Dose is calculated using the ampicillin component.
Max 2000 mg/dose (ampicillin) · Duration: 2–4 weeks · Continue until clinical recovery and imaging improvement; longer courses may be required
Enter weight on Kids to calculate doses
Vancomycin • i.v. • 15–15 mg/kg/dose • 4×/day
Max 2000 mg/day · Duration: 2–4 weeks · Monitor trough levels per local protocol; adjust for renal function
Enter weight on Kids to calculate doses
Ceftriaxone • i.v. • 50–75 mg/kg/day • 1×/day
Max 2000 mg/day · Duration: 2–4 weeks · Continue until clinical recovery and imaging improvement; longer courses may be required
• Ceftriaxone + clindamycin: alternative when ampicillin/sulbactam is unsuitable; clindamycin covers anaerobes and suppresses toxin production in S. aureus.
• Meropenem: severe disease, suspected resistant gram-negative organisms, or when broader beta-lactam coverage is required per local ICU protocol.
• De-escalate based on culture results and clinical response; MRSA coverage can be discontinued if cultures negative.
Enter weight on Kids to calculate doses
Clindamycin • i.v. • 10–10 mg/kg/dose • 3×/day
Max 600 mg/dose · Duration: 2–4 weeks · Step down to p.o. when clinically stable
Enter weight on Kids to calculate doses
Clinical notes
• Necrotizing pneumonia is a severe complication of CAP requiring prolonged IV therapy and close monitoring.
• Obtain blood and pleural fluid cultures before antibiotics when feasible.
• Consider chest CT when necrosis, abscess, or pleural complications are suspected.
• Surgical or interventional drainage may be required for empyema or loculated collections.
• Reassess clinically and radiographically; total antibiotic duration often exceeds standard CAP courses.
• AAP Red Book — Pneumonia and Antimicrobial Therapy (2024)
• PIDS/IDSA Clinical Practice Guideline — Pediatric CAP (principles applicable) (2011)
