Picture this: you’re seeing a 3 year old girl with fever for 4 days, cough and runny nose (her parents estimate that since starting preschool she has had cough and runny nose 75% of the time). She has no evidence of otitis media, or strep throat; her lung exam is difficult because she is uncooperative, but she is not tachypneic, has no increased work of breathing, and her O2 sat is 97% on room air. A clean-catch urine shows 1+ leukocytes with 6-10 wbc/hpf on micro; urine culture has been sent. A chest x-ray shows some vague haziness along the right heart border; radiologist read will not be available until tomorrow. Both diagnoses of UTI and pneumonia are possible but not clear-cut. What antibiotic covers both situations? While high-dose amoxicillin and augmentin are first-line for community-acquired pneumonia (CAP) in < 5-year-olds, resistance by UTI bugs to these antibiotics is high. While cephalexin is often used to treat pediatric UTI, first-generation cephalosporins are not a good choice for CAP. Your best bet is a 2nd or 3rd generation cephalosporin such as cefixime, cefdinir, or cefibuten. (Cefuroxime is not available in suspension form in the USA).