American Board of Family Medicine (ABFM) Practice Exam

What is the recommended first-line treatment for community-acquired pneumonia (CAP) in infants and school-aged children?

1. Azithromycin

2. Amoxicillin

3. Ceftriaxone

4. Doxycycline

The correct answer is: Amoxicillin

Amoxicillin is considered the recommended first-line treatment for community-acquired pneumonia (CAP) in infants and school-aged children because it effectively targets Streptococcus pneumoniae, which is a common bacterial pathogen associated with CAP in these age groups. Amoxicillin is preferred due to its favorable safety profile, ease of administration (especially in oral form), and its effectiveness against the typical organisms responsible for the pneumonia in otherwise healthy children. This antibiotic is also generally well-tolerated and has a low incidence of side effects compared to some alternatives. It is very effective in outpatient settings, which is important since most cases of CAP in children are managed in the community rather than requiring hospitalization. Other options, while sometimes used in specific circumstances, do not serve as first-line treatments for CAP in this age group. For instance, macrolides like azithromycin are typically reserved for atypical pneumonia or in cases of penicillin allergy, while ceftriaxone is usually reserved for more severe cases or those requiring hospitalization. Doxycycline is not recommended for children under eight years old due to the risk of dental staining and other side effects. Therefore, amoxicillin stands out as the most appropriate first-line choice in treating CAP in infants and school-aged children.