Pneumonia in Kids: Amoxicillin vs Cephalosporins

Christopher J. Chiu, MD; Justin L. Berk, MD, MPH, MBA


March 22, 2021

This transcript has been edited for clarity.

Christopher J. Chiu, MD: Welcome back. We are The Cribsiders, the pediatric medicine podcast that interviews leading experts in the field to bring you clinical pearls, practice-changing knowledge, and answers to lingering questions about core topics in pediatric medicine.

Justin L. Berk, MD, MPH, MBA: We are here to recap one of our latest episodes on community-acquired pneumonia (CAP) with Dr Susan Lipsett, an academic pediatric emergency medicine physician in Boston. We discussed the management, diagnosis, and treatment of this common respiratory infection.

Chiu: One of my favorite pearls was that if you are going to prescribe antibiotics for CAP in kids, the recommended first-line treatment is high-dose amoxicillin for 7 days. What did you get out of this, Justin?

Berk: She really drove home that amoxicillin is actually better than cephalosporins in treating pneumonia. We often think cephalosporins offer a little bit broader coverage, but for Streptococcus pneumoniae —the number-one cause of CAP — amoxicillin provides more efficient coverage.

Chiu: What about chest x-rays? We talked a little bit about those.

Berk: We mentioned this in our Things We Do For No Reason in Pediatrics episode as well. The diagnosis of pneumonia does not require an x-ray. In fact, CAP is a clinical diagnosis. Dr Lipsett pointed out that chest x-rays that are completely clear can help rule out pneumonia, but they certainly don't rule in pneumonia. (Note: Dr Lipsett does recommend a chest x-ray for hospitalized patients.)

Chiu: In another throwback to that episode, we talked about mycoplasma and whether it's truly pathogenic.

Berk: I thought that was interesting too. For mycoplasma pneumonia ("walking pneumonia"), we often prescribe azithromycin. But truthfully, it’s unclear whether mycoplasma is really a major cause of bacterial pneumonia or whether azithromycin really improves symptoms. There's still some uncertainty.

Our infographic has more practice recommendations from Dr Lipsett.

Figure. CAP in Children, with Dr Susan Lipsett. Created by Maximilian Cruz. Download PDF

Chiu: Well, I hope everyone checks out our discussion on CAP with Dr Lipsett at #11: Community-Acquired Pneumonia: The Alveoli Strike Back or anywhere you download podcasts.

Chris Chiu, MD, is assistant professor at The Ohio State University, where he is also the physician lead at OSU's Outpatient Care East Clinic and serves as the assistant clinical director for the internal medicine residency. He is an Air Force veteran and a self-proclaimed gadget geek. Follow him on Twitter

Justin Berk, MD, MPH, MBA, is assistant professor of medicine and pediatrics at the Warren Alpert School of Medicine at Brown University. He is a clinical educator active in ambulatory and inpatient care and pediatrics. He enjoys coffee, thinking about hiking, and being a generalist. Follow him on Twitter

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