Pediatric Hospital Medicine – SHM, AAP, APA

View all recommendations from this society

January 11, 2021

Do not use broad-spectrum antibiotics such as ceftriaxone for children hospitalized with uncomplicated community-acquired pneumonia. Use narrow-spectrum antibiotics such as penicillin, ampicillin or amoxicillin.

Using broad-spectrum antibiotic therapy does not improve rates of treatment failure, length of stay, or decrease costs when compared with narrowspectrum antibiotic therapy for children hospitalized with community-acquired pneumonia (CAP). The use of narrow-spectrum antibiotics for children hospitalized with CAP can limit the development of multi-drug resistant organisms, while achieving similar or better outcomes.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

A diverse committee with representatives from the Society of Hospital Medicine’s Pediatrics Special Interest Group, the American Academy of Pediatrics’ Section on Hospital Medicine and the Academic Pediatric Association’s Hospital Medicine Special Interest Group solicited a list of recommendations with specified criteria from colleagues and the various society listservs. Through an iterative process, recommendations were formatted, merged, and presented with an evidence review of publications from the past 10 years supporting each recommendation. From over 100 initial recommendations and through 2 rounds of a modified Delphi process, the highest scoring recommendations were chosen to represent the Pediatric Hospital Medicine Choosing Wisely list. The list was endorsed by the Boards of the Society of Hospital Medicine and the Academic Pediatric Association and peer reviewed by various AAP specialty groups and endorsed by the American Academy of Pediatrics’ Executive Committee.


Bradley JS1, Byington CL, Shah SS, et al; The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011 Oct;53(7):e25-76. doi: 10.1093/cid/cir531. Epub 2011 Aug 31.
Derek J. Williams, MD, MPH, Matthew Hall, PhD, Samir S. Shah, et al; Narrow Vs Broad-spectrum Antimicrobial Therapy for Children Hospitalized With Pneumonia. Pediatrics 2013;132;e1141.
Mary Ann Queen, MD, Angela L. Myers, MD, Matthew Hall, et al; Comparative Effectiveness of Empiric Antibiotics for Community-Acquired Pneumonia; Pediatrics. 2014;133(1);e23-9
Joanna Thomson, MD, MPH, Lilliam Ambroggio, PhD, MPH, Eileen Murtagh Kurowski, MD, MS, et al; Outcomes Associated With Guideline-Recommended Antibiotic Therapy for Pediatric Pneumonia. Journal of Hospital Medicine 2015;10:13–18.