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By Solomon Behar, MD on August 09, 2023

Chapter Summary: Short course antibiotics for common infections

When it comes to treating pediatric infections, many of us default to prescribing a 10 day course of antibiotics. Join Parul and Sol as they discuss which common infections can actually be effectively treated with a shorter duration of antibiotics.



  • Pediatric physicians tend to default antibiotic prescriptions to 10 days but in many cases guidelines suggest that shorter courses are safe and effective
    • CDC report linked here
  • Skin and Soft Tissue Infections
    • Most common organisms: MRSA, MSSA, GAS
      • Abscesses more often staph
      • Cellulitis more often GAS
    • Antibiotic choice based on most likely organism and resistance patterns
      • Generally, choices include clindamycin, TMP-SMX, linezolid for MRSA; 1st generation cephalosporin for MSSA and/or GAS
    • Treatment can be for 5 days; can be extended longer if the symptoms are not improving
    • Abscesses without surrounding cellulitis can be drained and no antibiotics are needed
  • Acute Otitis Media
    • Typically treating strep pneumo with high dose amoxicillin (90 mg/kg/day)
      • Again, depends on local susceptibilities 
    • Differing courses depending on age group
      • Kids < 2 yo = treatment for 10 days
      • Kids 2-5 yo = treatment for 7 days
      • Kids 6 yo and older = treatment for 5 days
  • Community Acquired Pneumonia
    • Typical organisms are strep pneumo in younger children or mycoplasma in the school age and older children
    • Treatment duration for CAP with likely strep pneumo
      • High dose amoxicillin TID (need TID dosing to penetrate lung tissue) for 5-7 days 

Editor’s Note:  Centers differ on the maximum dose per day.  For example, USCF and Children’s Hospital Minnesota suggest daily max doses of 2 grams/day; while noting that the absolute amoxicillin max dose per day is 4 grams/day.


  • Treatment for CAP with likely mycoplasma
    • Azithromycin for 5 days
  • Urinary Tract Infections/Simple Cystitis
    • Most common organisms E. coli and enteric gram negatives
    • In sexually active females, have to think about Staph Saprophyticus
    • Enterococcus can be seen in more complicated cystitis
    • Antibiotic choice depends on local resistance patterns
      • Commonly 1st, 2nd, 3rd generation cephalosporins are used
      • Older than 12
        • TMP-SMX: 3 day course
        • Fluoroquinolone: 3 day course
        • Nitrofurantoin: 5 day course
        • Beta-lactam/Cephalexin (for example): 3-7 day course
        • In adolescent females with first time cystitis who might be sexually active, coverage for S. Saprophyticus will be important (TMP-SMX/Fluoroquinolone) 
      • Younger than 12
        • Duration of therapy is debatable
        • Current trend: 5 day course of antibiotics, some data leading toward recommending 3-5 day course for first time uncomplicated simple cystitis in slightly older children
    • Pyelonephritis requires a longer course of antibiotics (7-10 days)
  • Appropriate 10 day treatment
    • Streptococcal Pharyngitis
      • Amoxicillin 50 mg/kg/day with a max of 1,000-1,200 mg/day
    • Sinusitis
      • 10-14 day course of antibiotics
Want to hear more from our experts? Listen to the full podcast episode here.

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  2. Gupta K, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52(5):e103-e120. PMID: 21292654
  3. King LM, et al. Duration of outpatient antibiotic therapy for common outpatient infections, 2017. Clin Infect Dis. 2021;72(10):e663-e666.  PMID: 32936884
  4. Lieberthal AS, et al. The diagnosis and management of acute otitis media. Pediatrics. 2013;131(3):e964-e999. PMID: 23439909
  5. Messinger AI, et al. Management of Pediatric Community-acquired Bacterial Pneumonia. Pediatr Rev. 2017;38(9):394-409. PMID: 28864731
  6. Michael M, et al. Short versus standard duration oral antibiotic therapy for acute urinary tract infection in children. Cochrane Database Syst Rev. 2003;(1):CD003966. PMID: 12535494
  7. Pernica JM, et al. Short-Course Antimicrobial Therapy for Pediatric Community-Acquired Pneumonia: The SAFER Randomized Clinical Trial. JAMA Pediatr. 2021;175(5):475-482. PMID: 33683325
  8. Stevens DL, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014;59(2):e10-e52. PMID: 24973422

Published by Solomon Behar, MD August 9, 2023