Pediatric Comm ommuni unity-Acqui ty-Acquire red d Pneumon neumonia: ia: Updated Updated Gui uidelin deline es
Pedia ediatric tric Community -Acquired Pneumoni Pneumoni a: Updated Update d Guidelines
The Regents Regents of the University of Califor nia (Dr. (Dr. Bradley’s employer) employe r) hold a consulting contract with Ce Cerexa rexa
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90
Penicillin MIC (mcg/mL)
80
60
50 19A 40
non 19A
30
20
10
0 0.01
0.02
0.03
0.06
0 .13
0.25
0.5
1
2
4
8
13
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with conjugate vaccines for: Haemophilus influenzae , type b, and S. pneumoniae , oral Less than 5 years of age (90 mg/kg/day div bid) (Preschool)
oral
Alternative:
Alternatives: , oral (90 oral; mg/kg/day amox component div bid) 5 Years of age and older
oral
oral (10 mg/kg on , oral (90 mg/kg/day div bid to a max d 1, followed by 5 mg/kg daily, of 4gm/day)* d 2-5 Alternative:
Alternatives: oral , oral (90 (15 mg/kg/day div bid to a max mg/kg/day amox component of 1 gm daily); ; div bid to a max dose of 4g for older than 7 amox/day) years (all ages) -Local penicillin resistance in invasive strains of pneumococcus low
-Local penicillin resistance in invasive strains of pneumococcus is significant
(in addition to beta-lactam, if bacterial diagnosis in doubt) Alternatives**:
Alternatives***: ; (in addition to beta-lactam, if diagnosis in doubt)
Alternative:
Alternatives***:
*For children with presumed bacterial CAP who do not have clinical, laboratory, or radiographic evidence that distinguishes bacterial CAP from atypical CAP, a macrolide can be added **Addition of ***
for suspected CA-MRSA for children who have reached growth maturity, or those who cannot tolerate macrolides
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Table5: Selection ofAntimicrobialTherapy forSpecificPathogens
Preferred (150-200 mg/kg/day div q 6 hours), or (200-300,000 u/kg/day div q 4-6 hours) Alternatives: (50 to 100 mg/kg/day q 12-24 hours) (Preferred for parenteral outpatient therapy) or (150 mg/kg/day div q 8 hours) May also be effective: (40 mg/kg/day div q 6-8 hours) or (40-60 mg/kg/day div q 6-8 hours)
Preferred (90 mg/kg/day div bid, or 45 mg/kg/day div tid)
Alternatives: A second or third generation cephalosporin ( ); PO, if susceptible, (1620 mg/kg/day div bid for children 6 months to 5 years and 8-10 mg/kg/day once daily for children 5 to 16 years, max daily dose 750 mg), or PO (30 mg/kg/day div tid for children < 12 years and 20 mg/kg/day div bid for children >12 years). Preferred: (100 mg/kg/day q 12- Preferred: PO (16 -20 mg/kg/day 24 hours) div bid for children 6 months to 5 years and 810 mg/kg/day once daily for children 5 to 16 years, max daily dose 750 mg), if susceptible, or linezolid PO (30 mg/kg/day div tid for children < 12 years and 20 mg/kg/day div bid for children >12 years). Alternatives: (300-400 m /k /da Alternative: PO* (30-40 div q 6 hours), (16-20 mg/kg/day mg/kg/day div tid) div q 12 hours for children 6 months to 5 years and 8-10 mg/kg/day once daily for children 5 to 16 years, max daily dose 750 mg) or linezolid (30 mg/kg/day div q 8 hours for children < 12 years and 20 mg/kg/day div q 12 hours for children >12 years) May also be effective: * (40 mg/kg/day div q 6-8 hours) or (40-60 mg/kg/day div q 6-8 hours),
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