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Comment & Response
April 15, 2019

World Health Organization Treatment Recommendations for Nonsevere Fast-Breathing Pneumonia Need to Be Updated—Reply

Author Affiliations
  • 1Save the Children, Seattle, Washington
  • 2Johns Hopkins School of Medicine, Baltimore, Maryland
  • 3University of Washington, Seattle, Washington
JAMA Pediatr. 2019;173(6):608-609. doi:10.1001/jamapediatrics.2019.0641

In Reply In our double-blind randomized noninferiority trial1 comparing placebo vs amoxicillin for nonsevere fast-breathing pneumonia in Malawian children aged 2 to 59 months, we were not able to show noninferiority of placebo but rather a slight yet statistically significant benefit from amoxicillin treatment.1 Our a priori trial hypothesis was consistent with the viewpoint of Woeltje et al; however, it was not supported by the data. While we agree most of these children do not require antibiotics to treat their fast-breathing pneumonia, a small number of children, even in this relatively low-risk population, appear to benefit from antibiotics based on our treatment failure criteria.

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