Intravenous to oral switch for moderate-severity CAP in children 2 months or older

For children 2 months or older with moderate-severity CAP who started with intravenous therapy, switch to oral therapy once the child has improved and is clinically stable (see Guidance for intravenous to oral switch for guidance on when to switch to oral therapy).

For children without penicillin hypersensitivity, use amoxicillin.
For children with nonsevere (immediate or delayed) penicillin hypersensitivity, or severe immediate¹ penicillin hypersensitivity who tolerated cefotaxime or ceftriaxone, use cefuroxime.
For children with severe immediate¹ penicillin hypersensitivity in whom cefotaxime or ceftriaxone was not used nor tolerated, or for children with severe delayed² penicillin hypersensitivity, use azithromycin, clarithromycin or doxycycline.

Note: Do not use amoxicillin+clavulanate for intravenous to oral switch.

Amoxicillin+clavulanate is not an appropriate choice for intravenous to oral switch for children 2 months or older with moderate-severity CAP. Compared with amoxicillin+clavulanate:

amoxicillin is less selective for resistance
amoxicillin has fewer adverse effects
at the dosage recommended for CAP (25 mg/kg up to 1 g orally, 8-hourly), the concentration of amoxicillin is significantly higher (which is needed in case of infection due to Streptococcus pneumoniae with a higher minimum inhibitory concentration [MIC] to penicillin).

¹ Severe immediate hypersensitivity reactions include anaphylaxis, compromised airway, airway angioedema, hypotension and collapse.Return

² 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