Improving treatment for children with community-acquired pneumonia in emergency rooms

Is this trial a fit for you?

A plain-English reading of the study's rules. Only the study team can confirm whether you qualify.

What this trial studies

This interventional trial compares a novel care pathway against usual care for children diagnosed with non-severe community-acquired pneumonia in participating pediatric emergency departments. Eligible children are 6 months to 18 years old, have fever and respiratory signs consistent with pneumonia, and are well enough to be discharged; children with chronic lung disease, cystic fibrosis, immunodeficiency, malignancy, or other major comorbidities are excluded. The pathway is designed to help clinicians better target antibiotic use given the high frequency of viral and mixed infections in pediatric CAP. The trial is being conducted at three Canadian pediatric centers in Calgary, Edmonton, and Vancouver to measure whether the pathway reduces unnecessary antibiotic prescribing while maintaining safe clinical outcomes.

Why it matters

Who can join: the full rules

Inclusion Criteria:

Children aged 6 month to 18 years presenting to the Emergency Department who are diagnosed with CAP and are well enough to be discharged home (i.e. 'non-severe' CAP) will be eligible. They must have a fever (on exam or by history) and at least one of:

* Tachypnoea measured at triage (\>60 bpm for age \<1, \>50 for 1-2 years of age, \>40bpm for 2-4 years of age, and \>30bpm for \>4 years of age)
* Cough on exam or by history
* Increased work of breathing on exam
* Auscultatory finding (focal crackles, bronchial breathing, etc.) consistent with CAP

Exclusion Criteria:

Children will be excluded if they have any of the following

* Cystic Fibrosis
* Anatomic Lung Disease
* Bronchiectasis
* Chronic Lung Disease requiring home oxygen or home ventilation
* Congenital heart Disease (requiring specific medical treatment or with exercise restrictions),
* History of repeated aspiration/velopharyngeal incompetence
* Malignancy
* Immunodeficiency (primary, acquired or iatrogenic)
* Pneumonia previously (clinically) diagnosed within the past month (that was presumed to have resolved prior to the episode prompting the current visit to the ED)
* Lung abscess within the past 6 months
* Children who present with ongoing fever after 4 days of amoxicillin, cefprozil, cefuroxime, levofloxacin, moxifloxacin or doxycycline are not eligible; as this duration of therapy with these drugs would normally be sufficient to treat bacterial CAP, a different approach would be required (ie. the care pathway as written might not be appropriate).
* Children will not be eligible to participate more than once

Where it's running

• Alberta Children's hospital
  Calgary, Alberta, Canada Recruiting
• Children's Hospital of Eastern Ontario (CHEO)
  Ottawa, Ontario, Canada Recruiting
• Stollery Children's Hospital
  Edmonton, Alberta, Canada Not yet recruiting
• BC Children's Hospital
  Vancouver, British Columbia, Canada Not yet recruiting
• McMaster Children's Hospital
  Hamilton, Ontario, Canada Not yet recruiting
• The Hospital for Sick Children
  Toronto, Ontario, Canada Not yet recruiting

Study contacts

• Study coordinator: Jeffrey Pernica, MD
• Email: pernica@mcmaster.ca
• Phone: 905-521-2100

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Other studies for the same condition or treatment. Recruiting studies are listed first.

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How to take part

1. Review the eligibility criteria above with your treating physician.
2. Check the official listing on ClinicalTrials.gov for the latest contact details and recruitment status.
3. Contact the study coordinator or principal investigator to ask for pre-screening. Pre-screening is free and never obligates you to enroll.