Recruiting

SNAP vs. Antibiotics

Sponsor:

Ann & Robert H Lurie Children's Hospital of Chicago

Code:

NCT06986148

Conditions

Community Acquired Pneumonia (CAP)

Community Acquired Pneumonia

Eligibility Criteria

Sex: All

Age: 1 - 5

Healthy Volunteers: Not accepted

Interventions

Immediate Antibiotic Prescribing Group Instructions

Safety Net Antibiotic Prescribing (SNAP) Group Instructions

Study Details

Brief summary:

The goal of this clinical trial is to determine if a "watch and wait" antibiotic strategy, called Safety Net Antibiotic Prescribing (SNAP), can safely reduce unnecessary antibiotic use while ensuring that children diagnosed with community-acquired pneumonia get better from their illness. The main aims of this study are:

  • To compare the effectiveness of SNAP versus immediate antibiotic prescribing in children with mild community-acquired pneumonia (CAP)
  • To identify which patient groups benefit most from the SNAP strategy
  • To identify factors that shape implementation of each prescribing strategy.

Researchers will compare the SNAP strategy (where parents or guardians are instructed to give antibiotics only if their child is not improving after 72 hours, or sooner if they are worsening) to the immediate antibiotic prescribing strategy (where parents or guardians are instructed to give the antibiotics right after their healthcare visit) to see if one strategy is more effective than the other.

Participants will be randomly assigned to either the immediate antibiotic group or the SNAP group at enrollment. Participation lasts 14 days with follow-up surveys at 4, 7, and 14 days after enrollment.

Conditions

Community Acquired Pneumonia (CAP)

Community Acquired Pneumonia

Study ID

NCT06986148

Start date

Sep 9, 2025

Status verified date

Jan, 2026

Completion date

Jul 16, 2029

Anticipated

Primary completion date

Jun 30, 2029

Anticipated

Eligibility Criteria

Eligibility Criteria

Sex: All

Age: 1 - 5

Healthy Volunteers: Not accepted

Inclusion Criteria:

  • Aims 1 and 2:
  • Presenting with signs and symptoms of lower respiratory tract infection
  • Diagnosed with community-acquired pneumonia (CAP) by a clinician
  • The treating clinician intends to prescribe antibiotics for CAP, AND
  • Well enough, as determined by the clinician at the time of the study enrollment visit, to be managed as an outpatient.
  • Aim 3:
  • Parent/guardian of child enrolled in the trial, OR
  • Clinician who makes prescribing decision at the study site, OR
  • Other practice-based parties (e.g. nurses, pharmacists, medical assistants, practice leaders) at study sites who can comment on the implementation of each prescribing strategy.

Exclusion Criteria:

  • Aims 1 and 2:
  • Hospitalization within the previous 7 days
  • Oxygen saturation below 90%, if measured
  • Incomplete immunization status (e.g., lacking at least 3 doses of the pneumococcal vaccines, typically given as part of the 2-, 4-, and 6-month vaccinations)
  • Chronic medical conditions that increase the risk of bacterial CAP (e.g., chronic lung disease, cystic fibrosis, sickle cell disease),
  • Substantially immunocompromised status (e.g., immunodeficiency, active cancer treatment, organ transplant with concurrent immunosuppressive agents)
  • Receipt of oral or parenteral antibiotics within the previous 7 days
  • Diagnosis of complicated pneumonia (e.g., empyema, lung abscess)
  • Known bacterial source of infection warranting immediate antibiotics
  • Pneumonia diagnosis within the previous 6 months, OR
  • Prior enrollment in the trial
  • Inability of the parent or guardian to speak English or Spanish
  • Aim 3:
  • Inability of the parent or guardian to speak English

Study Design

Enrollment

2000 participants

Anticipated

Allocation

Randomized

Intervention Model

Parallel Assignment

Primary purpose

Other

Interventions and Outcome Measures

Arms

active comparator: Immediate Antibiotic Prescribing

For participants randomized to this arm, a prescription is filled and the antibiotic is administered right after the index visit.

other: Safety Net Antibiotic Prescribing (SNAP)

For participants randomized to this arm, a prescription is provided, but the patient is instructed not to take the antibiotic unless the child is not improving at 72 hours or sooner if getting worse.

Interventions

Immediate Antibiotic Prescribing Group Instructions

Children randomized to the immediate antibiotic prescribing group will receive an antibiotic prescription with instructions to fill and administer the antibiotics.

Safety Net Antibiotic Prescribing (SNAP) Group Instructions

For children randomized to the SNAP group, their parents or guardians will receive a prescription for antibiotics, but will be told not to administer the antibiotic unless their child's symptoms show no improvement at 72 hours or worsen within 72 hours.

Primary outcome measure

  • Clinical Improvement [ Time Frame: From enrollment to day 7 ]
  • Antibiotic Use [ Time Frame: From enrollment to day 7 ]

Central Contacts and Locations

Central contacts

Todd Florin, MD, MSCE

312-227-6675taflorin@luriechildrens.org

Julia Szymczak, PhD

julia.szymczak@hsc.utah.edu

Locations

Children's Healthcare of Atlanta

Recruiting

Atlanta, Georgia, United States, 30329

Contacts

Laura Benedit

404-785-5437laura.benedit@choa.org

Principal Investigator:

Claudia Morris, MD

Ann & Robert H. Lurie Children's Hospital of Chicago

Recruiting

Chicago, Illinois, United States, 60611

Contacts

Anne Lakes

312-227-2488alakes@luriechildrens.org

Isheeta Jaria

312-227-1090ijaria@luriechildrens.org

Principal Investigator:

Todd Florin, MD, MSCE

Children's Hospital of Philadelphia

Recruiting

Philadelphia, Pennsylvania, United States, 19104

Contacts

Kellyann Baxendell

267-289-2906baxendellk@chop.edu

Jessica Albert

albertj1@chop.edu

Principal Investigator:

Jeffrey Gerber, MD, PhD

Primary Children's Hospital

Recruiting

Salt Lake City, Utah, United States, 84108

Contacts

Toni Harbour

801-587-7430toni.harbour@hsc.utah.edu

Jessica Jung

jessica.jung@hsc.utah.edu

Principal Investigator:

Sarah Becker, DO

More Information

Sponsor

Ann & Robert H Lurie Children's Hospital of Chicago

Last update posted

Jan 27, 2026

Last verified

Jan, 2026

Keywords

  • Community-acquired Pneumonia
  • Pediatric Respiratory Diseases
  • Pneumonia
  • Antibiotic Use
  • SNAP

Trial information was received from ClinicalTrials.gov and was last updated on 2026-09-09. This information was provided to ClinicalTrials.gov by Ann & Robert H Lurie Children's Hospital of Chicago on 2026-01-27.