Ongoing management of late-onset CAP (occurring more than 72 hours after birth) in term neonates, and CAP in children younger than 2 months

If the patient has improved on the initial empirical therapy for sepsis or septic shock, and meningitis and encephalitis are excluded, the antibiotic regimens below can be used for late-onset community-acquired pneumonia (CAP) (occurring more than 72 hours after birth) in term neonates (gestational age 37 weeks or older) and CAP in children younger than 2 months. Seek expert advice for management of preterm neonates, patients who are not improving, or patients with complications of pneumonia such as parapneumonic effusion, empyema or lung abscess.

If available, modify treatment based on the results of investigations, including susceptibility testing – see Directed therapy for pneumonia.

Amoxicillin or ampicillin are recommended in these guidelines for ongoing empirical antibiotic therapy because of the possibility of Haemophilus influenzae and other gram-negative bacteria. However, if the child was initially treated with benzylpenicillin and is improving, it is reasonable to continue therapy rather than changing to amoxicillin or ampicillin.

For ongoing empirical antibiotic therapy for late-onset CAP (occurring more than 72 hours after birth) in term neonates (gestational age 37 weeks or older), and CAP in children younger than 2 months, use:

Review the response to empirical therapy and consider a shorter duration of therapy if the term neonate rapidly improves and the results of investigations indicate a viral aetiologyMahajan, 2018.