1. Five-day treatment of community-acquired pneumonia in children was comparable to standard, 10-day treatment.
Evidence Rating Level: 2 (Good)
Community-acquired pneumonia (CAP) is a common presenting illness among children. Due to the high occurrence, it is important to understand the most appropriate treatment for CAP among this age group. This study aimed to compare the effectiveness of brief, high-dose amoxicillin (5 days) and standard high-dose amoxicillin treatment (10 days). The Short-Course Antimicrobial Therapy and Pediatric Respiratory Infections (SAFER) study was a two-center, parallel-group, noninferiority randomized clinical trial. This included a single-center pilot study from December 2012 to March 31, 2014 and a follow-up main study from August 2016 to December 31, 2019 at two Canadian hospital emergency departments. Children were required to be between the ages of 6 months and 10 years and had a fever within 48 hours, respiratory symptoms, chest radiography-confirming pneumonia, and a primary diagnosis of pneumonia. Exclusions included the need for hospitalization, previous β-lactam antibiotic therapy, and comorbidities that predispose children to severe disease/pneumonia. A total of 281 participants (median [IQR] age = 2.6 [1.6 to 4.9], 42.3% female) were randomly assigned to either 5 days high-dose amoxicillin plus 5 days of placebo (intervention) or 5 days high-dose amoxicillin plus 5 days of high-dose amoxicillin or another formulation (control). In per-protocol analyses, pneumonia was cured in 88.6% of intervention participants compared to 90.8% of the control group (risk difference -0.016, 97.5% confidence limit -0.087). Clinical cure at 2-3 weeks occurred in 85.7% of the intervention group compared to 84.1% of the control group in the intention-to-treat analysis (risk difference 0.023, 97.5% confidence limit -0.061). Overall, this study found that short-course (5-day) antibiotic treatment is comparable to standard care for children with CAP who did not require hospitalization. This sample was composed of children who were otherwise healthy, such that results may vary among more complex cases. However, clinical recommendations should take these results into consideration when treating CAP.
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