PediCAP is a research project focused on antibiotic therapy of severe and very severe childhood community acquired pneumonia

Through a collaboration between African and European partners it aims to provide data on optimal duration and oral step-down therapy for paediatric community acquired pneumonia.

Background

Community-acquired pneumonia is common and remains associated with substantial morbidity and mortality, especially in lower and middle-income countries. In Africa very severe pneumonia has a mortality of 10-15% among children. Childhood pneumonia is also a leading cause of hospitalization.

Antibiotics

Antibiotics are key to managing childhood pneumonia. WHO recommends injectable regimens, which cover a greater spectrum of bacterial pathogens but lead to longer hospital stays, high healthcare and societal costs, and to increased risks of nosocomial infections and acquisition of multidrug-resistant colonising bacteria. At present strong data to support a safe step-down to oral antibiotics, which would enable earlier discharge, are missing.

Capacity Building

PediCAP aims to establish an active community of practice between the research teams and collaborators which will ensure the skills are in place to deliver a high-quality trial and associated sub-studies. Furthermore, PediCAP’s long-term goal is to equip the participating teams in the South and the North with lasting capability to run, lead and design their own studies beyond this project. The Global Health Network (University of Oxford) will have a key role in achieving these goals by providing them with a variety of trainings and with tools to support their collaboration and professional development.

Project background

Community-acquired pneumonia is common and remains associated with substantial morbidity and mortality, especially in lower and middle-income countries. While standardising care is one important component in reducing mortality from severe pneumonia initially requiring hospitalisation, the antibiotics used are also clearly key. Optimising antibiotic treatment includes defining the right drug, right duration, right delivery and right dose. At present, strong data to support clinical decision-making for each of these factors in very severe/severe childhood pneumonia requiring inpatient care in lower and middle-income countries are lacking.

Goals of PediCAP

  • Fill the knowledge gaps on antibiotic therapy of community-acquired pneumonia in pediatric age, in terms of optimal duration, oral step-down schedule evaluating effectiveness, safety and selection of antimicrobial resistance
  • Evaluate economic impact of antibiotic therapy in terms of cost-effectiveness
  • Implement the infrastructure that links study sites in order to share knowledge, develop study specific and general research skill straining programme and promote capacity development initiatives.

Objectives of PediCAP

  • Optimize antibiotic treatment for childhood pneumonia in low middle-income countries by a randomised trial using an innovative duration - response design
  • Understand if the rate of clinical cure is superior with co-amoxiclav vs amoxicillin oral step-down therapy
  • Clarify the optimal antibiotic treatment duration that achieves high rates of clinical cure while minimising length of hospital stay, toxicity and antimicrobial resistance
  • Detect if optimal antibiotic therapy duration vary by key characteristics, such as age or severity, suggesting that antibiotic duration should be personalised to specific subgroups