Table 1

Are oral antibiotics as efficacious as intravenous antibiotics for the treatment of community acquired pneumonia?

StudyStudy groupInterventionStudy typeOutcomeKey resultsComments
APPIS trial21702 Children in eight developing countries in Asia, Africa and South America aged 3–59 months with WHO defined severe pneumoniaOral amoxicillin vs intravenous penicillin GMulticentre randomised equivalency studyTreatment failure up to 48 h: appearance of danger signs, persistent lower chest in-drawing, drug reaction, needs other antibiotic or deathTreatment failure was 19% in each group. Risk difference −0.4% (95% CI −4.2 to 3.3)Injectable penicillin and oral amoxicillin are equivalent for treatment of severe pneumonia.Concealment of allocation.Intention to treat.Non-blinded.
Campbell et al3134 Children from rural villages in the Gambia with WHO defined pneumoniaOral co-trimoxazole vs intramuscular procaine penicillin+oral penicillinQuasi-randomised equivalence studyTreatment failure at 1 week; persistence of lower chest in-drawing, other respiratory distress and high temperatureOn day 7 treatment failure occurred in 9.1% of the co-trimoxazole group and 10.2% of the combined group. Risk difference −0.01% (95% CI −0.11 to 0.09)No significant differences in global treatment failure between the two groups at 2-week follow-up.No concealment of allocation.Non-blinded.Intention to treat.
PIVOT trial4246 Children with community acquired pneumonia admitted to eight hospitals in Nottingham, UKOral amoxycillin vs intravenous benzylpenicillinMulticentre randomised controlled equivalence studyTime for temperature to decrease to <38°C for 24 h and cessation of O2 requirement. Length of stay, complicationsTime for temperature to decrease to <38°C for 24 h and cessation of O2 requirement. Length of stay, complicationsOral amoxicillin is effective for most children admitted to hospital with pneumonia.Concealment of allocation.Intention to treatNon-blinded.