The Pharmaceutical Journal
Vol 269 No 7216 p388
21 September 2002

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The Lancet (www.thelancet.com)

Three days of antibiotics as good as five days for childhood pneumonia

A THREE-DAY course of oral amoxicillin is just as effective for treating children with non-severe pneumonia as a five-day course of treatment, according to the results of a double-blind trial.

Researchers from the Pakistan Multicentre Amoxicillin Short Course Therapy (MASCOT) pneumonia study group treated 1,000 children with 15mg/kg oral amoxicillin every eight hours for three days, followed by placebo for two days. A second group of 1,000 children received the amoxicillin regimen for five days.

The treatment failure rate was comparable in both groups — 21 per cent in the three-day group and 20 per cent in the five-day group. In addition, the relapse rate in both groups was the same, at 1 per cent.

The researchers found that treatment was more likely to fail in certain instances, such as in children aged under 12 months, in those where illness lasted for three days or longer, in those who suffered vomiting and in those who did not adhere to the treatment. Treatment non-adherence was found to be associated with treatment failure in the five-day group (P<0.0001), but not the three-day group.

The researchers say that although previous research has shown the short-course antibiotic approach to be successful in treating otitis media, sinusitis and tonsillo-pharyngitis in children, evidence for the best duration of treatment for lower respiratory infections in childhood is limited.

They conclude that restricting anti-biotic treatment for non-severe pneumonia in children to three days would be advantageous because it would reduce the costs of therapy, as well as reduce side effects and possibly help contain the spread of antimicrobial resistance. In addition, they say a shorter duration of therapy would improve adherence to treatment, as other studies have found at least a quarter of children do not adhere to treatment regimens.

The study was published in The Lancet (2002;360:835).