Testing Which Antibiotics Work Best for the Treatment of Very Severe Pneumonia in Infants (SPEAR)

Project Description

The common treatment for children with the danger signs of very severe pneumonia, such as inability to feed or seizures, is to refer them to a hospital where they can receive supplemental oxygen and antibiotics. But which antibiotic is best for treating very severe pneumonia? The World Health Organization’s global guidelines recommend chloramphenicol for children 2 to 59 months of age.

To confirm the validity of this recommendation, Dr. Donald Thea at the Center for Global Health & Development and colleagues at collaborating institutions compared injectable chloramphenicol to injectable ampicillin plus gentamicin in children at hospitals in seven countries in Asia, South America, North America, and Africa.

The study showed that almost 50% more children failed treatment with chloramphenicol by the fifth day than those who received ampicillin and gentamicin. There are a variety of possible reasons for this outcome. The chloramphenicol may not have been able to kill the bacterium Streptococcus pneumoniae and had limited effect against Staphylococcus aureus; both of these bacteria were responsible for a significant number of pneumonia cases in the trial.

Based on these findings, the CGHD and its collaborators recommended that the WHO should revisit its guidelines for the treatment of very severe pneumonia. In addition, the analysis of the data gathered over the course of the study has yielded important information concerning which clinical characteristics confer a higher risk of treatment failure for children with severe pneumonia under antibiotic therapy.

This project is one activity of the CGHD’s Child and Family Applied Research project (CFAR).

Project Details

Principal Investigator Donald Thea
Boston University Co-Investigators William MacLeod, Jonathon Simon
  • Rai Asghar, Rawalpindi General Hospital, Rawalpindi, Pakistan
  • Salem Banajeh, Al-Sabeen Hospital, Sana’s, Yemen
  • Josefina Egas, Corporacion Ecuatoriana de Biotechnologia, Quito, Ecuador
  • Patricia Hibberd, Clinical Research Institute, New England Medical Center, Tufts University
  • Imran Iqbal, Nishter Hospital, Multan, Pakistan
  • Mary Katep-Bwalya, University Teaching Hospital, Lusaka, Zambia
  • Zafarullah Kundi, Rawalpindi General Hospital, Rawalpindi, Pakistan
  • Paul Law, Department of International Health, Johns Hopkins University
  • Irene Maulen-Radovan, Instituto Nacional de Pediatria, Division of Investigacion, Mexico City, Mexico
  • Greta Mino, Children’s Hospital, Guayaquil, Ecuador
  • Samir Saha, Dhaka Shishu Hospital, Dhaka, Bangladesh
  • Fernando Sempertegui, Corporacion Ecuatoriana de Biotechnologia, Quito, Ecuador
  • Mathuram Santosham, Department of International Health, Johns Hopkins University
  • Sunit Singhi, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  • Shamin Qazi, Department of Child and Adolescent Health and Development, World Health Organization
Country(ies) Bangladesh, India, Mexico, Pakistan, Yemen, Zambia
Dates of Research 2002–2005
Donor/Funder USAID logoUnited States Agency for International Development (USAID)