Age group | Main bacterial causes | Antibiotic of choice |
Birth to 3 weeks | Group B streptococci, Gram-negative enteric bacteria, Listeria monocytogenes, Staphylococcus aureus | Administer IV ampicillin and IV gentamicin or IV cefuroxime or IV cefotaxime (dose based on gestational age or birth weight) for 10 days* |
4 weeks to 3 months | Streptococcus pneumoniae, Chlamydia trachomatis, Bordetella pertussis, Staphylococcus aureus | If patient is afebrile, give oral or parenteral erythromycin or oral or parenteral clarithromycin for 10–14 days or oral azithromycin for 3–5 days†. If patient is febrile, administer IV cefuroxime or IV cefotaxime or IV ceftriaxone until fever disappears, followed by oral cefuroxime axetil or oral amoxicillin-clavulanic acid for a total course of 10–14 days* |
4 months to 18 years | Streptococcus pneumoniae, Mycoplasma pneumoniae, Haemophilus influenzae | Administer IV cefuroxime or IV cefotaxime or IV ceftriaxone until fever disappears, followed by oral cefuroxime axetil or oral amoxicillin-clavulanic acid for a total course of 10–14 days combined with oral or parenteral erythromycin or oral or parenteral clarithromycin for 10–14 days or oral azithromycin for 3–5 days* |
↵* Staphylococcal pneumonia is unusual; however, if blood or pleural fluid cultures grow Staphylococcus aureus, oxacillin or, in areas where methicillin-resistant S aureus is a reasonable possibility, vancomycin should be added.
↵† In infants aged <6 weeks, treatment with clarithromycin or azithromycin should be considered because there have been reports of hypertrophic pylotic stenosis in infants receiving erythromycin.
IV, intravenous.