Pediatric Coughs: Pneumonia


Valeria Wu, MD


Presentation: cough, fever, tachypnea, and respiratory distress  


Diagnosis: Clinical, look out for fine crackles, tachypnea, decreased breath sounds, desaturation, chest indrawing, lethargy, fever / radiograph can help support but not gold standard


Treatment: Supportive. Antipyretics, hydration. If bacterial, consider the following: 

  • < 1 month: ampicillin + gentamicin/3rd gen cephalosporin (NOT ceftriaxone) 

  • 1 -3 month: erythromycin or clarithromycin (NOT azithromycin) 

  • mo - 5 yr: high dose amoxicillin or 3rd gen cephalosporin 

  • 5 + : macrolide (add beta lactam or 3rd gen cephalosporin if resistance is high) 

General recommendations - escalate for more sick kids and consider local resistance! 


Take note: Young infants can have concurrent UTI. Full sepsis work up for neonates! Well appearing kids may just have viral pneumonia.  



Overmann KM, Florin TA. Pneumonia in Infants and Children. In: Tintinalli JE, Ma O, Yealy DM, Meckler GD, Stapczynski J, Cline DM, Thomas SH. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 9e. McGraw-Hill; Accessed October 29, 2020. 


Photo: Case courtesy of Dr Jeremy Jones, <a href=""></a>. From the case <a href="">rID: 27245</a>