Clinical Question

In children with pneumonia who do not need hospitalization, is five days of treatment with high-dose amoxicillin comparable with 10 days of treatment?

Bottom Line

In a limited study, children with community-acquired pneumonia who were treated with five days of high-dose amoxicillin had cure rates comparable with those who were treated for 10 days. (Level of Evidence = 1b)

Synopsis

The study took place before the COVID-19 pandemic in two emergency departments in Hamilton, Ontario, and enrolled children six months to 10 years of age with radiographically confirmed community-acquired pneumonia who were not sick enough to be hospitalized. The researchers randomized the children to receive five days of high-dose amoxicillin (75 mg per kg to 100 mg per kg per day) plus five days of placebo (n = 140) or 10 days of high-dose amoxicillin (n = 141). The dose range was based on Canadian Paediatric Society guidelines that allow for slight dose variation to simplify medication administration and reduce potential dosing errors. After two to three weeks of follow-up, more children who received five days of treatment had a clinical cure (85.7%) than those who received 10 days of treatment (84.1%). The number of days lost in caregiving was lower among those treated for five days (two days vs. three days, respectively), and there was no difference in absenteeism among the children (one day for each group). Approximately 10% of children in each group were lost to follow-up. The study was designed as a noninferiority study and needed 135 participants in each group to be confident that the two interventions were comparable.

Study design: Randomized controlled trial (nonblinded)

Funding source: Foundation

Allocation: Concealed

Setting: Inpatient (any location)

Reference: Pernica JM, Harman S, KamAJ, et al. Short-course antimicrobial therapy for pediatric community-acquired pneumonia: the SAFER randomized clinical trial. JAMA Pediatr. 2021;175(5):475–482.