A 3-year-old child is diagnosed with community-acquired pneumonia and is admitted. He has tachycardia, tachypnoea (RR 60/min), subcostal retractions, and temperature of 39.5°C. SpO2 is 88% on room air. Chest X-ray shows a dense lobar consolidation of the right lower lobe. What is the FIRST-LINE antibiotic according to WHO guidelines?
- A IV co-amoxiclav (amoxicillin-clavulanate)
- B IV ceftriaxone + IV azithromycin
- C Oral azithromycin alone for atypical coverage
- D IV or oral amoxicillin (high dose: 80–90 mg/kg/day) ✓
Explanation
Streptococcus pneumoniae remains the most common cause of community-acquired lobar pneumonia in children 1–5 years. WHO and IAP guidelines recommend amoxicillin as first-line treatment for non-severe and severe pneumonia in children; for hospitalized children requiring parenteral therapy, IV ampicillin is equivalent. High-dose amoxicillin (80–90 mg/kg/day) overcomes intermediate pneumococcal resistance. Ceftriaxone with azithromycin is used for atypical pneumonia or treatment failure. Azithromycin monotherapy targets Mycoplasma and Chlamydia (atypical organisms) which more commonly cause a milder, bilateral, perihilar pattern rather than dense lobar consolidation.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.