Benefits and risks Antibiotic treatment for non-severe pneumonia with no wheeze

43 alternative to parenteral antibiotics in low HIV settings see GRADE tables A7.10 A7.11 . Oral amoxicillin is an efective and safe alternative to parenteral antibiotics in low HIV settings in children with severe pneumonia chest indrawing who do not have any other serious signs or symptoms. Campbell et al 1988 compared oral co-trimoxazole versus IM procaine penicillin followed by oral ampicillin in 134 children with non-severe or severe pneumonia. At day 7 of follow up, treatment failure occurred in 6 out of 66 patients 9.1 in the oral co-trimoxazole group and 7 out of 68 patients 10.2 in the combined-treatment group. he risk diference was not signiicant: -0.01 95 CI -0.11 to 0.09. he study reported one death during the follow-up period in the injectable therapy group. Straus et al 1998 included 302 children with severe pneumonia and compared oral cotrimoxazole n=203 with oral amoxicillin n=99. Treatment failure rates were higher in the cotrimoxazole group 33 compared to oral amoxicillin 18 RR 1.79; 95 CI 1.13 to 2.84. here was no signiicant association between antimicrobial minimum inhibitory concentration and outcome among bacteraemic children treated with co-trimoxazole and amoxicillin. Addo-yobo et al 2004 evaluated 1702 children with severe pneumonia, comparing oral amoxicillin n = 857 versus IV penicillin n = 845 for two days followed by oral amoxicillin. Ater 48 hours, treatment failure occurred in 161 out of 845 patients 19 in the amoxicillin group and 167 out of 857 patients 19 in the parenteral penicillin group. he risk diference was not signiicant: -0.4 95 CI -4.2 to 3.3. At the end of follow up 14 days, the cumulative proportion of deaths in each group was 0.2 in oral versus 1 in parenteral, but this did not reach statistical signiicance RD -0.6, 95 CI -0.1 to 1.3. he authors reported similar recovery in both groups at 5 and 14 days. Atkinson et al 2007 conducted a study in eight paediatric centres in England general district and tertiary hospitals and enrolled all but the most severe cases of pneumonia. Children were randomly assigned to a 7-day treatment of either oral amoxicillin n = 100 or IV benzyl penicillin n = 103. he primary outcome examined was time for temperature to be 38 °C for 24 continuous hours. he study found equivalence between the two treatments, with a median time of 1.3 days for the primary outcome to be achieved in both groups. Hazir et al 2008 compared hospitalization and parenteral ampicillin four times a day for 2 days followed by 3 days oral amoxicillin with ambulatory home-treatment n = 1025 versus oral amoxicillin twice daily for 5 days n = 1012. he primary outcome was treatment failure measured by clinical deterioration. here were 87 8.6 treatment failures in the hospitalization group and 77 7.5 treatment failures in the ambulatory group by day 6: a non-statistically signiicant risk diference of 1.1, 95 CI - 1.3 to 3.5. Five 0.2 children died within 14 days of enrolment, one in the ambulatory group and four in the hospitalized group. In each case, treatment failure was declared before death and the antibiotic had been changed. None of the deaths were considered to be associated with treatment allocation. Another RCT that compared day care versus hospital care management of pneumonia [Ashraf, 2010], but did not compare an oral antibiotic arm with injectable