Four-day antibiotic treatment shows promise for childhood pneumonia in Africa

Musakanya Chingandu

The PediCAP consortium, a global partnership of 14 institutions, presented promising results from its main trial, PediCAP-A, at the European Society of Clinical Microbiology and Infectious Diseases (ESCMID Global) conference held from April 27-30, 2024, in Barcelona, Spain. This research introduces a more child-centred  approach to managing severe community-acquired pneumonia (CAP), a leading cause of hospitalisation and death in children in resource limited settings.

Currently, the World Health Organization recommends treating severe CAP with injectable antibiotics for five days, usually administered in an inpatient setting. While effective, this approach creates significant challenges. Lengthy hospital stays disrupt families and represent catastrophic financial events for some, strain hospital resources and increase the risk of acquisition of resistant nosocomial bacteria for affected children.

The PediCAP-A trial, conducted across five African countries, enrolled over 1100 children with severe pneumonia aged 2 months to –6 years. The research explored a safe and effective transition from injectable to oral antibiotics once a child had clinically improved. This switch from injectables to readily available oral antibiotics (Amoxicillin or Amoxicillin-clavulanate) has proven to be equally effective with two critical benefits: children needed to stay in hospital on average one less day and the trial established the safety of short treatment duration with this approach. The study found that a total of four  days of antibiotic treatment, encompassing both the initial injectable phase and the subsequent oral phase, is generally sufficient for recovery. This allows for earlier discharge from hospitals, alleviating the strain on families and healthcare systems.

Dr. Muhammad Sidat, a Study Coordinator from Universidade Eduardo Mondlane, Mozambique, shared his experience implementing the new treatment approach. “At the start, it was a bit challenging to convince doctors to accept that patients could be switched to oral medication so early, given that they were so severe when admitted to hospital with difficulty breathing and other signs of severe pneumonia,” he explains. “But we were able to make them comfortable with the step-down process. With time, they saw that patients allocated to oral stepdown were doing fine, and this spoke for itself – patients were getting better, able to leave the hospital early, and the treatment was working.”

Amoxicillin and Amoxicillin-clavulanate are readily available antibiotics and their paediatic formulations are available as both syrup and dispersible tablets. While syrups have been the traditional option for children, dispersible tablets are emerging as a preferred choice. Dr Constantine Mutata, a medical doctor at University of Zimbabwe Clinical Research Center explains, “Parents initially worry about their child’s ability to swallow tablets. However, once they understand these tablets don’t’ taste bitter, can be dissolved, making them easier to take, they prefer them. As a physician, I appreciate the precise dosing they offer.” Dispersible tablets are also easier to store and transport, adding to their convenience.

Health economist Lucy Cunnama from the University of Cape Town, South Africa, highlights the economic impact of this approach. “Being able to transition to oral antibiotics after four days has a significant impact for families,” she explains. “Children can be cared for at home, reducing the need for prolonged hospitalisation, which translates to cost savings not only for parents but the healthcare system as well.”

PediCAP-A’s findings have the potential to greatly improve how we approach childhood CAP in Africa. “We are delighted that EDCTP funding contributed to this important study to improve treatment options for children with severe pneumonia in Africa.” said Dr Johanna Schaefer, Project Officer at the EDCTP Association. This safe, effective, and affordable treatment strategy can lead to significant improvements in patient care, healthcare resource management, and antibiotic stewardship paving the way for healthier children.


About PediCAP

PediCAP is part of the EDCTP2 programme supported by the European Union (grant number RIA2017MC – 2023 – PediCAP) and is coordinated by Fondazione Penta ETS (Italy).

The PediCAP consortium includes: University College of London (united Kingdom);  St George’s University (United Kingdom); Global Antibiotic Research and Development Programme (Switzerland) Universidade Eduardo Mondlane (Mozambique); University of Oxford (United Kingdom); Swiss Tropical and Public Health Institute (Switzerland); University of Antwerp (Belgium);  Kwa-Zulu-Natal Research Institute for TB-HIV (South Africa); University Teaching Hospital Zambia (Zambia); University of Zimbabwe Faculty of Medicine and Health Sciences, Clinical Research Centre (Zimbabwe); Makerere University (Uganda); University of Cape Town (South Africa); Wits Health Consortium (South Africa); .