Lobar Pneumonia/Focal Consolidation

For severe pneumonia with suspected type I penicillin allergy, options should be discussed with a paediatric infectious diseases physician

Recommended Consults

Infectious Diseases

Duration of Therapy

Uncomplicated: 7 days (unless otherwise indicated)

Complicated pneumonia (with effusion, abscess, immunocompromised host, etc) may warrant a longer course of therapy

Clinical Improvement in 48-72 Hrs?

Suggested Regimen

Ceftriaxone IV 75-100 mg/kg/day divided q12h or q24h
Duration: 7 days

AND EITHER

Azithromycin IV/PO
(Day 1) 10mg/kg (Days 2-5) 5mg/kg
Duration: 5 days

OR

Clarithromycin PO 15 mg/kg/day divided BID
Duration: 7 days

ALSO CONSIDER

Vancomycin IV 60 mg/kg/day divided QID
Duration: 7 days

Target trough Vancomycin levels should be 15-20 mg/L

When to Consider Vancomycin

Vancomycin should be considered if severe pneumonia and risk for cephalosporin resistant Streptococcus pneumoniae, OR high risk for MRSA, OR rapidly progressive disease OR pneumatoceles/abscess, OR patient has features of septic shock