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

Use oral therapy for moderate-severity CAP in children 2 months or older because studies have shown equivalent outcomes to intravenous therapyAddo-Yobo, 2004 Atkinson, 2007 Hazir, 2008.

For children 2 months or older with moderate-severity CAP who can tolerate and absorb oral therapy, use:

amoxicillin 25 mg/kg up to 1 g orally, 8-hourly. The usual duration of therapy is 3 to 5 days; see advice on patient review and duration of therapy. amoxicillin

For children 3 months or older with moderate-severity CAP 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. The usual duration of therapy is 3 to 5 days; see advice on patient review and duration of therapy ². cefuroxime

For children in whom a suitable formulation of cefuroxime is not available, azithromycin may be used as an alternative at the dosages used below for penicillin hypersensitivity.

For children 2 months or older with moderate-severity CAP who have had a severe (immediate or delayed)³ hypersensitivity reaction to a penicillin, use:

1azithromycin 10 mg/kg up to 500 mg orally, daily for 3 days. See advice on patient review azithromycin

2clarithromycin 7.5 mg/kg up to 500 mg orally, 12-hourly. The usual duration of therapy is 3 to 5 days; see advice on patient review and duration of therapy clarithromycin

2doxycycline orally, 12-hourly⁴ ⁵. The usual duration of therapy is 3 to 5 days; 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.

¹ For patients with severe immediate penicillin hypersensitivity who tolerated initial intravenous therapy with ceftriaxone, it is safe to use cefuroxime.Return

² Cefuroxime is preferred to cefalexin or cefaclor because of its superior antipneumococcal activity; see Practical information on using beta lactams: cephalosporins for further information.Return

³ 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

⁴ An oral liquid formulation of doxycycline 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

⁵ 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