American Academy of Pediatrics

TABLE 4

Management of Worsening or Lack of Improvement at 72 Hours

Initial Management	Worse in 72 Hours	Lack of Improvement in 72 Hours
Observation	Initiate amoxicillin with or without clavulanate	Additional observation or initiate antibiotic based on shared decision-making
Amoxicillin	High-dose amoxicillin-clavulanate	Additional observation or high-dose amoxicillin-clavulanate based on shared decision-making
High-dose amoxicillin-clavulanate	Clindamycin^a and cefixime OR linezolid and cefixime OR levofloxacin	Continued high-dose amoxicillin-clavulanate OR clindamycin^a and cefixime OR linezolid and cefixime OR levofloxacin

Initial Management	Worse in 72 Hours	Lack of Improvement in 72 Hours
Observation	Initiate amoxicillin with or without clavulanate	Additional observation or initiate antibiotic based on shared decision-making
Amoxicillin	High-dose amoxicillin-clavulanate	Additional observation or high-dose amoxicillin-clavulanate based on shared decision-making
High-dose amoxicillin-clavulanate	Clindamycin^a and cefixime OR linezolid and cefixime OR levofloxacin	Continued high-dose amoxicillin-clavulanate OR clindamycin^a and cefixime OR linezolid and cefixime OR levofloxacin

Clindamycin is recommended to cover penicillin-resistant S pneumoniae. Some communities have high levels of clindamycin-resistant S pneumoniae. In these communities, linezolid is preferred.

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