Indiaclen Short Course Amoxycillin Therapy for Pneumonia With Wheeze
Status:
Completed
Trial end date:
2006-04-01
Target enrollment:
Participant gender:
Summary
Background: The current Integrated management of childhood infections (IMCI) algorithm
prescribes that children with wheeze and fast breathing presenting to first level health
facilities are given antibiotics if they continue to have fast breathing after two doses of
bronchodilator. The primary purpose of the algorithm is to prevent mortality due to bacterial
pneumonia. However, an unknown proportion of children managed in this fashion will have a
viral related wheezing illness or asthma rather than pneumonia. Although it is unlikely that
wheezing syndromes are a significant cause of mortality for children in developing countries,
these algorithms are likely to result in unnecessary administration of antibiotics as well as
inadequate treatment of recurrent wheezing illness. We do not have clear evidence about
whether antibiotics can be withheld in some categories of children with wheeze. It is clear
that wheeze can occur in bacterial infection and in addition co-infection with virus and
bacteria has been well demonstrated in several studies of pneumonia etiology in children.
Although some studies have found that children with more severe disease or who are blood
culture positive are more likely to be febrile at presentation, this sign is not sufficiently
sensitive or specific to determine whether antibiotics should be administeredSetting: The
study will be conducted in eight medical colleges situated in Lucknow, Nagpur, New Delhi,
Mumbai, Chennai, Trivandrum, Vellore, and Chandigarh. Design: This will be a multicentric,
randomized, double blind efficacy trial. . Hypothesis: The primary hypothesis is that the use
of oral amoxycillin for three days would be as effective, in terms of clinical cure on day 4
as compared to use of oral placeboMain objective: To compare the proportion of children aged
2 to 59 months presenting with non-severe pneumonia with wheeze whose respiratory rate does
not fall below the age specific cut-off after three doses of nebulized salbutamol, that
achieve clinical cure on day 4 on 3 day of treatment with oral amoxycillin versus
placebo.Inclusion criteria: Children aged 2-59 months with non-severe pneumonia based on WHO
criteria of respiratory rate above the age specific cut-off, audible / ausculatory wheeze.
Exclusion criteria: Children with severe disease, received any documented antibiotic
treatment in the past 48 hours, diagnosed asthmatic on maintenance therapy, complicating
acute non-pulmonary or chronic illness, known drug allergy, hospitalization in the past 2
weeks, history of measles within the last month, known immunodeficiency disorder, prior
enrollment in the study, residing in areas not accessible for follow-up or whose guardian
refuses to consent for the study. Sample size: Has been calculated to test the null
hypothesis. There will be 950 children in each arm. Thus each site is required to recruit a
minimum of 225 cases over 18 months.
Phase:
Phase 3
Details
Lead Sponsor:
King George's Medical University
Collaborator:
United States Agency for International Development (USAID)