 9 years.
Bacterial flora of the upper respiratory tract do not accurately reflect flora present in lower respiratory tract infections, and high-quality sputum is rarely obtainable from children. In otherwise healthy children without life-threatening disease, invasive procedures to obtain lower respiratory tissue or secretions usually are not indicated. Serologic tests are not useful for the most common causes of bacterial pneumonia.