title: Short-course antibiotic treatment for community-acquired alveolar pneumonia in ambulatory children: a double-blind, randomized, placebo-controlled trial.
abstract: BACKGROUND
  Studies on short-course treatment of childhood pneumonia in the developed world are lacking. We compared clinical and laboratory outcomes of a 3-day or a 5-day to a 10-day treatment in young children with community-acquired alveolar pneumonia.
  
  
  METHODS
  A double-blind, randomized, placebo-controlled trial was conducted in 2 stages: (1) 3 days versus 10 days and (2) 5 days versus 10 days. Amoxicillin (80 mg/kg/d; divided into 3 daily doses) was used for all arms. Case definition was: age 6-59 months; radiologically confirmed community-acquired alveolar pneumonia; temperature ≥38.5°C; peripheral white blood cell count ≥15,000/mm³; status permitting outpatient treatment. Scheduled visits were on days 4-5 and 10-14 with daily telephone interviews for 30 days. Treatment failure was defined by the need for a rescue treatment or hospitalization. Secondary outcomes were: duration of fever and symptoms and white blood cell and C-reactive protein responses.
  
  
  RESULTS
  During Stage 1, 4/10 (40%) and 0/12 (0%) evaluable patients failed in the 3-day and 10-day arms, respectively (P = 0.16). Therefore, the 3-day arm was replaced by a 5-day arm (Stage 2). No failures occurred in the 5-day (n = 56) and 10-day (n = 59) arms. Overall, 4/10 (0%), 0/56 and 0/42 (0%) children failed in the 3-day, 5-day and 10-day arms, respectively (P < 0.001, 3-day versus 5-day or 10-day). Secondary outcomes were similar in the 5-day and 10-day arms.
  
  
  CONCLUSIONS
  In 6- to 59-month-old outpatients with community-acquired alveolar pneumonia, a 5-day course with high-dose oral amoxicillin was not inferior to a 10-day course. The 3-day regimen may be associated with an unacceptable failure rate.
authors.affiliation: From the *The Pediatric Infectious Disease Unit, Soroka University Medical Center; †The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva; and ‡Department of Radiology, Hadassah University Medical Center, Jerusalem, Israel.
authors.forename: David
authors.initials: D
authors.lastname: Greenberg
authors.forename: Noga
authors.initials: N
authors.lastname: Givon-Lavi
authors.forename: Yair
authors.initials: Y
authors.lastname: Sadaka
authors.forename: Shalom
authors.initials: S
authors.lastname: Ben-Shimol
authors.forename: Jacob
authors.initials: J
authors.lastname: Bar-Ziv
authors.forename: Ron
authors.initials: R
authors.lastname: Dagan
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000188:drug therapy*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010919:Placebos; D018410:Pneumonia, Bacterial / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D010919:Placebos