The most common pathogens: Streptococcus pneumoniae, nontypeable Haemophilus influenzae, Moraxella catarrhalis. Also S. pyogenes, S. aureus, respiratory viruses.
No antibiotic use in the last one month.
-Amoxicillin 80-90 mg/kg/day PO divided twice daily for 7-10 days. This works for kids 2 months and older. For kids < 2 mo, it’s 30 mg/kg/day divided twice daily x 10d. Max dose for kids is 875 mg/dose.
Antibiotics in the past month (Treatment duration: 7-10 days)
-Amoxicillin/Clavulanate 90 mg/kg/day PO divided twice daily. This works for kids 2 months and older. For kids < 2 mo, it’s 30 mg/kg/day divided twice daily x 10d. Max dose for kids is 875 mg/dose.
-Cefdinir 14 mg/kg/day PO divided twice daily.
-Cefpodoxime 10 mg/kg/day PO twice daily. For kids 2 months and older. After 12 years, use adult doses.
-Cefuroxime
Treatment failure (Treatment duration: 7-10 days)
-Amoxicillin/Clavulanate 90 mg/kg/day PO divided twice daily. This works for kids 2 months and older. For kids < 2 mo, it’s 30 mg/kg/day divided twice daily x 10d. Max dose for kids is 875 mg/dose.
-Ceftriaxone 50mg/kg IM once daily for 3 days. Peds max: 1 gram / dose.
Severe Penicillin Allergy.
-Azithromycin 10 mg/kg/day PO x1 on day 1, then 5 mg/kg/day Po daily x 4 days. This is for 2mo -12 years.
-Clindamycin 10 mg/kg PO three times daily. NB: Clindamycin is NOT useful against gram-negative bacteria. So, it doesn’t cover H. influenza and M. Catarrhalis which gram-negatives.
Non-severe penicillin allergy.
Should be treated with an alternative antibiotic such as cefdinir, cefuroxime, cefpodoxime, or ceftriaxone.
Reference
Pediatrics. March 2013, Volume 131 / Issue 3. http://pediatrics.aappublications.org/content/131/3/e964
https://emedicine.medscape.com/article/994656-overview
Am Fam Physician. 2017 Jan 15;95(2):109-110. http://www.aafp.org/afp/2017/0115/p109.html
EMRA antibiotic Guide, 2017.