Amoxicillin for non-severe pneumonia in young children

Editor—The limitations of the paper on three v five days of antibiotic treatment for pneumonia merit additional emphasis.¹ The paper had an inadequate selection of indicators of treatment failure, an insufficiently discriminating treatment comparison (also pointed out by Borja and Rigau (next letter)), insufficient detailing of patients' history, dismissiveness towards caregivers' assessments, deficient survivor data, and difficulties in applying the conclusion of the study to broader populations.

If the conclusion was acted on, predictable deaths might occur, particularly in undiagnosed asthma. Roughly 54 000 people die in Britain each year from complications related to respiratory infections.

Skimping on antibiotics is a contested tactic. False economy is evident when patients are admitted to hospital and intubated for infections that could have been managed less invasively with appropriate antibiotics.

Skimping does not address the need for a new generation of antibiotics. No one seriously doubts that antibiotics are at times prescribed unnecessarily. But the tokenism is inappropriate, and dangerous skimping is likely to give a false comfort, which displaces the need for real action on the antibiotic problem.

Lobbying governments to support research and development in antibiotics and antiviral medicine and for adjunct changes in public policy is essential. A review of protocols for pharmaceutical approvals is also required, if the necessary developments for the future are to be viable.

Sacrificing people in the name of the species, when the real reason is poor economics, is no longer politically credible. We ought to be particularly sensitive, when it is a vulnerable group such as children, who are called on to make the sacrifice.