The initial treatment of children with pneumonia, but with no obvious pathology such as immune suppression, the most common cause of a baterial peumonia is Streptococcus pneumoniae and this is usually sensitive to penicillin. Therefore the antibiotic of choice is amoxicillin (if not penicillin allergic).
In children who are allergic to penicillin or if Mycoplasma pneumoniae is thought to be the causitive organism (e.g. in the older school-aged child and adolescent) a macrolide such as clarithromycin is the first choice.
Failure to respond to this should raise the possibility of other factors:
- mycoplasma - if used penicillin as first-line agent
- structural anomoly, including a foreign body
- tuberculosis
NICE have outlined guidance with respect to community acquired pneumonia in the community (1):
Reference:
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