Amoxicillin is the drug of first choice to treat community-acquired pneumonia (CAP) in children below 5 years of age. There is, however, no consensus about the dosage or the duration of the course of treatment. Dutch guidelines recommend a daily oral dosage of amoxicillin of 40 to 50 mg/kg, divided over three doses a day, for 5 days. A non-inferiority study has shown that treatment with a low dosage (35 to 50 mg/kg/day in two doses) is just as effective as treatment with a high dosage (70 to 90 mg/kg/day in two doses), and that a 3-day course of treatment is just as effective as a 7-day course. Reducing the overall use of antibiotics is important to prevent resistance and bacterial superinfections, and can result in fewer adverse effects, greater compliance and lower costs.
- Treating children with CAP under the age of 5 years with a low dosage of amoxicillin (35 to 50 mg/kg/day in two doses) is non-inferior to treatment with a high dosage (70 to 90 mg/kg/day in two doses) for 3 to 7 days.
- A 3-day course of amoxicillin treatment (using low or high dosage) is non-inferior to a 7-day course (using low or high dosage).
- The duration currently recommended in the Netherlands for the treatment of childhood CAP with amoxicillin at 40 to 50 mg/kg per day could perhaps be reduced even further, from 5 to 3 days.
- Adjustment of the duration of treatment should first be confirmed in research that includes the dosing frequency, the severity of the pneumonia and any comorbidity.
- Bielicki JA, Stöhr W, Barratt S, Dunn D, Naufal N, Roland D, et al. PERUKI, GAPRUKI, and the CAP-IT Trial Group. Effect of Amoxicillin Dose and Treatment Duration on the Need for Antibiotic Re-treatment in Children With Community-Acquired Pneumonia: The CAP-IT Randomized Clinical Trial. JAMA. 2021 Nov 2;326(17):1713-1724. doi: 10.1001/jama.2021.17843. Erratum in: JAMA. 2021 Dec 7;326(21):2208.
- Dekkers OM. Het non-inferioriteitsonderzoek. Gebu. 2015;49(3):27-34.
- Nederlands Huisartsen Genootschap. NHG-Standaard: Acuut hoesten. 2011. Laatste aanpassing versie 2.1, mei 2020 (in herziening). Available from: https://richtlijnen.nhg.org/standaarden/acuut-hoesten.
- Nederlandse Vereniging voor Kindergeneeskunde. Richtlijn Onderste luchtweginfecties. 14 oktober 2015. Available from: https://www.nvk.nl/themas/kwaliteit/richtlijnen/richtlijn?componentid=7864320
- World Health Organization guidelines review committee. Revised WHO classification and treatment of childhood pneumonia at health facilities: Evidence summaries. Geneva: WHO 2014:1-26. Available from: https://apps.who.int/iris/bitstream/handle/10665/137319/9789241507813_eng.pdf.
- Bradley JS, Byington CL, Shah SS, Alverson B, Carter ER, Harrison C, et al. Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011 Oct;53(7):e25-76. doi: 10.1093/cid/cir531.
- Harris M, Clark J, Coote N, Fletcher P, Harnden A, McKean M, et al. British Thoracic Society Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011. Thorax. 2011 Oct;66 Suppl 2:ii1-23. doi: 10.1136/thoraxjnl-2011-200598.
- de Velde F, de Winter BC, Koch BC, van Gelder T, Mouton JW; COMBACTE-NET consortium. Non-linear absorption pharmacokinetics of amoxicillin: consequences for dosing regimens and clinical breakpoints. J Antimicrob Chemother. 2016 Oct;71(10):2909-17. doi: 10.1093/jac/dkw226.
- World Health Organization. Pneumonia. Key facts. 11 november 2021. Available from: https://www.who.int/news-room/fact-sheets/detail/pneumonia.
- CBS. Available from: https://www.cbs.nl/nl-nl/cijfers/detail/7233?q=pneumonie#shortTableDescription. Accessed 14-12-2021.