| Severe CAP | Benzylpenicillin IM or IV for at least 3 days. When the child improves, switch to oral amoxicillin for a total course of treatment of 5 days If the child does not improve within 48 h or deteriorates, look for complications and treat accordingly (high-dose amoxicillin-clavulanic acid with or without a macrolide). If there are no apparent complications, switch to chloramphenicol 75 mg/kg/day IM or IV until the child has improved. Then continue orally for a total course of 10 days
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| Very severe CAP | Standard therapy: ampicillin IM or IV and gentamicin IM or IV for 5 days; if the child responds well, complete treatment with oral amoxicillin plus IM gentamicin for a further 5 days Alternative therapies: (a) chloramphenicol IM or IV until the child has improved and then continue orally for a total course of 10 days; (b) ceftriaxone IM or IV once daily for 10 days Treatment in case the child does not improve after 48 h of standard or alternative therapies: gentamicin IM or IV and cloxacillin or dicloxacillin or flucloxacillin or oxacillin IM or IV. When the child improves, continue cloxacillin (or dicloxacillin) for a total course of 3 weeks
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