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Three day versus five day treatment with amoxicillin for non-severe pneumonia in young children: a multicentre randomised controlled trial

BMJ 2004; 328 doi: (Published 01 April 2004) Cite this as: BMJ 2004;328:791
  1. ISCAP Study Group (sawasthi{at}
  1. Correspondence to: Professor Shally Awasthi, Department of Paediatrics and Clinical Epidemiology, King George's Medical University, Lucknow (UP)-226003, India


    Objective To assess the efficacy of three days versus five days of treatment with oral amoxicillin for curing non-severe pneumonia in children.

    Design Randomised, double blind, placebo controlled multicentre trial.

    Setting Outpatient departments of seven referral hospitals in India.

    Participants 2188 children aged 2-59 months, 1095 given three days of treatment and 1093 given five days.

    Intervention Oral amoxicillin 31-54 mg/kg/day in three divided doses.

    Main outcome measures Treatment failure: defined as development of chest indrawing, convulsions, drowsiness, or inability to drink at any time; respiratory rate above age specific cut points on day 3 or later; or oxygen saturation by pulse oximetry < 90% on day 3.

    Results The clinical cure rates with three days and five days of treatment were 89.5% and 89.9%, respectively (absolute difference 0.4 (95% confidence interval - 2.1 to 3.0)). Adherence to treatment regimen was 94% and 85% for three day and five day treatments, respectively. Loss to follow up was 5.4% by day 5. There were no deaths, 41 hospitalisations, and 36 minor adverse reactions. There were 225 (10.3%) clinical failures and 106 (5.3%) relapses, and rates were similar in both treatments. At enrolment, 513 (23.4%) children tested positive for respiratory syncytial virus, and Streptococcus pneumoniae and Haemophilus influenzae were isolated from the nasopharynx in 878 (40.4%) and 496 (22.8%) children, respectively. Clinical failure was associated with isolation of respiratory syncytial virus (adjusted odds ratio 1.95 (95% confidence interval 1.0 to 3.8)), excess respiratory rate of > 10 breaths/minute (2.89 (1.83 to 4.55)), and non-adherence with treatment at day 5 (11.57 (7.4 to 18.0)).

    Conclusions Treatment with oral amoxicillin for three days was as effective as for five days in children with non-severe pneumonia.


    • Funding US AID through INCLEN and IndiaClen.

    • Competing interests None declared.

    • Ethical approval The ethics committees of the participating institutions approved the study.

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