Methods for conducting a double-blind randomized controlled clinical trial of three days versus five days of amoxicillin dispersible tablets for chest indrawing childhood pneumonia among children two to 59 months of age in Lilongwe, Malawi: a study protocol

Amy Sarah Ginsburg, Susanne J. May, Evangelyn Nkwopara, Gwen Ambler, Eric McCollum, Tisungane Mvalo, Ajib Phiri, Norman Lufesi, Salim Sadruddin

Research output: Contribution to journalArticle

Abstract

Background: Pneumonia is the leading infectious cause of death in children under 5 years of age around the globe. In addition to preventing pneumonia, there is a critical need to provide greater access to appropriate and effective treatment. Studies in Asia have evaluated the effectiveness of 3 days of oral amoxicillin for the treatment of fast-breathing pneumonia; however, further evidence is needed to determine if 3 days of oral amoxicillin is also effective for the treatment of chest indrawing pneumonia. Methods: This is a double-blind, randomized, non-inferiority trial with the objective to assess the effectiveness of shorter duration amoxicillin dispersible tablet (DT) treatment of chest indrawing childhood pneumonia in a malaria-endemic region of Malawi. The primary objective of this study is to determine whether 3 days of treatment with oral amoxicillin DT in HIV-uninfected Malawian children two to 59 months of age with chest indrawing pneumonia is as effective as 5 days of treatment. The study will enroll 2000 children presenting to Kamuzu Central or Bwaila District Hospitals in Lilongwe, Malawi. Each child will be randomized to either 3 days of amoxicillin DT followed by 2 days of placebo DT or 5 days of amoxicillin DT. Children in the study will be hospitalized for 48 h after enrollment and will have scheduled study visits at Days 2, 4, 6 and 14. Treatment failure by Day 6 is the primary outcome. We hypothesize that the rates of treatment failure will be similar in both arms and that 3 days of treatment will be non-inferior to 5 days of amoxicillin DT for chest indrawing pneumonia using a relative non-inferiority margin of 1.5. This trial was approved by the Western Institutional Review Board and Malawi College of Medicine Research and Ethics Committee. Discussion: Given the paucity of data from Africa, African-based research is necessary to establish appropriate duration of treatment with amoxicillin DT for chest indrawing childhood pneumonia in malaria-endemic settings in the region. An expanded evidence base will contribute to future iterations of World Health Organization Integrated Management of Childhood Illness guidelines.

Original languageEnglish (US)
Article number476
JournalBMC Infectious Diseases
Volume18
Issue number1
DOIs
StatePublished - Sep 21 2018

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Malawi
Amoxicillin
Tablets
Pneumonia
Thorax
Randomized Controlled Trials
Research Ethics Committees
Therapeutics
Treatment Failure
Malaria
District Hospitals
Cause of Death
Respiration
Arm
Placebos
Medicine
HIV
Guidelines

Keywords

  • Africa
  • Amoxicillin
  • Chest indrawing
  • Childhood pneumonia
  • Treatment failure

ASJC Scopus subject areas

  • Infectious Diseases

Cite this

Methods for conducting a double-blind randomized controlled clinical trial of three days versus five days of amoxicillin dispersible tablets for chest indrawing childhood pneumonia among children two to 59 months of age in Lilongwe, Malawi : a study protocol. / Ginsburg, Amy Sarah; May, Susanne J.; Nkwopara, Evangelyn; Ambler, Gwen; McCollum, Eric; Mvalo, Tisungane; Phiri, Ajib; Lufesi, Norman; Sadruddin, Salim.

In: BMC Infectious Diseases, Vol. 18, No. 1, 476, 21.09.2018.

Research output: Contribution to journalArticle

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AU - McCollum, Eric

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AU - Phiri, Ajib

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