Infant Severe Sepsis and Bacterial Meningitis in Malawi
Status:
Completed
Trial end date:
2015-04-01
Target enrollment:
Participant gender:
Summary
This study aims to improve the outcome of infants (<2 months) with severe sepsis and
meningitis at the Queen Elizabeth Central Hospital, Blantyre, Malawi.
Currently WHO recommends the treatment of infant severe sepsis and bacterial meningitis with
14 to 21 day course of penicillin and gentamicin as first line. The second line treatment is
cefotaxime or ceftriaxone.
Severe bacterial infections are common in infants under 2 months of age and the mortality is
very high (~50%). There are several reasons for this; one is that the first line antibiotics
used are no longer as effective as they used to be. Bacterial resistance to the first line
antibiotics has increased and some infections especially of the central nervous system may
only be partly treated and not eradicated by present therapy. First line treatment is cheap
and available but requires 4 injections a day, for at least 14 days, a total of 58
injections. Many mothers find this number too much and abscond. The investigators second line
therapy is ceftriaxone which is also available and cheap and the advantage of being given as
a daily injection. The disadvantage is that it can cause (reversible) jaundice particularly
in premature babies and it must not be given with calcium products. The investigators do not
give calcium to the investigators infants as the investigators cannot routinely check
electrolytes. All the most common causes of bacterial meningitis in this age group in the
investigators setting are sensitive to ceftriaxone.
The investigators wish to undertake an open randomized trial of penicillin and gentamicin v
ceftriaxone as first line treatment for infant meningitis. The investigators are able to
monitor for side effects.
The investigators hypothesise that the ceftriaxone arm will have 20% less deaths that the
penicillin and gentamicin group.