Failure of first line agents
- no improvement or clinical deterioration after 72 hours of antibiotic therapy
- recurrence within 3 months
- Need to consider resistant organisms, especially penicillin-resistant S. pneumoniae and ampicillin resistant H. influenzae.
Usual Pathogens
S. pneumoniae
M. catarrhalis
H. influenzae
Occasionally:
S. aureus
Group A Streptococci
Anaerobes
| Empiric Therapy | Duration | |
|---|---|---|
|
Amoxicillin-clavulanate (7:1 - Clavulin -200 or -400) |
45mg/kg/d PO div bid-tid | 10 days |
| +/- | ||
| Amoxicillin | 45mg/kg/d PO div bid-tid | 10 days |
Penicillin allergy
| Empiric Therapy | Dose | Duration |
|---|---|---|
| [Clindamycin | 20-30mg/kg/d PO div tid | 10 days |
| + | ||
| Cefixime] | 8mg/kg/d PO div bid | |
| or | ||
| Ceftriaxone | 100mg/kg IV daily | 10 days |
Severe penicillin allergy or cephalosporin allergy
| Empiric Therapy | Duration | |
|---|---|---|
| Levofloxacin | 10-20mg/kg/d PO div q12-24h | 10 days |