Children admitted to hospital with severe pneumonia may be able to return home sooner and complete their treatment with oral antibiotics, according to a major international clinical trial.
The research, led by experts from City St George's, University of London, UCL Innovative Clinical Trials Unit and partners across Africa and Europe, challenges current treatment practices and could help ease pressure on healthcare services worldwide.
Pneumonia remains one of the leading infectious causes of child deaths globally, particularly in low and middle-income countries. Under existing World Health Organization (WHO) guidance, children hospitalised with severe community-acquired pneumonia are typically prescribed five days of injectable antibiotics, requiring them to remain in hospital even after their condition has significantly improved.
Extended hospital stays can place additional strain on healthcare systems, increase costs, and expose young patients to a greater risk of hospital-acquired infections, including antibiotic-resistant infections. They can also create financial and emotional pressures for families.
One of Africa's Largest Childhood Pneumonia Studies
The PediCAP trial enrolled 1,101 children aged between two months and six years who had severe community-acquired pneumonia requiring hospital treatment. The study involved 13 hospitals across South Africa, Uganda, Zambia, Zimbabwe, and Mozambique.
All children initially received a WHO-recommended injectable antibiotic. Once their condition improved, some children were switched to oral amoxicillin or oral amoxicillin-clavulanate, while others continued with injectable antibiotics for the full five-day course.
Researchers found that children who switched to oral antibiotics recovered just as successfully as those who completed the standard injectable treatment.
Hospital readmission or death within 28 days occurred at similar rates across all treatment groups:
- 6% for oral amoxicillin
- 7% for oral amoxicillin-clavulanate
- 6% for injectable antibiotics
The findings demonstrate that an earlier switch to oral treatment is both safe and clinically effective.
Shorter Antibiotic Courses Also Proved Effective
The study also examined whether shorter antibiotic treatment durations could deliver the same outcomes as longer courses.
Researchers compared total treatment lengths ranging from four to eight days and found that four to five days of antibiotics were just as effective as treatment courses lasting seven or eight days.
This suggests that many children with severe pneumonia could recover successfully with significantly reduced antibiotic exposure, supporting wider antimicrobial stewardship efforts and helping to combat antibiotic resistance.
Children who transitioned to oral antibiotics were also discharged approximately one day earlier than those who remained on injectable treatment throughout the recommended five-day period.
Professor Julia Bielicki, Professor of Paediatric Infectious Diseases at City St George's, University of London and co-lead author of the study, said:
"Every year millions of children around the world are admitted to hospital with severe pneumonia. Our study shows that once a child is clinically improving, it is safe to switch from injectable to oral antibiotics, and complete treatment at home.
“This simple change could help children get back to their families sooner, reduce pressure on busy hospitals, lower healthcare costs and avoid sometimes catastrophic financial impacts on families from lost caregiver earnings. Because amoxicillin is affordable and widely available, these findings have the potential to change clinical practice and improve care for children around the world."
The trial was funded through the European Union's EDCTP2 programme and sponsored by the Penta Foundation.
The findings are likely to be of significant interest to healthcare leaders, paediatricians, and policymakers, particularly as health systems seek evidence-based ways to improve patient outcomes while making the best use of limited resources.
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