Oral therapy for S. pneumoniae (pneumococcal) bronchiectasis exacerbations in children

If S. pneumoniae is isolated in the sputum sample of a child with a bronchiectasis exacerbation, useChang, 2023:

amoxicillin 25 mg/kg up to 1 g orally, 8-hourly; see advice on modification and duration of therapy. amoxicillin

For children who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin1, use:

cefuroxime (child 3 months or older) 15 mg/kg up to 500 mg orally, 12-hourly; see advice on modification and duration of therapy. cefuroxime

For children who have had a severe (immediate or delayed)2 hypersensitivity reaction to a penicillin, or those who require an alternative oral liquid formulation, use the results of susceptibility testing to guide therapy. While awaiting results, use:

doxycycline orally, 12-hourly34; see advice on modification and duration of therapy doxycycline

child less than 21 kg: 2.2 mg/kg

child 21 to less than 26 kg: 50 mg

child 26 to 35 kg: 75 mg

child more than 35 kg: 100 mg.

If doxycycline cannot be used, while awaiting the results of susceptibility testing, other options are azithromycin, clarithromycin or moxifloxacin.

1 For patients with severe immediate penicillin hypersensitivity who tolerated initial intravenous therapy with ceftriaxone, it is safe to use cefuroxime.Return
2 Severe immediate hypersensitivity reactions include anaphylaxis, compromised airway, airway angioedema, hypotension and collapse. Severe delayed hypersensitivity reactions include cutaneous adverse drug reactions (eg drug rash with eosinophilia and systemic symptoms [DRESS], Stevens–Johnson syndrome/toxic epidermal necrolysis [SJS/TEN], severe blistering or desquamative rash), and significant internal organ involvement (eg acute interstitial nephritis).Return
3 Doxycycline use is limited because an oral liquid formulation is not marketed in Australia but is available via the Special Access Scheme. For formulation options for children or people with swallowing difficulties, see Don’t Rush to Crush, which is available for purchase from the Advanced Pharmacy Australia website or through a subscription to eMIMSplus.Return
4 When used short term (eg less than 21 days), doxycycline has not been associated with tooth discolouration, enamel hypoplasia or bone deposition so can be used in children of all ages.Return