Aim: This study aimed to compare the efficacy and safety of intravenous (IV) antibiotics versus oral antibiotics in the treatment of pediatric pneumonia, focusing on clinical improvement, duration of hospital stay, incidence of complications, and adverse drug reactions. Material and Methods: A prospective, randomized, comparative clinical trial was conducted over 12 months at a tertiary care hospital. A total of 100 pediatric patients aged 2–12 years diagnosed with community-acquired pneumonia (CAP) were randomly assigned into two groups: Group A received IV Ceftriaxone, and Group B received oral Amoxicillin-Clavulanic Acid. Clinical improvement within 72 hours, duration of hospital stay, incidence of complications, treatment failure, and adverse drug reactions were assessed. Statistical analysis was performed using SPSS version 19.0, with a p-value <0.05 considered significant. Results: The IV antibiotics group demonstrated significantly faster clinical improvement (70.5 ± 4.8 hours vs. 73.2 ± 5.1 hours, p=0.03), earlier fever reduction (23.8 ± 4.5 hours vs. 26.4 ± 5.2 hours, p=0.04), and higher oxygen saturation levels (96.5 ± 1.8% vs. 94.8 ± 2.2%, p=0.02). The duration of hospital stay and days on oxygen support were also shorter in the IV group (6.5 ± 1.2 days vs. 7.1 ± 1.4 days, p=0.04; 1.8 ± 0.9 days vs. 2.4 ± 1.1 days, p=0.03). However, no statistically significant differences were observed in complications, ICU admissions, treatment failure, or adverse drug reactions between the two groups. Conclusion: Intravenous antibiotics demonstrated superior efficacy in terms of faster clinical improvement, shorter hospital stays, and better oxygenation outcomes. However, oral antibiotics remain a viable and cost-effective alternative for mild to moderate cases, with comparable safety profiles. Individualized treatment approaches based on disease severity and patient-specific factors are essential for optimizing outcomes in pediatric pneumonia management.