Testing Oral Antibiotics Versus Injectable Antibiotics in the Treatment of Severe Pneumonia (APPIS)

The World Health Organization (WHO) currently recommends that children with severe pneumonia be admitted to a health facility for antibiotic injections and supportive care while children with non-severe pneumonia be treated in the community (outside of health facilities) with oral antibiotics.

The death rate for pneumonia is substantially higher in poor countries. Limited access to health care, delays in diagnosis and treatment, misdiagnosis, and concurrent co-morbid conditions such as malnutrition contribute to the poor outcomes for children with pneumonia in the developing world. In an effort to get appropriate care to sick children sooner, Center for Global Health & Development (CGHD) researchers and collaborators hypothesized that children with less serious, but still severe, pneumonia might do well with an oral antibiotic that could be administered at home. To test this hypothesis, the CGHD and collaborators conducted a study at nine sites in eight countries in Africa, Asia, and Latin America.

More than 1,700 children who had been brought to tertiary care hospitals with severe pneumonia were enrolled into the study. Each child was randomized to receive either an oral antibiotic (amoxicillin) or antibiotic injections (penicillin). The study found that the children receiving oral antibiotics fared equally as well as those receiving injectables. An expert panel convened by the WHO commended these findings. However, they concluded that the safety and efficacy of home-based care needed to be directly tested and established. The CGHD agreed to take its proof to the next level with further study.

Boston University is a member of the World Health Organization Collaborating Center of Pharmaceutical Policy (WHOCCPP).

This project is one activity of the CGHD’s Child and Family Applied Research project (CFAR).

Project Details

Principal Investigator Donald Thea
  • Emmanuel Addo-Yobo, Komfo-Anokye Teaching Hospital, School of Medicine, University of Science and Technology, Kumasi, Ghana
  • Dang Duc Anh, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
  • Hesham El-Sayed, Faculty of Medicine, Suez Canal University Ismailia, Egypt
  • Shamim Qazi, World Health Organization
  • Samir Saha, Dhaku Shishu, Bangladesh Institute of Child Health, Dhaka
  • Tran Anh Tuan, Children Hospital No 1, Ho Chi Minh City, Vietnam
Country(ies) Colombia, Ghana, India, Mexico, Pakistan, South Africa, Vietnam, Zambia
Donor/Funder USAID logo United States Agency for International Development (USAID)