Children who are treated at home for severe pneumonia do just as well as youngsters admitted to hospital, a finding that could be a boon for health care and medical costs in poor countries.
US researchers, who publish this study in Saturday's issue of The Lancet, looked at the outcome of 2,037 Pakistani children aged between three and 59 months who had severe pneumonia.
Roughly half of the children were treated in hospital, receiving the standard antibiotic ampicillin through an intravenous drip, and the other half were treated at home, receiving amoxicillin in an oral syrup.
The rate of treatment failures was almost the same, at around eight percent in both groups.
Five children died within 14 days of the start of treatment, one of them in the home-based group and the other four in the hospitalised group.
None of these deaths could be associated with the treatment given to them, and none of the other children in the trial had any serious adverse effects from the drugs says the study.
The authors, led by Donald Thea of Boston University School of Public Health, call on the UN's World Health Organisation (WHO) to overhaul its recommendation that children with severe pneumonia without other complications be hospitalised.
"Home treatment with high-dose oral amoxicillin is equivalent to currently recommended hospitalisation and parenteral ampicillin for treatment of severe pneumonia without underlying complications," they say.
Hospitalisation in poor countries is often difficult because of poor transport, cost and distance from the child's home, the doctors note. In addition, bad hygiene in the hospital may present a hazard of its own.
If a child is treated at home with the help of a community medical worker, many deaths could be prevented and costs to the national medical system could be reduced, they argue.
Pneumonia leads to the death of more than two million children each year, according to figures issued in 2006 by the UN's Children's Fund (UNICEF).