Shorter, Low-Dose Amoxicillin Feasible for Pediatric Community-Acquired Pneumonia

Amoxicillin antibiotic drug capsules.
Amoxicillin 35 to 50 mg/kg per day noninferior to 70 to 90 mg/kg per day; three days noninferior to seven days for duration.

HealthDay News — For children with community-acquired pneumonia (CAP) discharged from an emergency department or hospital, lower-dose outpatient oral amoxicillin was noninferior to a higher dose and three-day duration was noninferior to seven days, according to a study published in the Nov. 2 issue of the Journal of the American Medical Association.

Julia A. Bielicki, Ph.D., from St. George’s University of London, and colleagues assessed the optimal dose and duration of oral amoxicillin for children with CAP. In total, 824 children (aged ≥6 months) with clinically diagnosed CAP treated with amoxicillin on discharge from emergency departments and inpatient wards of 28 hospitals in the United Kingdom and one in Ireland (February 2017 to April 2019) were randomly assigned 1:1 to receive oral amoxicillin at a lower dose (35 to 50 mg/kg/day; 410 patients) or higher dose (70 to 90 mg/kg/day; 404 patients), for a shorter duration (three days; 413 patients) or a longer duration (seven days; 401 patients).

The researchers found that clinically indicated antibiotic retreatment for respiratory infection within 28 days after randomization (primary outcome) occurred in 12.6 percent with the lower dose versus 12.4 percent with the higher dose and in 12.5 percent with three-day treatment versus 12.5 percent with seven-day treatment. Both groups showed noninferiority with no significant interaction between dose and duration. The only significant differences were three-day versus seven-day treatment for cough duration (hazard ratio, 1.2; 95 percent confidence interval, 1.0 to 1.4; P = 0.04) and sleep disturbed by cough (hazard ratio, 1.2; 95 percent confidence interval, 1.0 to 1.4; P = 0.03). Even among children with severe CAP, differences in dose and length of treatment were not significant for the primary end point.

“Disease severity, treatment setting, prior antibiotics, and acceptability of the noninferiority margin require consideration when interpreting the findings,” the authors write.

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