Results from the PediCAP trial were published in The Lancet on July 23, 2026. The multi-country study demonstrated that switching children with severe pneumonia from injectable to oral antibiotics is as safe and effective as continuing injectable treatment.

The trial enrolled 1,101 children aged two months to six years with severe community-acquired pneumonia. Thirteen hospitals across South Africa, Uganda, Zambia, Zimbabwe, and Mozambique participated in the study.

Children who remained on injectable antibiotics received treatment for five days, consistent with World Health Organization guidelines. Rates of hospital readmission or death within 28 days were 6% for children switched to oral amoxicillin, 7% for those switched to oral amoxicillin-clavulanate, and 6% for those who remained on injectable antibiotics. Oral amoxicillin performed as well as the broader-spectrum antibiotic amoxicillin-clavulanate. A total antibiotic course of four to five days was as effective as longer durations.

"Our study shows that once a child is clinically improving, it is safe to switch from injectable to oral antibiotics, and complete treatment at home," Professor Julia Bielicki said. Bielicki is a Professor of Pediatric Infectious Diseases at City St George's, University of London.

The trial used a multi-arm, multi-stage design to evaluate both antibiotic type and duration of treatment simultaneously. In the PediCAP-A trial, children were randomized to one of 11 different treatment groups, including oral amoxicillin, oral co-amoxiclav, and continued intravenous antibiotics for five days. The PediCAP-A trial enrolled 1,101 children aged 2 months to 6 years with severe community-acquired pneumonia, with children randomized to different treatment durations ranging from 4 to 8 days.

In the PediCAP-B trial, a separate group of 202 children was randomized to receive either co-amoxiclav 4:1 or 14:1 for a total of 6 days of treatment, with the goal of assessing pharmacokinetics. "PediCAP is the first large-scale study to use our innovative multi-arm trial design to evaluate different antibiotics and treatment durations at the same time," Dr Michelle Clements said. Clements is the Principal Statistician at UCL Innovative Clinical Trials Unit.

The trial was coordinated by the Penta Foundation and conducted in partnership with the MRC Clinical Trials Unit at UCL. The trial was funded by the European Union's EDCTP2 programme. The trial was sponsored by the Penta Foundation.