Published: 14 November 2023
Can infection-fighting antibiotic use be reduced?
Pneumonia is a serious but common lung infection among young children. Around 700 children under the age of 5 develop pneumonia and 40 lives are lost each year in the UK.
Under UK and international guidelines, children with bacterial community-acquired pneumonia (developed outside of hospital) are usually given three daily doses of the antibiotic amoxicillin over 5 to 7 days. However, until recently, there was little evidence to guide the most appropriate length or dose of treatment.
With NIHR funding of £2 million, the Community-Acquired Pneumonia: randomIsed controlled Trial (CAP-IT) looked at whether lower doses and fewer days of treatment with amoxicillin are as good at treating pneumonia as higher doses and a longer period of treatment.
In addition to improving children’s care, finding the minimum amount of antibiotic needed to safely treat pneumonia could cut the NHS’s £8 million treatment costs and help tackle the rising problem of global antibiotic resistance.
Collaborative research to improve children’s care
Co-led by Michael Sharland, Professor of Paediatric Infectious Diseases at St George’s University London, CAP-IT recruited 814 children who had been admitted to hospital with community-acquired pneumonia across the UK and Ireland.
“This study wouldn’t have been possible without the NIHR Clinical Research Network’s regional teams working in collaboration with the PERUKI* and GAPRUKI** networks,” explained CAP-IT researcher Dr Damian Roland, Consultant in Paediatric Emergency Medicine at University Hospital of Leicester NHS Trust.
The children, aged between 6 months and 5 years, received either 3 or 7 days of twice-daily antibiotic after leaving hospital. Half of each group received the higher dose (70–90 mg/kg), while the other half received 35–50 mg/kg.
Published in JAMA, CAP-IT researchers found that children who received 3 days’ treatment were no more likely to need additional antibiotics during the first month than those who received 7 days’ treatment. The lower dose of antibiotic was also as effective as the higher dose, and coughs lasted only slightly longer in the shorter treatment group.
The team also noted that neither the shorter course nor lower antibiotic dose led to increased resistance in the main pneumonia-causing bacteria in the UK and globally.
Tackling antibiotic resistance by changing practice
As one of the largest antibiotic trials involving children attending hospital, CAP-IT’s evidence has challenged usual practice regarding amoxicillin use. Its findings are expected to inform future guidelines and alter practice regarding the best dose and length of antibiotic treatment for young children.
“The results of the CAP-IT trial will allow 100,000 children to receive shorter treatment with antibiotics between 2021 and 2026.”
Professor Michael Sharland
If widely adopted, the lower and fewer doses of antibiotics will save the NHS money while making the medication schedule easier for patients and their families to follow.
As hoped, CAP-IT’s results provided much-needed evidence to tackle the health threat of antibiotic resistance, giving support to the UK’s 5-year national action plan to contain and control antibiotic resistance by 2040.
*The Paediatric Emergency Research in the United Kingdom & Ireland (PERUKI) and the **General and Adolescent Paediatric Research in the United Kingdom & Ireland (GAPRUKI) networks bring together clinicians and researchers who share the vision of improving the care of children in their respective specialties through high quality multi-centre research.
The study was funded by the NIHR Health Technology Assessment (HTA) Programme.
More information about the study is available on the NIHR’s Funding & Awards website.