Every year, millions of children are admitted to hospitals with severe pneumonia, mostly in resource-limited settings. Until now, standard international guidelines have required children to stay in the hospital for a full week of intravenous antibiotic treatment through a drip, even if they start feeling better much sooner. This long hospital stay places a heavy emotional and financial strain on families, stretches healthcare resources thin and exposes recovering children to the risk of hospital-acquired infections.
To see if care could be improved, the PediCAP clinical trial followed more than 1,100 children aged two months to six years across 13 hospitals in South Africa, Uganda, Zambia, Zimbabwe and Mozambique. The researchers wanted to find out if children could safely switch from intravenous injections to oral antibiotics once they started improving and whether a shorter total course of four to five days worked just as well as standard longer treatments.
The results, published in The Lancet, show a clear path forward for children’s healthcare. The trial found that switching children to oral antibiotics as soon as they are well enough to take them is just as safe and effective as keeping them on intravenous treatment. Both of the oral antibiotics tested, amoxicillin and co-amoxiclav, worked equally well, matching the success rate of standard hospital care while allowing children to recover comfortably at home about a day earlier. Furthermore, a total treatment duration of just four to five days was entirely sufficient for most children to make a full recovery, with no added risk of complications, readmissions, or prolonged illness.
Comparing the two oral options, amoxicillin emerged as the preferred choice because it is more affordable, widely available and has a narrower spectrum, meaning it has a lower potential to drive bacterial resistance compared to broader-spectrum alternatives.
These findings offer a practical way to improve everyday care. By safely stepping children down to oral amoxicillin as soon as they improve, healthcare providers can reduce unnecessary hospital stays, lower the risk of hospital-based infections, ease the financial burden on families and help preserve antibiotic effectiveness for the future, all while ensuring children get the protection and care they need.
The PediCAP trial was run by the UCL Innovative Clinical Trials Unit in partnership with St George’s University of London. The trial was funded by the European Union’s EDCTP2 programme and coordinated by the Penta Foundation.