Five day treatment of pediatric pneumonia is as effective as longer treatment

Article by Bruce Sylvester.

Treatment of common pneumonia in children six months to 10 years-old with a five-day course of high-dose amoxicillin is as effective as 10-day treatment, Canadian researchers report.

The paper was published on March 8, 2021 in JAMA Pediatrics.

“Several studies have proven that adults with pneumonia do fine with short courses of antibiotics, and now we have proven a short course of antibiotics also works for children,” said Jeffrey Pernica, MD, lead author, associate professor of pediatrics of McMaster’s Michael G. DeGroote School of Medicine and an infectious disease pediatrician for Hamilton Health Sciences in Hamilton, Ontario, Canada.

Children were eligible for the study if they were 6 months to 10 years-old, had a fever within 48 hours of examination, respiratory symptoms, chest radiography and had received a primary diagnosis of pneumonia in the emergency room.

Children were ineligible if they required hospitalization, had a predisposition to severe disease and/or pneumonia of unusual origin or had previously received β-lactam antibiotic therapy.

The investigators enrolled 281 subjects, median age 2.6 years-old.  

The “intervention group” received five days of high-dose amoxicillin therapy followed by 5 days of placebo. The “control group” received 5 days of high-dose amoxicillin followed by a different formulation of 5 days of high-dose amoxicillin.

The endpoint was clinical cure at 14 to 21 days.

The investigators reported clinical cure at 14 to 21 days in 85.7% of subjects in the intervention group and in 84.1% in the control group.

 The authors concluded, “Short-course antibiotic therapy appeared to be comparable to standard care for the treatment of previously healthy children with CAP [community-acquired pneumonia] not requiring hospitalization. Clinical practice guidelines should consider recommending 5 days of amoxicillin for pediatric pneumonia management in accordance with antimicrobial stewardship principles.”