Can You CAP-IT? Amoxicillin dose and duration for pediatric CAP

Reviewed by Erica Stohs, MD, MPH, University of Nebraska

“CAP-IT,” a recent multicenter, randomized controlled trial, evaluated children 6 months and older with community acquired pneumonia (CAP) discharged from the ED or hospital. The topline results showed that amoxicillin 35-50 mg/kg/day was noninferior to 70-90 mg/kg/day and 3-day duration was noninferior to 7-days in preventing antibiotic re-treatment within 4 weeks.

Investigators from the 29 hospitals in the U.K. and Ireland randomized over 800 children with guideline-defined clinical CAP to low-dose vs high-dose amoxicillin and 3- vs 7-day duration. The primary outcome was clinically indicated antibiotic re-treatment for a respiratory infection within 28 days, which occurred in 12.6% vs 12.4% for low-dose vs high dose amoxicillin arms, respectively. The primary outcome was also the same, 12.5%, for both 3-day and 7-day duration arms.

Among secondary outcomes, cough and cough-induced sleep disturbance lasted longer in the shorter duration group. However, the shorter duration group reported fewer adverse events and were more likely to comply with the regimen. Importantly, baseline Streptococcus pneumoniae colonization and penicillin susceptibilities were available in over 75% of the participants. Colonization with S. pneumoniae was seen in 42% of participants; penicillin non-susceptibility was seen in 17%.

The “CAP-IT” trial offers pediatric providers data to support shortening CAP therapy duration. When generalizing results of this study, readers should consider local S. pneumoniae PCN susceptibilities.


Bielicki JA, et al. Effect of amoxicillin dose and treatment duration on the need for antibiotic re-treatment in children with community-acquired pneumonia. JAMA 2021;326(17):1713-1724. doi:10.1001/jama.2021.17843

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