Pharmacotherapy of childhood pneumonia

Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality among children under 5 years. Although viral infections have been frequently recognized, death has been attributable to bacterial infections (especially due to Streptococcus pneumoniae).

In the past twenty years, childhood mortality due to CAP has been declining because of accessible health care and prompt antibiotic use. The basic options of antibiotics to treat children with CAP are presented.

In daily practice, antibiotic prescription to treat childhood CAP is based on age and severity assessment. For those children aged less than 2 months, hospitalization and parenteral administration of ampicillin plus aminoglycoside or ampicillin plus third-generation cephalosporin is mandatory. For those patients aged 2 months and older with non-severe or severe CAP, the first option is amoxicillin or aqueous penicillin G, respectively; for very severe presentation, oxacillin and third-generation cephalosporin are recommended. If atypical bacteria infection is suspected, macrolide must be given in any age or severity group.

Few antibiotics are included in the guidelines to treat childhood CAP. The choice of which antibiotic should be given is based on clinical evaluation.