Trial Results

Children with pneumonia leaving hospital can have antibiotic treatment reduced to three days, the CAP-IT trial finds!

Children being discharged from hospital with pneumonia can be treated with 3 days of antibiotics rather than 7. These results from the CAP-IT trial were published on the 2nd November 2021 in the Journal of the American Medical Association. Pneumonia (sometimes called chest infection) is common in young children. It is usually treated with the antibiotic drug amoxicillin. But, until now, there has been little evidence to guide how long treatment should be given for, or what dose should be used. CAP-IT found that a shorter duration of treatment of 3 days of amoxicillin was as good as a longer duration of 7 days in terms of children not needing further antibiotic treatment within 4 weeks.

As well as comparing duration, dosing was also studied, with half the participants in each duration group receiving a lower dose (35-50 mg/kg) and the other half a higher dose (70-90 mg/kg). It found that a lower dose of amoxicillin was as good as a higher dose.

The trial found no differences in symptoms between the different durations or doses given other than resolution of cough being slightly faster in the group receiving 7 days of amoxicillin (10 days recovery vs. 12 days). There was no indication of differences in time to return to normal activities for parents and children or in additional use of healthcare services between arms. Side effects, taking doses correctly and development of resistance were also comparable between arms. All children in CAP-IT received amoxicillin in twice daily doses rather than 3 times daily. Although not a randomised comparison, children did well on twice daily dosing, suggesting that twice daily dosing regimens may be used.

824 children were recruited between Feb 2017 and April 2019 at emergency children’s departments and on children’s wards in 29 hospitals the UK and Ireland. Children who took part were aged 6 months or over, weighing between 6 and 24kg and the decision to treat their chest infection with amoxicillin had been made. The average age was 2.5 years. They were randomised to receive a lower vs higher dose of amoxicillin and a shorter vs longer duration of treatment.

The trial did not include children with complicated chest infections needing to be in hospital for long periods of time or children receiving different types of antibiotics. Therefore our results cannot be generalised to more severely ill children or those being treated for atypical chest infections. The CAP-IT trial was funded by the NIHR HTA.

Bielicki JA, Stöhr W, Barratt S, et al. Effect of Amoxicillin Dose and Treatment Duration on the Need for Antibiotic Re-treatment in Children With Community-Acquired Pneumonia. JAMA. 2021;326(17):1713-1724. doi:10.1001/jama.2021.17843