Pediatric Outpatient

If viral pneumonia is diagnosed, then treatment is often supportive (maintaining hydration, antipyretics) since we have very few effective antiviral agents. The bacterial pathogens are the same as for adults with S. pneumoniae as the predominant pathogen, then M. pneumoniae, and then the other organisms. Resistance issues with these organisms are similar to those seen in adult patients. Fluoroquinolones and tetracyclines should not be used in children younger than 5 years of age. High-dose amoxicillin (50 mg/kg/day), amoxicillin/clavulanate (70-90 mg/kg/day), intramuscular ceftriaxone (50 mg/kg/day), azithromycin (10 mg/kg/day), and clarithromycin (7.5 mg/kg/

day) are all potential agents for use in children. Dosing of antibiotics for pediatrics patients is presented in Table 71-4.

Pediatric Inpatient

If the child is not admitted to the ICU, then the CDC recommends the use of IV cefur-oxime, cefotaxime, ceftriaxone, or ampicillin/sulbactam plus a macrolide or azalide. If the child is admitted to the ICU, then only the third-generation cephalosporins (ce-fotaxime or ceftriaxone) plus a macrolide or azalide should be administered.30

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