First choice antimicrobial	Alternative antimicrobial in the event of immediate (e.g. anaphylaxis) or delayed type (e.g. rash) hypersensitivity reaction
CAP (more than 1 month old) (mild, moderate or severe)	Amoxicillin orally 25 mg/kg/dose every 8 hours (Maximum 1 g/dose) Comment: Oral antibiotics are first line therapy for children with CAP unless unable to tolerate orals. Prescribe highest concentration amoxicillin suspension, to reduce volume per dose required for administration (for example: 100mg/mL amoxicillin suspension)	Immediate Type hypersensitivity Roxithromycin orally 4 mg/kg/dose every 12 hours (Maximum 150 mg/dose)
CAP (more than 1 month old) (unable to tolerate oral) (mild, moderate or severe)	Benzylpenicillin IV 60 mg/kg/dose every 6 hours (Max 2.4gram/dose)	Delayed type hypersensitivity, Cefotaxime IV 50mg/kg/dose every 6 hours (Maximum 2 g/dose) Immediate type hypersensitivity, seek ID advice.
Empyema	Benzylpenicillin IV 60mg/kg/dose every 6 hours (Maximum 2.4 g/dose) PLUS Lincomycin IV 15 mg/kg/dose every 8 hours (Max 1.2 g/dose) Consult Respiratory team regarding pleural drainage. Seek ID advice within 72 hours.	Delayed Type hypersensitivity, Cefotaxime IV 50mg/kg/dose every 6 hourly (Maximum 2 g/dose) PLUS Lincomycin IV 15 mg/kg/dose every 8 hours (Max 1.2 g/dose)
Severe pneumonia (PICU/HDU care required) (Less than or equal to 5 years of age)	Cefotaxime IV 50mg/kg/dose every 6 hours (Maximum 2 g/dose) Discuss with ID within 48 hours. If S. Aureus (including nmMRSA) suspected, Cefotaxime IV 50mg/kg/dose every 6 hourly (Maximum 2 g/dose) PLUS Lincomycin IV 15 mg/kg/dose every 8 hours (Max 1.2 g/dose) Seek ID advice within 24 hours.	Immediate Type Hypersensitivity Seek ID advice
Life-threatening pneumonia (PICU/High dependency unit care required) (Less than or equal to 5 years of age)	If life threatening pneumonia OR multi-resistant MRSA suspected: Cefotaxime IV 50mg/kg/dose every 6 hours (maximum 2 g/dose) PLUS Lincomycin IV 15 mg/kg/dose every 6 hours (Max 1.2 g/dose) PLUS Vancomycin IV 15 mg/kg/dose every 6 hours (maximum initial dose of 750 mg) (Perform therapeutic drug monitoring for Vancomycin.) PLUS consider Azithromycin IV 10 mg/kg once daily (maximum 500 mg/day). Seek ID advice within 24 hours	Immediate Type Hypersensitivity Seek ID advice
Severe pneumonia (PICU/HDU care required) (More than 5 years of age)	Cefotaxime IV 50mg/kg/dose every 6 hours (maximum 2 g/dose). CONSIDER Azithromycin IV 10mg/kg once daily (maximum 500 mg/day). (Swap to oral Roxithromycin 4 mg/kg/dose (maximum 150 mg/dose) twice daily, after 24 hours if possible). Seek ID advice within 24 hours. If S. Aureus (including nmMRSA) suspected Cefotaxime IV 50mg/kg/dose every 6 hourly (Maximum 2 g/dose) PLUS Lincomycin IV 15 mg/kg/dose every 8 hours (Max 1.2 g/dose) Seek ID advice within 24 hours.	Immediate Type Hypersensitivity Seek ID advice
Life-threatening pneumonia (PICU/HDU care required) (More than 5 years of age)	If life threatening pneumonia OR multi-resistant MRSA suspected: Cefotaxime IV 50mg/kg/dose every 6 hours (maximum 2 g/dose) PLUS Lincomycin IV 15 mg/kg/dose every 6 hours (Max 1.2 g/dose) PLUS Vancomycin IV 15 mg/kg/dose every 6 hours (maximum initial dose of 750 mg) (Perform therapeutic drug monitoring for Vancomycin.) PLUS consider Azithromycin IV 10 mg/kg once daily (maximum 500 mg/day). Seek ID advice within 24 hours	Immediate Type Hypersensitivity Seek ID advice