ADULTS - FIRST LINE (IDSA recommendations)
Standard

High-dose therapy
  • High-dose therapy is recommended if one of the following is present:
    • Geographic regions with high endemic rates (≥10%) of invasive penicillin-resistant S. pneumoniae
    • Those with severe infection (e.g. fever ≥ 39°C [102°F], and threat of suppurative complications
    • Age > 65 years
    • recent hospitalization
    • Antibiotic use within the past month
    • Immunocompromised [3]
ADULTS - SECOND LINE (PENICILLIN ALLERGIC)

  • Risk of penicillin cross-sensitivity is very low with these cephalosporins [4]
  • AAP - American Academy of Pediatrics
CHILDREN - FIRST LINE (AAP recommendations)
Standard
  • Amoxicillin 45 mg/kg/day in 2 divided doses for a minimum of 10 days

High-dose therapy - recommended in communities with a high prevalence of nonsusceptible S. pneumoniae (>10%, including intermediate- and high-level resistance)
  • Amoxicillin 80 - 90 mg/kg/day in 2 divided doses (maximum of 2 g per dose) for a minimum of 10 days

Moderate-to-severe illness - defined as the presence of one of the following: < 2 years old; attending child care; recently been treated with an antimicrobial
  • Amoxicillin-clavulanate (Augmentin®) 80 – 90 mg/kg/day of the amoxicillin component with 6.4 mg/kg per day of clavulanate in 2 divided doses with a maximum of 2 g per dose for a minimum of 10 days [4]
CHILDREN - SECOND LINE (PENICILLIN ALLERGIC)
  • Cefdinir 7 mg/kg every 12 hours or 14 mg/kg once daily for a minimum of 10 days
  • Cefpodoxime (Vantin®) 5 mg/kg every 12 hours (Max 200 mg/dose) for a minimum of 10 days
  • Cefuroxime (Ceftin®) 30 mg/kg/day divided twice a day (Max 1,000 mg/day) for a minimum of 10 days [4,5]

Young children (< 2 years old)