Pneumonia - Community-Acquired (Pediatric) Drug Summary

Last updated: 10 July 2026
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Aminoglycosides

Drug Dosage Remarks
Amikacin 15 mg/kg/day IM/IV divided 8-12 hourly
Neonate: 10 mg/kg loading dose followed by 15 mg/kg/day divided 12 hourly 		Adverse Reactions
  • Ototoxic effects (can cause irreversible ototoxicity resulting in hearing loss, dizziness, vertigo); Renal effects (reversible nephrotoxicity, acute renal failure has been reported usually when other nephrotoxic drugs have also been administered); Neuromuscular effects (neuromuscular blockade resulting in respiratory depression and muscular paralysis especially after rapid IV infusion); Hypersensitivity reactions
Special Instructions
  • Ototoxicity and nephrotoxicity are most likely in patients with renal impairment, in patients who are receiving high doses or for long periods or who are also receiving or have received other ototoxic/nephrotoxic drugs
    • Consider monitoring of serum concentrations and/or peak serum concentrations/MIC ratio in these patients
  • Use with caution in neonates due to renal immaturity, patients with conditions associated with muscle weakness, pre-existing renal dysfunction, vestibular or cochlear impairment
Dibekacin 1-2 mg/kg/day IM divided 12-24 hourly
Gentamicin 6-7.5 mg/kg/day IM/IV divided 8 hourly
Premature/full-term neonate ≤1 week: 2.5 mg/kg IM/IV 12 hourly
Kanamycin 30-50 mg/kg/day IM divided 12-24 hourly
Netilmicin Premature/full-term neonate <1 week old: 6 mg/kg/day or 3 mg/kg IM/IV 12 hourly
Neonate >1 week to 1 year old: 7.5-9 mg/kg/day or 2.5-3 mg/kg IM/IV 8 hourly
Children >1 year old: 6-7.5 mg/kg/day or 2-2.5 mg/kg IM/IV 8 hourly

Antibacterial Combination

Drug Dosage Remarks
Co-trimoxazole
(Sulfamethoxazole [SMZ] and Trimethoprim [TM])		 8-12 mg/kg/day PO divided 12 hourly based on TM Adverse Reactions
  • GI effects (nausea/vomiting, anorexia, diarrhea, rarely antibiotic-associated diarrhea/colitis,); Dermatologic effects (rash, pruritus, photosensitivity); Hypersensitivity reactions can range from mild (eg rash) to severe/life-threatening (eg Stevens-Johnson syndrome, toxic epidermal necrolysis); Urogenital effect (crystallization in the urine)
  • Rarely hematologic effects which may be more common if given for long periods or with high doses; Rarely hepatic, or renal effects; Aseptic meningitis has occurred
Special Instructions
  • Maintain adequate fluid intake
  • Contraindicated in patients <2 months of age and patients with sulfonamide allergy
  • Use with extreme caution or not at all in patients with hematological disorders especially megaloblastic anemia due to folic acid deficiency
  • Use with caution in patients with renal impairment or severe hepatic dysfunction and in patients with folate deficiency (may consider administration of calcium folinate)
  • Use with caution in patients with G6PD deficiency

Cephalosporins

Drug Dosage Remarks
First Generation
Cefalexin
(Cephalexin)		 25-50 mg/kg/day PO divided 6 hourly Adverse Reactions
  • Hypersensitivity reactions (urticaria, pruritus, rash, severe reactions [eg anaphylaxis] can occur); GI effects (diarrhea, nausea/vomiting, rarely antibiotic-associated diarrhea/colitis); Other effects (candidal infections, injection site inflammation)
  • High doses may be associated with CNS effects (encephalopathy, convulsions); Rarely hematologic, hepatic and renal effects have occurred
Special Instructions
  • May be taken with food to decrease gastric distress
  • Ceftriaxone is contraindicated in hyperbilirubinemic neonates
  • Avoid simultaneous administration of Ceftriaxone with IV Ca-containing solution
  • Use with caution in patients allergic to Penicillin, there may be 10% chance of cross sensitivity; and patients with renal impairment and GI disease especially with history of colitis
Cefazolin 25-50 mg/kg/day IM/IV divided 6-8 hourly
May be increased to 100 mg/kg/day in severe infections
Second Generation
Cefaclor ≥1 month: 20-40 mg/kg/day PO divided 8 hourly
Max dose: 1 g/day
Cefuroxime ≥1 month: 10-15 mg/kg PO 12 hourly or 75-100 mg/kg/day IM/IV divided 8 hourly
May be increased to 100-150 mg/kg/day IM/IV divided 8 hourly in severe infections
Third Generation
Cefditoren pivoxil ≥12 years old: 400 mg PO 12 hourly x 14 days
Cefixime >6 months old: 1.5-3 mg/kg PO 12 hourly
Severe infections: 6 mg/kg PO 12 hourly
>30 kg: 50-100 mg PO 12 hourly
Cefotaxime Neonates ≤7 days old
1.2-2 kg: 100 mg/kg/day IM/IV divided 12 hourly
>2 kg: 100-150 mg/kg/day IM/IV divided 8-12 hourly
Neonates >7 days old
1.2-2 kg: 150 mg/kg/day IM/IV divided 8 hourly
>2 kg: 150-200 mg/kg/day IM/IV divided 6-8 hourly
Infants and children: 100-200 mg/kg/day IM/IV divided 6-12 hourly
Cefpodoxime 8-10 mg/kg/day PO divided 12-24 hourly
Ceftazidime 30-100 mg/kg/day IM/IV divided 8-12 hourly
Max dose: 6 g/day IM/IV divided 8 hourly
Neonates and infants: 25-60 mg/kg/day IM/IV divided 12 hourly
Ceftibuten ≥6 months old, ≥45 kg: 9 mg/kg PO 24 hourly
Max dose: 400 mg/day
Ceftizoxime ≥6 months old: 40-80 mg/kg/day IV divided 6-12 hourly
May be increased to 120 mg/kg/day
Ceftriaxone ≤2 weeks old: 20-50 mg/kg/day IM/IV
3 weeks-12 years old: 20-80 mg/kg/day IM/IV
Fourth Generation
Cefepime >2 months old and  ≤40 kg:
50 mg/kg IM/IV 8-12 hourly
Fifth Generation
Ceftaroline
fosamil		 Neonates and infants <2 months old: 6 mg/kg/dose IV infusion over 60 minutes 8 hourly1
≥2 months to <2 years old:
8 mg/kg/dose IV infusion over 5-60 minutes 8 hourly
≥2 years to <18 years old:
<33 kg: 12 mg/kg IV infusion over 5-60 minutes 8 hourly
≥33 kg: 600 mg IV infusion over 5-60 minutes 12 hourly
1Dose based on pharmacokinetic and pharmacodynamic analyses only.

Chloramphenicol

Drug Dosage Remarks
Chloramphenicol Neonates 0-7 days old:
25 mg/kg/day IV
Neonates >7 days old:
≤2 kg: 25 mg/kg/day IV
>2 kg: 50 mg/kg/day IV divided 12 hourly
Infants and children:
50-100 mg/kg/day IV divided 6 hourly 		Adverse Reactions
  • Hematologic effects (reversible bone-marrow depression, rarely severe irreversible aplastic anemia); Hypersensitivity reaction (anaphylactoid reactions); CNS effects (optic atrophy, neuropathy paresthesias); GI effects (nausea/vomiting, diarrhea, stomatitis, glossitis, bitter taste)
  • Gray syndrome may occur in patients given high doses (abdominal distention, vomiting, ashen color, irregular respiration, circulatory collapse, death)
Special Instructions
  • Avoid in patients with pre-existing bone-marrow depression or blood dyscrasias
  • Use with caution in neonates and patients with G6PD deficiency
  • Dosage must be adjusted for patients with hepatic or renal insufficiency
  • Due to narrow therapeutic/toxic ratio, monitor serum levels if possible, particularly in patients with hepatic or renal disease

Macrolides

Drug Dosage Remarks
Erythromycin 30-50 mg/kg/day PO divided 6 hourly Adverse Reactions
  • GI effects (nausea/vomiting, abdominal discomfort, diarrhea and other GI disturbances, antibiotic-associated diarrhea/colitis, stomatitis, infantile hypertrophic pyloric stenosis); Other effects (candidal infections, headache)
  • Hypersensitivity reactions are uncommon (urticaria, pruritus, rash, rarely anaphylaxis); Rarely cardiotoxicity, hepatotoxicity; Dose-related tinnitus/hearing loss have occurred with some macrolides
  • Azithromycin and Clarithromycin tend to cause less GI disturbances than Erythromycin
  • Clarithromycin may cause tooth and tongue discoloration, dysgeusia
Special Instructions
  • May take with food to decrease gastric distress
  • Use with caution in patients with hepatic dysfunction
Midecamycin 30 mg/kg/day PO divided 6-8 hourly
Roxithromycin ≥40 kg: 5-8 mg/kg/day PO divided 12 hourly
Spiramycin 50-100 mg/kg/day PO divided 8-12 hourly
Advanced Macrolides
Azithromycin 10 mg/kg/day PO x 3 days
10 mg/kg/day PO x 1 day followed by
5 mg/kg/day PO x 4 days
Clarithromycin 15 mg/kg/day PO divided 12 hourly or
>12 years old: 250 mg PO 12 hourly x 7 days

Other Antibiotics

Drug Dosage Remarks
Glycopeptide
Vancomycin ≤1 week old: Initially, 15 mg/kg slow IV followed by 10 mg/kg 12 hourly
1 week-1 month old: Initially, 15 mg/kg slow IV followed by 10 mg/kg 8 hourly
Infant >1 month old: 40 mg/kg/day slow IV divided 6-12 hourly 		Adverse Reactions
  • Rapid infusion or high dose (≥15-20 mg/kg/hr) is associated with red neck or red man syndrome (erythema multiforme-like reaction with intense pruritus, tachycardia, hypotension, rash in the face, neck, upper trunk, back and upper arms)
  • CV effect (cardiac arrest); Dermatologic effects (urticaria, macular skin rash); GI effect (nausea); Hematologic effects (eosinophilia, neutropenia); Other effects (chills, fever)
Special Instructions
  • Use with caution in patients with renal impairment or those receiving other nephrotoxic or ototoxic drugs
Lincosamide
Clindamycin Children >1 month old:
8-25 mg/kg/day PO divided 6-8 hourly
or
Neonates <1 month old:
15-20 mg/kg/day IM/IV divided 6-8 hourly
Children >1 month old:
20-40 mg/kg/day IM/IV divided 6-8 hourly 		Adverse Reactions
  • CV effects (hypotension, arrhythmia); CNS effects (dizziness, headache); Dermatologic effects (dry skin, erythema, pruritus, rash); GI effects (abdominal pain, diarrhea, nausea/vomiting, pseudomembranous colitis)
Special Instructions
  • Use with caution in patients with severe renal or hepatic impairment, history of atopy, pseudomembranous colitis, regional enteritis, ulcerative colitis, or in patients on antiperistaltic agents (eg opiates, Diphenoxylate with atropines)
  • Discontinue drug if patient develops significant diarrhea
Oxazolidinone
Linezolid Infants and children <1 year old: 10 mg/kg/dose PO/IV 8 hourly for 10-14 days
Children ≥12 years old:
600 mg PO/IV 12 hourly for 10-14 days 		Adverse Reactions
  • CNS effects (dizziness, headache); Dermatologic effects (pruritus, rash); GI effects (abdominal pain, diarrhea, nausea/vomiting, pseudomembranous colitis); Hematologic effects (anemia, eosinophilia, leukopenia, pancytopenia); Hepatic effects (increased ALT, AST, ALP); Other effects (blurred vision, loss of vision, anaphylaxis, dyspnea)
Special Instructions
  • Avoid use in patients with pheochromocytoma, thyrotoxicosis, or taking sympathomimetics, vasopressive or dopaminergic or serotonergic agents
  • Use with caution in patients with uncontrolled hypertension, history of seizures, severe renal or hepatic impairment, pre-existing myelosuppression, phenylketonuria
  • Monitor patient’s CBC weekly during therapy
Steroid Antibacterial
Na fusidate
(Sodium fusidate)		 >12 years old: 500 mg PO 8 hourly Adverse Reactions
  • GI effects (dyspepsia, nausea/vomiting, epigastric pain, jaundice, change of liver function); Other effect (anorexia)
Special Instructions
  • Use with caution in patients with hepatic impairment, biliary obstruction or disease, galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption
  • Monitor liver function in patients with hepatic dysfunction, biliary pathway abnormalities, high-dose prolonged use, in combination with other antibiotics

Other Beta-Lactams

Drug Dosage Remarks
Carbapenems
Ertapenem 3 months-12 years old: 30 mg/kg IM/IV divided 12 hourly
Max dose: 1 g/day 		Adverse Reactions
  • GI effects (diarrhea, nausea/vomiting, antibiotic-associated diarrhea/colitis, tongue/tooth discoloration, altered taste); Hypersensitivity reactions ranging from mild (eg rash) to severe (eg anaphylaxis) can occur; CNS effects (mental disturbances, confusion; Imipenem/cilastatin: Seizures and convulsions have been reported especially in patients with history of CNS lesions and/or renal dysfunction); Rarely severe dermatologic reactions (eg exfoliative dermatitis, Stevens-Johnson syndrome, etc) and hepatic effects
Special Instructions
  • Use with caution in patients allergic to penicillins, cephalosporins or other beta-lactams, patients with renal impairment
  • Imipenem/cilastatin is contraindicated in patients with CNS infections
Imipenem/cilastatin ≥3 months old, ≥40 kg: 1-2 g/day IV divided 6-8 hourly
Max dose: 4 g/day
or
<40 kg: 15 mg/kg IV 6 hourly
Max dose: 60 mg/kg/day
Meropenem >3 months-12 years old:
10-20 mg/kg IV 8 hourly
Max dose: 120 mg/kg/day divided over 3-4 doses
Monobactam
Aztreonam 1 week-<2 years old: 30 mg/kg IM/IV 6-8 hourly
2-12 years old: 30-50 mg/kg IM/IV 6-8 hourly
Max dose: 8 g/day 		Adverse Reactions
  • Hypersensitivity reactions (rash, urticaria, pruritus, severe reactions [eg anaphylaxis] can occur); GI effects (diarrhea, nausea/vomiting, antibiotic-associated diarrhea/colitis); Other effect (candidal infections)
Special Instructions
  • Use with caution in patients allergic to penicillins, cephalosporins or other beta-lactams, and patients with renal or hepatic impairment

Penicillins

Drug Dosage Remarks
Benzylpenicillin (Penicillin G, Penicillin G Na,
Penicillin G K)		 Mild-moderate infection: 25,000-50,000 U/kg/day IM/IV divided 6 hourly
Severe infection: 250,000-400,000 U/kg/day IM/IV divided 4-6 hourly 		Adverse Reactions
  • Hypersensitivity reactions (rash, urticaria, pruritus, severe reactions [eg anaphylaxis] can occur); GI effects (diarrhea, nausea/vomiting, rarely antibiotic-associated diarrhea/colitis); Other effect (candidal infections)
  • Rarely hematologic, renal and hepatic effects; High doses may be associated with CNS effects (encephalopathy, convulsions)
Special Instructions
  • Avoid in patients with Penicillin allergy
  • Use with caution in patients with renal impairment
Phenoxymethylpenicillin
(Penicillin V K, Penicillin V)		 <12 years old: 25-50 mg/kg/day PO divided 6-8 hourly
Max dose: 3 g/day
Aminopenicillins with or without Beta-lactamase Inhibitors
Amoxicillin (Amoxycillin) 20-45 mg/kg/day PO divided 8 hourly
High-dose: 80-90 mg/kg/day
or
>3 months old, <40 kg:
20-90 mg/kg/day PO in divided doses
>3 months old, ≥40 kg: 500-1,000 mg PO 8 hourly
Amoxicillin/clavulanic acid1
(Co-amoxiclav, Amoxicillin/clavulanate)		 20-60 mg/kg/day PO divided 8-12 hourly based on Amoxicillin or
≤3 months old, <4 kg:
25 mg/5 mg/kg IV infusion over 30-40 minutes 12 hourly
≥3 months old, <40 kg:
25 mg/5 mg/kg slow IV injection over 3-4 min or IV drip/infusion over 30-40 minutes 8 hourly
≥3 months old, ≥40 kg:
1,000 mg/200 mg slow IV injection over 3-4 minutes or IV drip/infusion over 30-40 minutes 8 hourly
Amoxicillin/sulbactam <2 years old and nursing infant: 125 mg PO 8 hourly
2-6 years old: 250 mg PO 8 hourly or 375 mg IM/IV 6-8 hourly
6-12 years old: 375 mg PO 8 hourly or 750 mg IM/IV 6-8 hourly
≥12 years old: 500-1,000 mg PO 8 hourly or 1,500 mg IM/IV 8 hourly
Ampicillin 50-100 mg/kg/day PO divided 6 hourly or
100-200 mg/kg/day IM/IV divided 6 hourly
Ampicillin/sulbactam
(Sultamicillin: Pro-drug of Ampicillin/sulbactam)		 <30 kg: 25-50 mg/kg/day PO divided 12 hourly based on Ampicillin
≥30 kg: 220-440 mg PO 12 hourly based on Ampicillin or
150-200 mg/kg/day IM/IV divided 6-8 hourly
Antistaphylococcal Penicillins
Cloxacillin >1 month old and <20 kg: 50-100 mg/kg/day PO divided 6 hourly or 12.5-25 mg/kg PO 6 hourly
≥20 kg: 250-500 mg PO 6 hourly
Flucloxacillin 25 mg/kg/day PO divided 6 hourly or
<6 months old: 25 mg/kg IM/IV 6 hourly
6 months-2 years old: 25-50 mg/kg IM/IV 6 hourly
2-10 years old: 125-250 mg IM/IV 6 hourly
Oxacillin ≥1 month old:
Mild-moderate infection:
100-150 mg/kg/day IM/IV divided 6 hourly
Severe infection: 150-200 mg/kg/day IM/IV divided 6 hourly
Antipseudomonal Penicillin with or without Beta-lactamase Inhibitor
Piperacillin/tazobactam <6 months old: 150-300 mg/kg/day IV divided 6-8 hourly based on Piperacillin
≥6 months old: 240 mg/kg/day IV divided 8 hourly based on Piperacillin
1Dose and frequency are product specific and not all products are interchangeable. Please see the latest MIMS for specific formulations and prescribing information.

Quinolone

Drug Dosage Remarks
Levofloxacin 500 mg PO 24 hourly for 7 days Adverse Reactions
  • GI effect (GI disturbances); Dermatologic effects (pruritus, rash); CNS effects (headache, dizziness, vertigo, drowsiness, insomnia); Hematologic effects (eosinophilia, leukopenia); Other effect (asthenia)
Special Instructions
  • Avoid in patients with history of tendon disorder related to fluoroquinolones, epilepsy, and G6PD deficiency
  • Should be given in children >18 years of age
  • Excessive/direct sun exposure should be avoided

Tetracyclines

Drug Dosage Remarks
Doxycycline >8 years old and ≤45 kg:
4.4 mg/kg PO 24 hourly on day 1
followed by 2.2 mg/kg PO 24 hourly on subsequent days 		Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, antibiotic-associated diarrhea/colitis has occurred, discoloration of teeth, dysphagia, esophageal ulceration has occurred when taken with an insufficient amount of liquid); Other effects (candidal infections, interference with skeletal development and bone growth, photosensitivity)
  • Rarely renal dysfunction, hepatotoxicity, hematologic effects, intracranial pressure with headache and visual disturbances; Hypersensitivity reactions have occurred
Special Instructions
  • Avoid long exposure to sunlight or tanning beds
  • Take with plenty of fluid while sitting/standing and before bedtime
  • Avoid in patients ≤8 years of age
  • Use with caution in renal or hepatic impairment
Tetracycline >8 years old: 25-50 mg/kg/day PO divided 6 hourly

Vaccines

Drug Dosage Remarks
Vaccine, pneumococcal
(Pneumococcal
polysaccharide
conjugate vaccine,
10-valent [PCV10])		 0.5 mL/dose IM
3-dose primary series: 3 doses at
1-month intervals beginning at 2 months1 of age
Booster dose given at least 6 months after the last primary dose and preferably between twelfth and fifteenth months
2-dose primary series: first dose at 2 months, second dose 2 months later; booster dose same as 3-dose primary series
7-11 months old, previously unvaccinated: First 2 doses given 1 month apart followed by third dose in the second year with at least 2-month interval
12-23 months old, previously unvaccinated: 2 doses at least 2 months apart
1-5 years old, previously vaccinated: 2 doses at least 2 months apart 		Adverse Reactions
  • Injection site reactions, irritability, fever, loss of appetite
Special Instructions
  • Administer in anterolateral aspect of thigh or deltoid muscle of upper arm
    • Administer SC in patients with thrombocytopenia or bleeding disorder
  • Contraindicated in patients with hypersensitivity to any vaccine component
  • Defer vaccination for patients with acute severe febrile illness
  • Use with caution in immunodeficient patients or in patients on immunosuppressive treatment
Vaccine, pneumococcal
(Pneumococcal
polysaccharide
conjugate vaccine,
13-valent [PCV13])		 0.5 mL/dose IM
Infant
3-dose primary series: 3 doses at
2-month intervals beginning at 2 months1 of age
Booster dose between 12-15 months of age
2-dose primary series: First dose at 2 months, second dose 2 months later
Booster dose between 11-15 months of age
7-11 months old, previously unvaccinated: First 2 doses given 1 month apart followed by third dose in the second year at least 2 months after second dose
Children
12-23 months old, previously unvaccinated: 2 doses at least 2 months apart
12-23 months old incompletely vaccinated with 1 dose of PCV13
<12 months old: 2 doses at least 2 months apart
12-23 months incompletely vaccinated with 2-3 doses of PCV13 <12 months old: 2 doses at least 2 months apart
24-71 months old incompletely vaccinated with PCV13: 1 dose at least 2 months from the first dose
2-17 years old, previously unvaccinated: Single dose
Infant and Children
Previously vaccinated with pneumococcal 7-valent vaccine:
May switch at any point in the schedule
Vaccine, pneumococcal
(Pneumococcal
polysaccharide
conjugate vaccine,
15-valent [PCV15])		 0.5 mL/dose IM
Infant
3-dose primary series: 3 doses at 2-month intervals beginning at 2 months1 of age
Booster dose between 12-15 months of age
2-dose primary series: First dose at 2 months1, second dose 2 months later
Booster dose between 11-15 months of age
7-11 months old, previously unvaccinated: First 2 doses given 1 month apart followed by third dose in the second year at least 2 months after second dose
Children
12-23 months old, previously unvaccinated: 2 doses at least 2 months apart
12-23 months old incompletely vaccinated with 1 dose of PCV13
<12 months old: 2 doses at least 2 months apart
12-23 months old incompletely vaccinated with 2-3 doses of PCV13 <12 months old: 2 doses at least 2 months apart
24-71 months old incompletely vaccinated with PCV13: 1 dose at least 2 months from the first dose
2-17 years old, previously unvaccinated: Single dose
Infant and Children
Previously vaccinated with another PCV: May switch at any point in the schedule
Vaccine, pneumococcal
(Pneumococcal
polysaccharide
vaccine, 20-valent
[PCV20])		 0.5 mL/dose IM
Infant
3-dose primary series: 3 doses at
2-month intervals beginning at 2 months1 of age
Booster dose between 11-15 months of age
2-dose primary series: First dose at 2 months1, second dose 2 months later
Booster dose between 11-15 months of age
7-11 months old, previously unvaccinated: First 2 doses given 1 month apart followed by third dose in the second year at least 2 months after second dose
Children
12-23 months old, previously unvaccinated: 2 doses at least 2 months apart
24-60 months old completely vaccinated with PCV13: 1 dose at least 2 months from the first dose
5-17 years old, regardless of prior vaccination with PCV13: Single dose
Vaccine, pneumococcal
(Pneumococcal
polysaccharide
vaccine, 23-valent
[PCV23])		 0.5 mL/dose IM/SC
≥2 years old: Single dose and at least 2 months after the final dose of PCV13
Revaccination: 5 years after the first dose in immunocompromised patients
1May be given as early as 6 weeks old

Disclaimer

All dosage recommendations are for children with normal renal and hepatic function unless otherwise stated. 
Not all products are available or approved for above use in all countries. 
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs. 
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information. 

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