Chloramphenicol versus benzylpenicillin and gentamicin for the treatment of severe pneumonia in children in Papua New Guinea: a randomised trial.

Abstract

BACKGROUND:

Pneumonia is the most frequent cause of child mortality in less-developed countries. We aimed to establish whether the combination of benzylpenicillin and gentamicin or chloramphenicol would be better as first-line treatment in children with severe pneumonia in Papua New Guinea.

METHODS:

We did an open randomised trial in which we enrolled children aged 1 month to 5 years of age who fulfilled the WHO criteria for very severe pneumonia and who presented to hospitals in two provinces. Children were randomly assigned to receive chloramphenicol (25 mg/kg 6 hourly) or benzylpenicillin (50 mg/kg 6 hourly) plus gentamicin (7.5 mg/kg daily) by intramuscular injection. The primary outcome measure was a good or an adverse outcome.

FINDINGS:

1116 children were enrolled; 559 children were treated with chloramphenicol and 557 with benzylpenicillin and gentamicin. At presentation the median haemoglobin oxygen saturation was 71% (IQR 57-77) for those allocated chloramphenicol and 69% (55-77) for those allocated penicillin and gentamicin. 147 (26%) children treated with chloramphenicol and 123 (22%) treated with penicillin and gentamicin had adverse outcomes (p=0.11). 36 children treated with chloramphenicol and 29 treated with penicillin and gentamicin died. More children treated with chloramphenicol than penicillin and gentamicin represented with severe pneumonia within 1 month of hospital discharge (p=0.03).

INTERPRETATION:

For children with severe pneumonia in less-developed countries the probability of a good outcome is similar if treated with chloramphenicol or with the combination of benzylpenicillin and gentamicin.

• Authors: Trevor Duke, Harry Poka, Frank Dale, Audrey Michael, Joyce Mgone, Tilda Wal
• Journal: Lancet (London, England) (Lancet) Vol. 359 Issue 9305 Pg. 474-80 (Feb 09 2002) ISSN: 0140-6736 [Print] England
• PMID: 11853793 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial)

Chemical References

• Anti-Bacterial Agents
• Gentamicins
• Chloramphenicol
• Penicillin G

Topics

• Anti-Bacterial Agents (therapeutic use)
• Child, Preschool
• Chloramphenicol (therapeutic use)
• Comorbidity
• Drug Therapy, Combination
• Female
• Gentamicins (therapeutic use)
• Humans
• Infant
• Male
• New Guinea
• Penicillin G (therapeutic use)
• Pneumonia (drug therapy, microbiology, mortality)
• Treatment Outcome