Empirical therapy for suspected Chlamydophila (Chlamydia) pneumoniae or Mycoplasma pneumoniae moderate-severity CAP in children 2 months or older
For children 2 months or older with moderate-severity CAP, the benefit of empirical therapy for Chlamydophila (Chlamydia) pneumoniae or Mycoplasma pneumoniae is uncertainArnold, 2023Biondi, 2014Gardiner, 2015Williams, 2017. Consider adding an antibiotic with activity against these pathogens if a viral aetiology has been excluded, the child is not improving on empirical therapy and C. pneumoniae or M. pneumoniae is suspected based on the clinical syndrome (eg focal wheeze, rash, headache, sore throat).
If antibiotic therapy is indicated for moderate-severity C. pneumoniae or M. pneumoniae CAP in children 2 months or older, and the child can tolerate and absorb oral therapy, add to amoxicillin or cefuroxime:
1azithromycin 10 mg/kg up to 500 mg orally, daily. See advice on patient review and duration of therapy azithromycin
OR
2clarithromycin 7.5 mg/kg up to 500 mg orally, 12-hourly. See advice on patient review and duration of therapy clarithromycin
OR
2doxycycline orally, 12-hourly12. See advice on patient review 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.
Do not use doxycycline if Bordetella pertussis infection is suspected (eg children who have been in contact with a patient with pertussis, children with paroxysmal cough associated with cyanosis or apnoea). If B. pertussis infection is confirmed, see Pertussis for management.
For children 2 months or older with moderate-severity CAP who cannot tolerate or absorb oral therapy, add to the intravenous benzylpenicillin or cephalosporin regimen:
azithromycin 10 mg/kg up to 500 mg intravenously, daily. Switch to oral therapy once the child is able to tolerate and absorb oral medication – see regimens above. See advice on patient review and duration of therapy. azithromycin