Overview

This trial is active, not recruiting.

Conditions bacterial infection, sepsis, infant, newborn
Treatment ceftriaxone, procaine penicillin and gentamicin, oral cotrimoxazole and gentamicin
Phase phase 3
Sponsor Aga Khan University
Start date November 2003
End date December 2005
Trial size 426 participants
Trial identifier NCT00189384, SC/SNL 11150-0902-50001-269

Summary

Approximately one-third of neonatal deaths in developing countries are due to infections acquired through the birth canal and/or exposure to an unclean environment soon after birth. Current World Health Organization recommendations for the management of infants younger than 2 months of age who have serious bacterial infections involve hospitalization and parenteral therapy for at least 10 days with antibiotic regimens containing penicillin or ampicillin combined with an aminoglycoside.However, in many settings throughout the developing world, this is not currently possible, nor is this standard of care likely to be feasible in the near future. Several studies have reported that for a variety of sociocultural reasons many families are unable or unwilling to access hospital-based care and their sick young infants do not get hospitalized, and instead, receive a variety of home-based antibiotic therapies, or none at all. In our community field sites, approximately 70% of families refuse hospital referral for a sick newborn, despite provision of transport.

Thus, there is an urgent need to define the role of community/first-level facility-based care versus hospitalization for the management of young infants with serious bacterial infections, and the potential for community-based parenteral antibiotics as an alternative strategy in resource poor areas with high neonatal mortality rates. Bang and colleagues have demonstrated significant reductions in neonatal mortality from infections in an underdeveloped rural district in Maharashtra, India by a field-based case management approach which used oral cotrimoxazole and intramuscular gentamicin given for 7 days as treatment for neonates with sepsis.

This study is an equivalence randomized controlled trial (RCT) comparing once daily IM ceftriaxone injection to once daily IM procaine penicillin and gentamicin injection, to once daily intramuscular gentamicin injection and twice daily oral cotrimoxazole, given for 7 days in babies with clinically-diagnosed possible serious bacterial infection (pneumonia, or sepsis with or without local infections such as skin or umbilical infections) whose families refused referral to a hospital. After supplementary informed consent, patients meeting specific inclusion and exclusion criteria are randomly allocated to one of the three regimens being tested. The study hypothesis is that all 3 regimens will perform equally well in the treatment of sepsis in a first-level facility setting.

United States No locations recruiting
Other Countries No locations recruiting

Study Design

Allocation randomized
Intervention model single group assignment
Masking open label
Primary purpose treatment

Primary Outcomes

Measure
The primary outcome of success rate will be defined as patient cured or improved with the regimen assigned to, on day 7 of therapy.
time frame:

Secondary Outcomes

Measure
Completion rates
time frame:
Adverse events
time frame:
Relapse rates
time frame:

Eligibility Criteria

Male or female participants up to 59 days old.

Inclusion Criteria: - Age 0-59 days presenting to Young Infant community study site - Clinical diagnosis of possible serious bacterial infection by study physician according to specified clinical criteria - Parents refuse to accept referral care and sign (or thumb imprint) document stating this. - Parents consent to community centre-based intramuscular antibiotic injections Exclusion Criteria: - Age over 59 days - Presence of severe jaundice diagnosed clinically or by laboratory investigation (bilirubin > 12 g/dl in term and > 7 in pre-term baby). - Presence of obvious meningitis (bulging fontanelle, observed seizures) - Patient previously enrolled in antibiotic therapy trial - Parents accept hospital referral - Parents do not consent to any injectable therapy

Additional Information

Official title Randomized Controlled Trial of Intramuscular Ceftriaxone Versus Procaine Penicillin Versus Cotrimoxazole and Gentamicin for Management of Serious Bacterial Infections in Young Infants in Community Settings
Principal investigator Anita KM Zaidi, MBBS, SM
Trial information was received from ClinicalTrials.gov and was last updated in September 2006.
Information provided to ClinicalTrials.gov by Aga Khan University.