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©2013 UpToDate ® Print Email Doses of antimicrobials for the treatment of pneumococcal pneumonia in children older than three months Parenteral therapy Oral therapy (step-down therapy or mild infection) Streptococcus pneumoniae susceptible to penicillin (MIC ≤2 mcg/mL) Preferred regimens Ampicillin 150 to 200 mg/kg per day divided every 6 hours (maximum daily dose 6 g) Amoxicillin 90 mg/kg per day in 2 doses or 45 mg/kg per day in 3 doses Penicillin 200,000 to 250,000 units/kg per day divided every 4 or 6 hours (maximum daily dose 24 million units) Alternative regimens Ceftriaxone* 50 to 100 mg/kg per day divided every 12 or 24 hours (maximum daily dose 4 g) Cefpodoxime 10 mg/kg per day divided in 2 doses (maximum daily dose 400 mg) Cefotaxime 150 mg/kg per day divided every 8 hours (maximum daily dose 10 g) Cefuroxime 20 to 30 mg/kg per day divided in 2 doses (maximum daily dose 2 g) Clindamycin 40 mg/kg per day divided every 6 or 8 hours (maximum daily dose 3.6 g) Cefprozil 15 to 30 mg/kg per day in 2 doses (maximum daily dose 1g) Vancomycin 40 to 60 mg/kg per day divided every 6 or 8 hours (maximum daily dose 4 g) Levofloxacin (if susceptible) Age 6 months to 5 years: 16 to 20 mg/kg per day divided in 2 doses (maximum daily dose 750 mg) Age 5 to 16 years: 8 to 10 mg/kg once daily (maximum daily dose 750 mg) Linezolid Age <12 years: 30 mg/kg per day divided in 3 doses (maximum daily dose 1800 mg) Age ≥12 years: 20 mg/kg per day divided in 2 doses (maximum daily dose 1200 mg) S. pneumoniae resistant to penicillin (MIC ≥4 mcg/mL) Preferred regimens Ceftriaxone 100 mg/kg per day divided every 12 or 24 hours (maximum daily dose 4 g) Levofloxacin (if susceptible) Age 6 months to 5 years: 16 to 20 mg/kg per day divided in 2 doses (maximum daily dose 750 mg) Age 5 to 16 years: 8 to 10 mg/kg once daily (maximum daily dose 750 mg) Linezolid Age <12 years: 30 mg/kg per day divided in 3 doses (maximum daily dose 1800 mg) Age ≥12 years: 20 mg/kg per day in 2 doses (maximum daily dose 1200 mg) Alternative regimens Ampicillin 300 to 400 mg/kg per day divided every 6 hours (maximum daily dose 6 g) Clindamycin • 40 mg/kg per day divided in 2 doses (maximum daily dose 1.8 g) Levofloxacin Age 6 months to 5 years: 16 to 20 mg/kg per day divided every 12 hours (maximum daily dose 750 mg) Age 5 to 16 years: 8 or 10 mg/kg once daily (maximum daily dose 750 mg) Linezolid Age <12 years: 30 mg/kg per day divided every 8 hours (maximum daily dose 1800 mg)

Clindamycin • 40 mg/kg per day divided in 2 doses (maximum daily dose 1.8 g) Levofloxacin Age 6 months to 5 years: 16 to 20 mg/kg per day divided every 12 hours (maximum daily dose 750 mg) Age 5 to 16 years: 8 or 10 mg/kg once daily (maximum daily dose 750 mg) Linezolid Age <12 years: 30 mg/kg per day divided every 8 hours (maximum daily dose 1800 mg) Age ≥12 years: 20 mg/kg per day divided every 12 hours (maximum daily dose 1200 mg) Clindamycin • 40 mg/kg per day divided every 6 or 8 hours (maximum daily dose 3.6 g) Vancomycin 40 to 60 mg/kg per day divided every 6 or 8 hours (maximum daily dose 4 g) * Preferred for parenteral outpatient therapy. • Clindamycin resistance appears to be increasing in certain geographic areas among S. pneumoniae infections. From: Bradley JS, Byington CL, Shah SS, et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis 2011; 53:e25, with permission of the Infectious Diseases Society of America. Copyright © 2011 Oxford University Press.