Supportive Treatment and Antibiotics for Mild Pediatric Pneumonia

National guidelines make two recommendations for treatment of young children with mild pneumonia - one to avoid routine antibiotics and another to use narrow-spectrum antibiotics. No studies have compared the effectiveness of these two approaches. This pilot study will evaluate study processes and feasibility of a future clinical trial that proposes to test whether low-risk children managed as outpatients with mild community-acquired pneumonia (CAP) treated with supportive treatment without antibiotics will have a similar clinical response, with fewer adverse effects, compared with those treated with a supportive treatment plan that includes antibiotics.

Inclusion Criteria:Age 12-71 months; andDiagnosis of CAP, defined using established criteria:Signs and symptoms of lower respiratory tract infection (LRTI), defined as any of the following:new or different cough; ornew or different sputum production; orchest pain; ordyspnea/shortness of breath; ordocumented tachypnea; orabnormal findings consistent with LRTI on physical examination (e.g., crackles/rales, rhonchi, wheezing) andFever, defined as tactile temperature at home or measured temperature ≥38ºC rectal, ≥37.7ºC oral, or ≥37.5ºC axillary, andClinician diagnosis of CAP,Intention to treat as an outpatient after ED/primary care visit, andMild disease, defined as lack of respiratory distress per adapted Pediatric Infectious Diseases Society/Infectious Diseases Society of America criteria: none of the following: dyspnea, concerning retractions per treating clinician, grunting, nasal flaring, apnea, altered mental status, SpO2<93% in room air, or respiratory rate >50 breaths per minute for ages 12-24 months or respiratory rate > 40 breaths per minute if age>24 months.Exclusion Criteria:Hospitalization within one-month preceding study visit; orIncomplete immunization status (<2 doses of Hib and pneumococcal vaccines); orChronic complex medical conditions (chronic heart disease followed by cardiology, chronic lung disease (not including asthma), congenital airway or lung malformations, cystic fibrosis, tracheostomy tube, requiring positive-pressure ventilation, neuromuscular disorders affecting the lungs or chest wall); orConditions that compromise the immune system (HIV with CD4 count less than 400, primary immunodeficiency, asplenia, sickle cell disease, receipt of hematopoietic stem cell or solid organ transplant, cancer on active chemotherapy, immunosuppressive agents, daily corticosteroids for more than 7 consecutive days in past 14 days); orSystemic antibiotic receipt (more than 1 dose) within the previous two weeks of CAP diagnosis; orRadiographic findings of a consolidation of a concerning size or complexity in the view of the treating clinician; orRadiographic findings of complicated pneumonia (pleural effusion larger than trace in size, empyema, [complex/septated collection] abscess, necrotic lung disease); orPneumonia known to be due to bacterial source at the time of enrollment, as documented by blood culture or PCR if available, or another clear source of bacterial infection requiring immediate antibiotics; orDiagnosed with pneumonia in the previous month; orProvider diagnosis of aspiration pneumonia; orSevere (type 1) drug allergy to amoxicillin; orAny other condition that in the judgement of investigators or the clinical team could affect safety of the subject; orNo access to a telephone or video technology for follow-up; orCurrent enrollment in another clinical trial of an investigational agent; orPrevious enrollment in this trial; orParent/guardian non-English or non-Spanish speaking; orKnown allergy to milk and/or red dye.