• Children with community-acquired pneumonia and any high risk features — admit immediately.
• Children with community-acquired pneumonia at intermediate risk — consider hospital assessment. The threshold for arranging this should be low. Arrange if the child has any significant health problems such as chronic respiratory disease or congenital heart disease, or the carers are not able to cope.
• Prescribe an antibiotic for children managed at home:
• For children less than 5 years of age — amoxicillin is the first-choice. For a child allergic to penicillin, a macrolide (erythromycin or clarithromycin) is an alternative.
• For a child over 5 years of age — prescribe either amoxicillin or a macrolide. Prescribe a macrolide for children allergic to penicillin and at times when there is a known Mycoplasma outbreak.
• For children who are managed at home advise carers to check on the child regularly, including through the night, and seek medical advice if they are unable to cope or if the child deteriorates, particularly if:
• The breathing rate increases, or if there are any episodes of apnoea or signs of increased effort of breathing.
• A baby takes less than 50% of its normal feeds, or there are signs of dehydration such as dry mouth or infrequent passage of urine.
• The child becomes less responsive or difficult to rouse.
• A persistent increase in fever develops.
• If a child deteriorates on treatment or does not improve after 48 hours of treatment, review and refer for hospital assessment.

In depth