Children hospitalised with severe pneumonia can safely switch from injectable to oral antibiotics once they begin to recover, a clinical trial has determined.
The PediCAP trial (ISRCTN63115131) was led by researchers from City St George’s, University of London, UCL Innovative Clinical Trials Unit, and partners across Africa and Europe. The study enrolled 1,101 children aged two months to six years with community-acquired pneumonia that developed outside hospital but was severe enough to require hospital treatment. Thirteen hospitals across South Africa, Uganda, Zambia, Zimbabwe and Mozambique contributed to the study.
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Pneumonia remains one of the leading infectious killers of children worldwide, particularly in low- and middle-income countries. Current World Health Organization (WHO) guidelines recommend five days of injectable antibiotics for children hospitalised with severe community-acquired pneumonia, often requiring them to stay in hospital even after they have already substantially improved.
All children in the trial began treatment with an injectable antibiotic, and some were then assigned to either oral amoxicillin or oral amoxicillin-clavulanate when their condition had improved. Researchers compared these children to those who received the injectable treatment for the full five days.
The study found that children who switched to oral antibiotics recovered just as well as those who remained on injectable treatment. Rates of hospital readmission or death within 28 days were similar across all groups – 6% for oral amoxicillin, 7% for oral amoxicillin-clavulanate and 6% for injectable antibiotics – showing that an early switch to oral treatment is a safe and effective strategy.
Children who switched to oral antibiotics left hospital around one day earlier compared to those who remained on injectable treatment for the full five days.
Researchers also compared duration of treatment and found that a course of four to five days was as effective as longer courses of seven or eight days.
Professor Julia Bielicki, Professor of Paediatric Infectious Diseases at City St George’s, University of London, said: “Every year millions of children around the world are admitted to hospital with severe pneumonia. Our study shows that once a child is clinically improving, it is safe to switch from injectable to oral antibiotics, and complete treatment at home.”
The trial was funded by the European Union’s EDCTP2 programme and sponsored by the Penta Foundation.
Antibiotic resistance is becoming an issue of significant global concern. The WHO predicts that with the current level of action, the total cost to treat resistant bacterial infections alone will reach $412bn annually up to 2035, with additional productivity losses of $443bn per year.
