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Remember to check allergy status

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Paediatric Treatment - Lower Respiratory Tract Infections

Note: Low doses of penicillins are more likely to select out resistance 1. Do not use quinolone (ciprofloxacin, ofloxacin) first line due to poor pneumococcal activity 2 B-. Reserve all quinolones (including levofloxacin) for proven resistant organisms.

Community-acquired pneumonia

Give safety-net advice[1D] and likely duration of different symptoms, eg cough 6 weeks.[1D]

Medicine Calendar

First line: amoxicillin

see BNFc

5 days, review at 3 days. Treat for 7-10 days if poor response.

OR clarithromycin

see BNFc

5 days, review at 3 days. Treat for 7-10 days if poor response.

If severe: amoxicillin and clarithromycin

Dosing as above

7-10 days

Acute cough, bronchitis

NICE-CKS
NICE 69

Antibiotics have little benefit if no co-morbidity.[1A+,2A-]

Second line: 7-day delayed antibiotic,[3D] safety net, and advise that symptoms can last 3 weeks.[3D]

Consider CRP if antibiotic is being considered.[4A-]
No antibiotics if CRP<20mg/L and symptoms for >24 hours; delayed antibiotics if 20-100mg/L; immediate antibiotics if >100mg/L.[5D]

Medicine Calendar

First line: self-care and safety netting advice

Second line: amoxicillin

see BNFc

5 days

The POCAST project is funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London and by the Imperial College Healthcare Charity (Grant Ref No:7006/P36U).