APPIS trial2 | 1702 Children in eight developing countries in Asia, Africa and South America aged 3–59 months with WHO defined severe pneumonia | Oral amoxicillin vs intravenous penicillin G | Multicentre randomised equivalency study | Treatment failure up to 48 h: appearance of danger signs, persistent lower chest in-drawing, drug reaction, needs other antibiotic or death | Treatment 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 al3 | 134 Children from rural villages in the Gambia with WHO defined pneumonia | Oral co-trimoxazole vs intramuscular procaine penicillin+oral penicillin | Quasi-randomised equivalence study | Treatment failure at 1 week; persistence of lower chest in-drawing, other respiratory distress and high temperature | On 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 trial4 | 246 Children with community acquired pneumonia admitted to eight hospitals in Nottingham, UK | Oral amoxycillin vs intravenous benzylpenicillin | Multicentre randomised controlled equivalence study | Time for temperature to decrease to <38°C for 24 h and cessation of O2 requirement. Length of stay, complications | Time for temperature to decrease to <38°C for 24 h and cessation of O2 requirement. Length of stay, complications | Oral amoxicillin is effective for most children admitted to hospital with pneumonia.Concealment of allocation.Intention to treatNon-blinded. |