Duration of therapy for moderate-severity CAP in children 2 months or older

If a pathogen is identified in a child 2 months or older with moderate-severity CAP, see Directed therapy for pneumonia for modification and duration of therapy.

For moderate-severity CAP in children 2 months or older, the usual duration of antibiotic therapy (intravenous + oral) is 3 to 5 daysBielicki, 2021Kuitunen, 2023Li, 2022Lipshaw, 2020Marques, 2022McCallum, 2022Pernica, 2021Same, 2021Shapiro, 2021Williams, 2022; for azithromycin (which has a long intracellular half-life), the usual duration of therapy is 3 days. If the child significantly improves after 48 to 72 hours of antibiotic therapy, stop antibiotic therapy.

If the child is not improving after 48 to 72 hours of antibiotic therapy, reassess the diagnosis. Consider infective and noninfective diagnoses – see Approach to managing children 2 months or older with CAP who are not improving. If CAP remains the likely diagnosis, reassess disease severity and, if the child was taking oral therapy, the need for intravenous therapy.

For children in tropical regions of Australia1 who are not improving, perform culture and serology testing for Burkholderia pseudomallei (see Melioidosis for details).

1 Tropical regions of Australia refer to regions north of 20°S latitude. This includes areas of Queensland north of Mackay, the Northern Territory north of Tennant Creek, and Western Australia north of Port Hedland.Return