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 3-day duration was noninferior to 7 days, according to a study published in the Nov. 2 issue of the Journal of the American Medical Association.
Julia A. Bielicki, PhD, 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 (3 days; 413 patients) or a longer duration (7 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% with the lower dose versus 12.4% with the higher dose and in 12.5% with 3-day treatment versus 12.5% with 7-day treatment. Both groups showed noninferiority with no significant interaction between dose and duration. The only significant differences were 3-day versus 7-day treatment for cough duration (hazard ratio, 1.2; 95% CI, 1.0-1.4; P =.04) and sleep disturbed by cough (hazard ratio, 1.2; 95% CI, 1.0-1.4; P =.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.