Modification and duration of therapy for late-onset CAP (occurring more than 72 hours after birth) in term neonates, and CAP in children younger than 2 months

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

For term neonates (gestational age 37 weeks or older) with late-onset community-acquired pneumonia (CAP) (occurring more than 72 hours after birth), intravenous antibiotic therapy is usually recommended for the full duration of treatment. However, evidence suggests that adequate blood concentrations of antibiotics can be achieved for neonates treated with oral antibioticsHikmat, 2022Keij, 2019. Oral antibiotics can be considered to complete antibiotic therapy for CAP when the neonate has shown significant improvement on initial intravenous therapy and maintaining intravenous access has become challenging – seek expert advice.

For children 1 month to younger than 2 months with late-onset CAP, consider switching to oral therapy to complete the course when the child is clinically stable and can tolerate and absorb oral medicines (see Guidance for intravenous to oral switch for guidance on when to switch to oral therapy). If a pathogen is not identified, use:

The total duration of therapy (intravenous + oral) for ampicillin and amoxicillin is 5 days.