IndiaCLEN Multicentre Trial of Home Versus Hospital Oral Amoxicillin for Management of Severe Pneumonia in Children
Condition: Pneumonia
MeSH terms: Pneumonia
Study type: Interventional

Summary: 
      The purpose of this study is to determine the safety and efficacy of oral amoxicillin in
      treating WHO defined severe pneumonia(cough and fast breathing with lower chest indrawing) at
      home and at hospital using an open labelled multicentric prospective two-arm randomized
      clinical trial to determine the differences in failure of treatment with a 7 day course of
      oral amoxicillin administered for first 48 hours in the hospital in comparison to being sent
      home after enrolment, in children 3 to 59 months old who have severe pneumonia. The
      investigators developmental hypothesis were to test whether the community/home based oral
      amoxicillin is efficacious for treating severe pneumonia.
    

Detailed description: 
      Primary objectives of this trial are to assess the rates of treatment failure (as defined
      below) within the first 7 days or efficacy of a 7 day course of oral amoxycillin when
      administered at home in comparison to administration of oral amoxycillin for first 48 hours
      in the hospital.

      Treatment failure is defined as follows-

        -  Clinical deterioration of disease any time after enrollment: developing any sign of very
           severe disease such as persistent vomiting (vomiting repeated thrice within an hour due
           to any reason), central cyanosis, grunt, stridor, abnormally sleepy or difficult to
           wake, inability to drink, convulsions, or death.

        -  Change of antibiotic: due to persistent vomiting (vomiting of amoxycillin within 20
           minutes of administration; 3 such attempts), or, developing a co-morbid condition, or
           persisting fever > 98.6°F with lower chest indrawing even after 3rd day, or, fever alone
           at or after day 5, or, lower chest indrawing alone (non responsive to three doses of
           nebulization with bronchodilator) at or after day 5(as reported by the mother), or,
           persistence of fast breathing after day 7 which is non responsive to three doses of
           nebulisation with bronchodilator.

        -  Hospitalization: any time in home managed patients or clinical decision to extend the
           hospitalization longer than 48 hours in hospitalized children or re-hospitalization in
           those discharged after 48 hours from hospital. It could be related to pneumonia, or to
           therapy with amoxycillin [relatedness determined by the Data & Safety Monitoring Board
           (DSMB)].

        -  Children who need to restart antibiotics i.e. "failure of treatment", between day 8th
           and day 14th due to reappearance of any danger signs, lower chest indrawing or fast
           breathing which is non responsive to three trials of nebulization with bronchodilator.

        -  Serious adverse event considered possibly or probably related to amoxycillin.

        -  Left against medical advice (LAMA) or Voluntary withdrawal of consent from study from
           enrollment uptill day 14th.

        -  Loss to follow up uptill day 14th.

      Secondary objectives of this trial are to determine in children receiving oral amoxycillin
      for severe pneumonia, the following:

        -  Determine the proportion of children who need to restart antibiotics i.e. "failure of
           treatment", between day 8th and day 14th due to reappearance of any danger signs, lower
           chest indrawing or fast breathing which is non responsive to three trials of
           nebulization with bronchodilator.

        -  To identify clinical predictors at baseline and during the course of treatment that
           predicts "failure of oral treatment", from enrollment till day 14th.

        -  The costs of home and hospital management of severe pneumonia with oral amoxycillin.

        -  Left against medical advice (LAMA) or Voluntary withdrawal of consent from day 7th to
           day 14th.

        -  Loss to follow up from day 8th to day 14th.
    

Intervention name(s): Severe Pneumonia - Home Management
Intervention type(s): Other
Intervention description(s): For those randomized to home management, first dose will be administered by the mother/caretaker under supervision at health facility. The health personnel will assess the parameters like temperature, Respiratory rate, Lower chest indrawing, Pulse rate, clinical deterioration, Other signs eg. co-morbid conditions, Assessment of adherence, Adverse event when they visit the home after 24 hours, 72 hours and on day 8th.
Mothers will be advised to return to the healthcare facility at their scheduled times and any time during the study period if there is clinical deterioration. The symptoms and signs of clinical deterioration will be discussed with the mother as described in the "patient discharge counselling checklist". Mothers will be given a "study patient data card" with contact Numbers.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Efficacy of Treatment; Severe; home treatment; treatment at hospital