Clinical management of community-acquired pneumonia in young children

Introduction: Community-acquired pneumonia (CAP) is the leading cause of mortality among children under 5 years worldwide. However, the choices of chemical therapy for the empirical treatment of CAP are frequently debated. Areas covered: The authors provide an update on the chemical management recommendations for childhood CAP. The authors have performed a MEDLINE literature search, using the keywords 'guidelines,' 'community-acquired pneumonia,' AND 'children.' Articles published in English, providing consensual recommendations on management of children >2 months and <5 years with CAP but without HIV infection, were included. Furthermore, the authors discuss the latest evidence guiding the rational use of antibiotics in young children with CAP. Expert opinion: For the chemical management of CAP, the first-line antibiotic options are amoxicillin (50 mg/kg/day, every 12 h) among ambulatory patients and aqueous penicillin G (200,000 IU/kg/day, every 6 h) or ampicillin (200 mg/kg/day, every 6 h) for hospitalized children. Ceftriaxone can be considered in the treatment of very severe cases. Oxacillin or macrolide may be added in specific situations, if Staphylococcus aureus or atypical bacteria, respectively, are potential etiological agents, although not deemed common. Penicillins remain the first-line choice of antibiotic for the treatment of CAP in young children.