Pneumonia could be treatable by the oral antibiotic amoxicillin rather than injectable penicillin

Pneumonia - one of the world’s deadliest diseases for young children in developing countries - could be treatable by the oral antibiotic amoxicillin rather than injectable penicillin, with implications for better health outcomes and reduced costs, conclude authors of an international study in this week’s issue of THE LANCET.

Nearly 2 million children under 5 years of age die every year in developing countries from respiratory diseases such as pneumonia. Penicillin given by injection is the recommended treatment for severe pneumonia defined by the World Health Organisation (lower chest indrawing). It is proposed that oral amoxicillin could reduce referral, admission, and treatment costs if it can be proven to be as effective as injectable penicillin.

In a randomised trial done in eight developing countries in Africa, Asia, and South America, around 1700 children aged between 3 months and 5 years admitted to tertiary care centres were randomly allocated to receive either injectable penicillin or oral amoxicillin. The main outcome measure of the study—treatment failure after 48 hours— was the same in both groups (19%). There was also no difference in outcome between the two groups at 5-day and 14-day follow-up.

Investigator Shamin Qazi (WHO) comments: “Our findings have several important beneficial implications if applied as public-health policy; oral amoxicillin will reduce;

1. the risk of needle-associated complications such as needle-borne infections;
2. the need for referral or admission;
3. treatment administration costs; and
4. transport, food, and lost income costs for the family”.

In an accompanying commentary (p 1104), Keith P Klugman (Emory University, Atlanta, USA) states: “The researchers point out the benefits that accrue from this observation—ie, diminished risk associated with the use of needles, decreased cost to the health system, and indeed reduced cost to the patients’ families. The investigators also suggest that the results could reduce the perceived need for hospitalisation of children with severe pneumonia. Here, the evidence is less clear. All the children enrolled in this study were initially admitted to hospital. Therefore, they also received the probable benefits of medical attention, nutritional support, and supplemental oxygen therapy…nonetheless, this study supports the idea of further work to demonstrate the safety and efficacy of oral antibiotics for severe pneumonia therapy in outpatient settings, perhaps together with improved access to nutritional support and oxygen.”