HOPE: Hospitalised pneumonia with extended treatment in young children to prevent long-term complications.

Associate Professor Cass Byrnes
University of Auckland & Starship Children’s Hospital 

What is the problem and who does it affect?

Respiratory disease is the third most common cause of death in New Zealand, and in a single year can result in more than 23,000 children hospitalised; pneumonia plays a large role in these figures.  New Zealand has startling rates of pneumonia as well as comparatively poor outcomes including permanent lung-scarring which leads to the respiratory condition bronchiectasis. One possible reason for such high rates is that those children presenting with pneumonia are inadequately treated.

There is no standardised, best-practice treatment model in the international guidelines and hence the current approach is rather ad hoc. The current recommendation is a short course of antibiotics, initially intravenously administered in hospital for 2-3 days, followed by 2-3 more days of in-home antibiotics upon discharge.

 

What is this project hoping to achieve?

Dr Cass Byrnes and her team are running a randomised controlled trial to determine whether a more effective treatment could be a longer course of antibiotics than the current standard of care in children that are known to be at higher risk of developing later disease.

Children under 5 years-of-age hospitalised with severe pneumonia will be randomly assigned to one of two groups. Both will have the regular course of intravenous antibiotics followed by: 1) 3 days of amoxicillin and 8 days of placebo, or; 2) longer course of oral amoxicillin for 13-14 days.

The primary outcome will be improved short-term (4 weeks after treatment) and longer-term clinical outcomes for those treated with a longer course. The use of placebo allows the team to discern patterns more accurately than if they were to just compare short versus long course. It is estimated that around 250 children will be recruited in total into one of the two groups.

The team will also be investigating certain inflammatory biomarkers which may be able to predict more severe bouts of the infection, allowing for a more tailor-made, often longer, courses of treatment.  This will inform international guidelines to benefit children hospitalised with pneumonia.