New treatment strategy could bring children with pneumonia home from hospital earlier

Musakanya Chingandu

Summary: The PediCAP trial found that it is safe to switch children in hospital with pneumonia from injectable to oral antibiotics once their health improves.

Children who are recovering from severe pneumonia could safely switch from injectable to oral antibiotics earlier, allowing them to come home from hospital sooner. This is according to new results from the PediCAP clinical trial, presented today at the ESCMID Global conference in Barcelona.

The current World Health Organization (WHO) guidelines recommend that children with severe community-acquired pneumonia are treated for five days with an injectable antibiotic. This means children must stay in hospital for the full five days, even if they get better sooner.

Longer hospital stays are more expensive, affect the wellbeing of children and their families, and place a higher burden on healthcare facilities. Furthermore, keeping children in hospital increases their risk of developing antibiotic resistant infections.

The PediCAP clinical trial found that children recover just as well if they switch from injectable to oral antibiotics, taken by mouth, once a healthcare worker confirms that they are improving. This would allow children to finish their treatment at home and leave hospital sooner.

PediCAP included 1,100 children aged two months to six years old with pneumonia that had developed at home but was severe enough to require treatment in hospital. The trial took place in hospitals across South Africa, Uganda, Zambia, Zimbabwe and Mozambique.

PediCAP is the first large MAMS-ROCI clinical trial, a novel approach developed by the MRC Clinical Trials Unit at UCL. This innovative trial design allows researchers to test different antibiotic options taken over different durations.

All children in the trial began treatment with a WHO-recommended injectable antibiotic. Some were assigned to switch to either oral amoxicillin or oral amoxicillin-clavulanate when their condition had improved, as confirmed by a healthcare worker. Researchers compared these children to those who received the WHO-recommended hospital treatment for the full five days.

The trial found that switching children in hospital with pneumonia to oral antibiotics when their health improves is safe and works just as well as staying on injectable antibiotics for five days.

Both oral antibiotics were equally effective, but amoxicillin is a better choice as it is more affordable and readily available.

PediCAP also compared how well children recovered with different lengths of antibiotic treatment, ranging from four to eight days in total. They found that all shorter lengths were just as good as eight days of treatment. Generally, four days of treatment was enough for most children.

On average, children who switched to oral antibiotics had a shorter hospital stay by one day compared with those who stayed on injectable antibiotics. This strategy could establish a more convenient and equally effective alternative to the WHO’s current treatment recommendations, meaning children can return home from hospital sooner.

PediCAP was run by the MRC CTU at UCL in partnership with St George’s University of London. The trial was funded by the European Union’s EDCTP2 programme and coordinated by the Penta Foundation.