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Cutting antibiotics for children’s lung infections gives same results as full doses

New research shows lower dose and shorter course antibiotic treatment of pneumonia in children is safe and works. The data offer new ways of preventing infections resistant to antibiotics.

The CAP-IT trial looked at different doses of antibiotic amoxicillin and length of treatment in tackling pneumonia in children. It found little difference in outcomes between high and low doses, or between long and short courses.

Southampton’s Prof Saul Faust, Prof Paul Little and Dr Katrina Cathie were co-authors of the findings published in the journal JAMA.

Tackling rising antibiotic resistance

Antibiotic resistance is a growing threat to health worldwide. It sees bacteria evolve defences against the antibiotics used to kill them. While less common in children’s infections in the UK, antibiotic resistant infections are difficult to treat, making even minor infections potentially life-threatening.

Resistance occurs when bacteria are exposed to antibiotics frequently, or for long enough. That sees the toughest individuals survive and multiply. That’s why reducing unnecessary use of antibiotics is key to tackling its rise.

The CAP-IT results show the scope for cutting antibiotic use, whilst keeping the same safety and benefits as full dose treatment.

Optimising pneumonia treatment

Pneumonia is common in young children. It sees the lungs’ air sacs (alveoli) become inflamed, often due to bacterial infection.

Amoxicillin is the antibiotic most often used to tackle these infections. CAP-IT is one of the largest trials to try to optimise both dosing and length of treatment.

824 young children (average age 2.5 years) with pneumonia took part at 29 hospitals in the UK and Ireland. On leaving hospital took either a low or high dose of amoxicillin, for either three or seven days.

The study team took nasal swabs to check for resistant bacteria then monitored the children for four weeks. Over that time they measured the number of infections needing further antibiotics. At the end of four weeks they took more nasal swabs.

New infections, side effects or and levels of resistant bacteria were the same across the groups. Coughing persisted for slightly longer in those taking amoxicillin for three days rather than seven, but here was no difference in any symptoms between high and low dose groups.

Prof Saul Faust, Professor of Paediatric Immunology and Infectious Diseases and Director of the NIHR Southampton Clinical Research Facility, said:

“These results show we can reduce the amoxicillin dose for some specific groups of children without compromising the quality of the treatment.

“That’s great for fighting antibiotic resistance in children’s pneumonia, but also opens the door to similar studies in other infections. That shift will help fight the rise in hard-to-treat antibiotic resistant bacterial infections.”

The CAP-IT trial was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme.


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