Treatments and/or Procedures

Study Criteria

Inclusion Criteria:

Children aged 6 months to 10 years presenting with CAP will be eligible. CAP will be
defined if all of the four following numeric criteria are met:

  1. fever (>37.5 C axillary, > 37.7 C oral, or >38 C rectal) recorded in the ED or at home
     in the 48h prior to presentation;

  2. any one of:

       1. tachypnoea on exam (>60 bpm for age <1 y, >50 bpm for 1-2 y of age, >40 bpm for
          2-4 y of age, and >30 bpm for >4 y of age);

       2. cough on exam or by history;

       3. increased work of breathing on exam; or

       4. auscultatory findings (focal crackles, bronchial breathing, etc.) consistent with
          pneumonia;

  3. infiltrates on chest radiograph consistent with bacterial CAP as judged by the ED
     physician; and

  4. the attending ED physician diagnoses the child with primary CAP. (Children treated
     with systemic steroids in the ED will be presumed to have primary asthma exacerbation
     with possible infection and therefore will not meet inclusion criteria.)

Participants must be well enough to be treated as outpatients (discharged home by the ED
physician, adequate volume status, able to tolerate oral medication, oxygen saturation >
90%, no evidence of impending respiratory failure), and have no evidence of empyaema or
necrotizing pneumonia on chest radiograph.

Exclusion Criteria:

Children will be excluded if they have any of the following: cystic fibrosis, anatomic lung
disease, bronchiectasis, congenital heart disease, history of repeated aspiration or
velopharyngeal incompetence, malignancy, conditions requiring treatment with immune
suppressants, primary immunodeficiency, advanced HIV infection, prolonged admissions (>48
h) to hospital within the past 2 months, pneumonia previously diagnosed within the past
month, lung abscess diagnosed within the past six months, receipt of > 24 hours of
beta-lactam antibiotic therapy already received at presentation to the ED, receipt of at
least a 5 day course of amoxicillin < 72h prior to presenting to the ED, receipt of an
intravenous cephalosporin or azithromycin in the ED, or suspected allergy to penicillin.
Children will not be eligible to participate more than once.