A 6-year-old child being treated for community-acquired pneumonia has had a temperature decrease from 102 to 101 after 72 hours of azithromycin therapy. What should be done next?

In the management of community-acquired pneumonia in children, a lack of adequate response to initial antibiotic therapy, such as a persistent fever even if slightly reduced, may indicate that the current antibiotic is not effectively addressing the causative organism.

Since the child in this scenario has only experienced a modest decrease in temperature after 72 hours of azithromycin therapy, it raises concern that the infection might not be adequately treated. Switching to a penicillin could be appropriate if the clinician suspects that a different bacterial strain, potentially one that is more effectively targeted by a penicillin antibiotic, could be responsible for the pneumonia.

Penicillins generally cover Streptococcus pneumoniae, a common pathogen in community-acquired pneumonia, and if the initial choice of azithromycin is not producing the desired clinical benefit, changing to a penicillin may provide a more effective therapeutic approach.

While continuing the same antibiotic or adding another might seem reasonable, they do not directly address the need for altering treatment based on the child’s response. Monitoring for additional fever alone may delay the necessary change in therapy that is needed to combat the infection effectively. Thus, changing the antibiotic to a penicillin represents a more proactive and targeted response to the child's clinical status.