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