Dose is calculated using the ampicillin component.
Max 2000 mg/dose (ampicillin) · Duration: 2–4 weeks · Total i.v. plus p.o. course; step down when clinically improved and drainage adequate
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 · Add when MRSA risk, severe disease, or positive MRSA screen; monitor trough levels; discontinue if cultures negative
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 · Total i.v. plus p.o. course; step down when clinically improved and drainage adequate
• Ceftriaxone + clindamycin: alternative first-line in some centers; covers typical CAP pathogens plus anaerobes and S. aureus.
• Meropenem: severe sepsis, suspected ESBL or resistant gram-negative organisms, or when beta-lactam options fail per ICU protocol.
• Add vancomycin (or linezolid) when MRSA is suspected or proven; de-escalate based on cultures.
• Step down to p.o. amoxicillin or amoxicillin/clavulanate when cultures are negative and patient is improving (CPS, local protocol).
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; covers anaerobes and S. aureus toxin suppression
Enter weight on Kids to calculate doses
Clinical notes
• Pleural empyema requires antibiotics plus pleural source control — antibiotics alone are insufficient when drainage is inadequate.
• Obtain blood and pleural fluid cultures before antibiotics when feasible; send Gram stain and culture of pleural fluid.
• Pleural drainage (chest tube or image-guided) is indicated for moderate–large effusions, loculations, pus on aspiration, or clinical deterioration despite antibiotics.
• Intrapleural fibrinolytics (e.g. alteplase ± DNase) may be considered for loculated collections when drainage remains incomplete per local surgical protocol (CPS, tertiary-center experience).
• Continue antibiotics 2–4 weeks total (i.v. then p.o. step-down when afebrile, draining adequately, and clinically improved).
• AAP Red Book — Pneumonia and Antimicrobial Therapy (2024)
• PIDS/IDSA Clinical Practice Guideline — Pediatric CAP (principles applicable) (2011)
