Despite advances in our understanding of the epidemiology and distribution of deaths from pneumonia,1 more than 150 million cases of pneumonia still occur annually, with almost 2.4 million deaths worldwide. Pneumonia is perhaps the most frequent cause of death in children under 5, including during the newborn period.2 Deaths from pneumonia in children have increased in the wake of the HIV epidemic in Africa. Most deaths occur early in the course of illness. Because severe pneumonia is usually related to bacterial infection, treatment has largely focused on various antibiotic strategies.

In the accompanying randomised controlled trial, Asghar and colleagues compare the effectiveness of injectable ampicillin plus gentamicin or chloramphenicol in children aged 2-59 months with severe pneumonia (defined by World Health Organization criteria).3 The trial took place in inpatient wards in tertiary care hospitals in Bangladesh, Ecuador, India, Mexico, Pakistan, Yemen, and Zambia. Significantly more children failed treatment with chloramphenicol at five days (16% v 11%, relative risk 1.43, …