{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T16:35:51Z","timestamp":1791995751674,"version":"4.4.0"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2018,12,28]],"date-time":"2018-12-28T00:00:00Z","timestamp":1545955200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004423","name":"World Health Organization","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004423","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004423","name":"World Health Organization","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004423","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,7,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Globally, most deaths due to childhood pneumonia occur at the community level. Some countries are still using oral co-trimoxazole, despite a World Health Organization recommendation of oral amoxicillin for the treatment of fast-breathing pneumonia in children at the community level.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted an unblinded, cluster-randomized, controlled-equivalency trial in Haripur District, Pakistan. Children 2\u201359 months of age with fast-breathing pneumonia were treated with oral amoxicillin suspension (50 mg\/kg\/day) for 3 days in 14 intervention clusters and oral co-trimoxazole suspension (8 mg trimethoprim\/kg and 40 mg sulfamethoxazole\/kg\/day) for 5 days in 14 control clusters by lady health workers (LHW). The primary outcome was treatment failure by day 4 for intervention clusters and by day 6 for control clusters. The analysis was per protocol.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Out of the 15 749 cases enrolled in the study, 9153 cases in intervention and 6509 cases in control clusters were included in the analysis. Treatment failure rates were 3.6% (326) in intervention clusters and 9.1% (592) in control clusters. After adjusting for clustering, the risk of treatment failure was lower in intervention clusters (risk di\ufb00erence [RD] -5.5%, 95% confidence interval [CI] -7.4\u2013-3.7%) than in control clusters. Children with incomplete adherence had a small increase in treatment failure versus those with complete adherence (RD 2.9%, 95% CI 1.6\u20134.1%). No deaths or serious adverse events occurred.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>A 3-day course of oral amoxicillin, administered by LHWs, is an effective and safe treatment for fast-breathing pneumonia in children 2\u201359 months of age. A shorter course of amoxicillin improves adherence to therapy, is low in cost, and puts less pressure on antimicrobial resistance.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical Trials Registration<\/jats:title>\n                  <jats:p>ISRCTN10618300.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciy918","type":"journal-article","created":{"date-parts":[[2018,11,22]],"date-time":"2018-11-22T07:12:21Z","timestamp":1542870741000},"page":"397-404","source":"Crossref","is-referenced-by-count":17,"title":["Comparison of 3 Days Amoxicillin Versus 5 Days Co-Trimoxazole for Treatment of Fast-breathing Pneumonia by Community Health Workers in Children Aged 2\u201359 Months in Pakistan: A Cluster-randomized Trial"],"prefix":"10.1093","volume":"69","author":[{"given":"Salim","family":"Sadruddin","sequence":"first","affiliation":[{"name":"World Health Organization, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibad ul Haque","family":"Khan","sequence":"additional","affiliation":[{"name":"Monitoring and Evaluation Consultant, Islamabad, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew P","family":"Fox","sequence":"additional","affiliation":[{"name":"Department of Global Health, Boston University School of Public Health, Massachusetts"},{"name":"Department of Epidemiology, Boston University School of Public Health, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdul","family":"Bari","sequence":"additional","affiliation":[{"name":"Independent Consultant, Islamabad"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Attaullah","family":"Khan","sequence":"additional","affiliation":[{"name":"Directorate General, Health Services, Khyber Pakhtunkhwa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald M","family":"Thea","sequence":"additional","affiliation":[{"name":"Department of Global Health, Boston University School of Public Health, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanullah","family":"Khan","sequence":"additional","affiliation":[{"name":"White Ribbon Alliance, Islamabad"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inamullah","family":"Khan","sequence":"additional","affiliation":[{"name":"United Nations International Children\u2019s Emergency Fund Peshawar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ijaz","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Health Sector Reform Unit, Department of Health, Khyber Pakhtunkhwa, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shamim A","family":"Qazi","sequence":"additional","affiliation":[{"name":"Independent Consultant, Geneva, 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