Lower Doses of Antibiotics and Shorter Treatment Durations Just As Effective on Children with Pneumonia: Study

Nearly half of children under the age of two receive antibiotics at some point for acute respiratory infections

For children hospitalized with pneumonia, prescribing a three-day course of antibiotics appears to be just as effective as seven days, according to the findings of a new study that may help inform doctors and reduce antibiotic overuse, which may increase the proliferation of antibiotic-resistant bacteria.

Children treated for pneumonia can be cared for as effectively with a shorter duration of antibiotics and a lower dose, according to new data from researchers in the U.K., which was published earlier this month in Journal of the American Medical Association (JAMA).

Researchers conducted a randomized clinical trial involving 814 children who needed amoxicillin to treat community-acquired pneumonia, who were treated at 28 hospitals in the UK and one hospital in Ireland from February 2017 to April 2019 in the CAP-IT study.

Patients with community-acquired pneumonia were discharged from an emergency department, observational unit or inpatient ward within 48 hours of being given antibiotic treatment. Children were randomized into four groups to receive oral amoxicillin at a lower dose of 35-50 mg/kg of body weight, a higher dose of 70-90 mg/kg of weight, for a shorter duration of three days, or for a longer duration of seven days.

According to the findings, rates of antibiotic retreatment within 28 days were similar in low dose and high dose patient groups, 12.6% compared to 12.4%. Rates of retreatment were also similar in shorter and longer duration groups, 12.5% in both three day and seven-day groups. These findings suggest the shorter durations and lower doses were just as effective as the higher doses and longer duration treatments.

Pneumonia is common in young children, and is typically treated with the antibiotic amoxicillin. However, there has been little research on how long a duration of treatment or what dose was the most effective to treat children safely.

Nearly half of all children under two years old receive antibiotics for acute respiratory infections. Exposure to antibiotics from such an early age and consistently throughout a person’s life can increase the risk of the development of antibiotic-resistant bacteria; so-called superbugs.

The study also used a different dosing schedule of giving the antibiotics twice a day instead of three times a day, as it is typically prescribed. Overall, the number of doses needed to treat pneumonia could be reduced from 15 to 21 doses over five to seven days down to six doses over only three days.

Additionally, the number of side effects like diarrhea and skin rash were similar in both groups. Researchers also indicated the shorter course and lower dose helped increase the body’s resistance to the pneumococcus bacteria, the main bacteria that causes pneumonia.

“Among children with CAP discharged from an emergency department or hospital ward (within 48 hours), lower-dose outpatient oral amoxicillin was noninferior to higher dose, and 3-day duration was noninferior to 7 days, with regard to need for antibiotic re-treatment,” the researchers concluded. “However, disease severity, treatment setting, prior antibiotics received, and acceptability of the noninferiority margin require consideration when interpreting the findings.”