Management of Pediatric Pneumonia
General Supportive Care (All Severity Levels)
- Oxygen therapy — target SpO₂ ≥92%; continuous monitoring
- Hydration — IV fluids if unable to feed; maintain electrolyte balance
- Fever control — paracetamol for fever >38.5°C
- Nutrition — continue breastfeeding; soft foods encouraged
- Positioning — semi-recumbent if tolerated
- Antipyretics — paracetamol; avoid NSAIDs in young children
Outpatient Management — Non-Severe Pneumonia
Indication: Fast breathing, no danger signs, SpO₂ normal, feeding adequately
| Drug | Dose | Duration |
|---|---|---|
| Amoxicillin (first choice) | 40 mg/kg/dose TWICE daily | 5 days |
| Cotrimoxazole (if amoxicillin unavailable) | Age/weight-based BD | 5 days |
- Counsel mother on danger signs requiring immediate return
- Follow-up at 2 days
Inpatient Management — Severe Pneumonia
Indication: Chest indrawing + danger signs or hypoxia (SpO₂ <92%)
Step 1: Supportive
- Oxygen via nasal prongs / face mask / hood
- IV access; IV fluids (10 ml/kg bolus if shock features)
- Monitor SpO₂, RR, temperature, hydration
Step 2: Antibiotics
First-line (WHO/IMNCI):
| Drug | Dose | Route |
|---|---|---|
| Benzylpenicillin | 50,000 IU/kg/dose q6h | IV/IM |
| Ampicillin | 100 mg/kg/day divided | IV |
| + Gentamicin | 5 mg/kg/day once daily | IV/IM |
Second-line:
- IV Ceftriaxone: 50–75 mg/kg/day (single daily dose)
- Cefotaxime: 100 mg/kg/day divided 6–8 hourly
Organism-Specific Antibiotic Regimens
Pneumococcal Pneumonia
- Penicillin G 50,000 IU/kg/day IV/IM in divided doses × 7 days
- Alternatives: IV cefotaxime, ceftriaxone, or co-amoxiclav
Staphylococcal Pneumonia
- Cloxacillin or Co-amoxiclav or Penicillin G — first line
- Ceftriaxone — effective
- Vancomycin / Teicoplanin / Linezolid — if no response (MRSA)
- Duration: 2–6 weeks (prolonged therapy desirable)
H. influenzae Pneumonia
- Ampicillin 100 mg/kg/day IV + Co-amoxiclav
- Cefotaxime 100 mg/kg/day or Ceftriaxone 50–75 mg/kg/day
Streptococcal (Group A) Pneumonia
- Penicillin G 50,000–100,000 IU/kg/day IV × 7–10 days
- Alternatives: Cefaclor, Cefuroxime, Ceftriaxone, Cefotaxime
Atypical Pneumonia (Mycoplasma / Chlamydia)
- Macrolides — Erythromycin / Azithromycin / Clarithromycin × 7–10 days
- Tetracycline — alternative (avoid <8 years)
Gram-Negative Pneumonia (E. coli, Klebsiella)
- IV Cefotaxime or Ceftriaxone (75–100 mg/kg/day) ± Aminoglycoside
- Duration: 10–14 days
Pseudomonas Pneumonia (CF patients)
- Ceftazidime — drug of choice
Neonatal Pneumonia
- Ampicillin / Cloxacillin + Gentamicin (community acquired)
- Cephalosporin + Amikacin (hospital-acquired)
Kerosene / Hydrocarbon Aspiration Pneumonia
- Do NOT induce vomiting
- No gastric lavage (aspiration risk)
- Oxygen supplementation
- Routine antibiotics NOT indicated
- Supportive care only
Management of Complications
| Complication | Treatment |
|---|---|
| Empyema / Pyopneumothorax | Intercostal drainage (ICD) under water seal or low-pressure aspiration |
| Pneumatoceles | No specific treatment needed; observe |
| Lung abscess (metastatic) | Surgical drainage |
| Significant pleural thickening | Decortication (open thoracotomy or VATS) |
| Respiratory failure | Mechanical ventilation (IPPV / CPAP) |
| Pericarditis (purulent) | Pericardiocentesis + antibiotics |
Criteria for Hospital Discharge
- SpO₂ ≥92% on room air
- Afebrile or minimal fever
- Feeding well
- Caregiver able to administer oral antibiotics
- Follow-up plan in place