This is a multi-center, randomized, double-blind, placebo-controlled, superiority clinical trial will test the effectiveness of short (5-day) vs.standard (10-day) course therapy in children who are diagnosed with CAP and initially treated in outpatient clinics, urgent care facilities, and emergency departments. Primary objective is to compare the composite overall outcome (Desirability of Outcome Ranking, DOOR) among children 6-71 months of age with CAP assigned to a strategy of short course (5 days) vs standard course (10 days) outpatient beta-lactam therapy at Outcome Assessment Visit #1 (Study Day 8 +/- 2 days)
This is a multi-center, randomized, double-blind, placebo-controlled, superiority clinical trial evaluating short course (5 day) vs. standard course (10 day) of oral beta-lactam antibiotic therapy (amoxicillin, amoxicillin-clavulanate, cefdinir) for treatment of CAP in children 6-71 months of age who have clinically improved prior to enrollment. The study will randomize approximately 400 enrolled subjects to one of the two study arms (approximately 200 children in each arm) in order to reach 360 subjects completing Outcome Assessment Visit 1. Subjects will be randomized (1:1) to receive either a standard course of the initially prescribed antibiotic (10 days) or a short course of the initially prescribed antibiotic (5 days) plus 5 days of matching placebo. The study will recruit potential subjects from children who are diagnosed with CAP and who are initiated on oral beta-lactam therapy by healthcare providers in EDs, outpatient clinics, and urgent care centers at the study sites. Day -5 is defined as the date on which oral beta-lactam therapy is initiated for a diagnosis of CAP. Potential subjects will be identified at any time following clinical diagnosis of pneumonia. These subjects will be assessed for eligibility and enrolled on Day -3 to -1 of their initially prescribed oral beta-lactam therapy. Subjects may also be enrolled on Day 1 (the first day of receipt of study agent) provided they have not yet received any doses of the healthcare provider-prescribed antibiotic therapy for that day. The Primary objective is to compare the composite overall outcome (Desirability of Outcome Ranking, DOOR) among children 6-71 months of age with CAP assigned to a strategy of short course (5 days) vs standard course (10 days) outpatient beta-lactam therapy at Outcome Assessment Visit #1 (Study Day 8 +/- 2 days). The Secondary objectives are: 1) To compare the composite overall outcome (DOOR) among children 6-71 months of age with CAP assigned to a strategy of short course (5 days) vs standard course (10 days) outpatient beta-lactam therapy at Outcome Assessment Visit #2 (Study Day 22 +/- 3 days); 2) To compare the resolution of symptoms (a component of DOOR) among children 6-71 months of age with CAP assigned to a strategy of short course (5 days) vs standard course (10 days) outpatient beta-lactam therapy at Outcome Assessment Visits #1 and #2; 3) To compare the clinical response (a component of DOOR) among children 6-71 months of age with CAP assigned to a strategy of short course (5 days) vs standard course (10 days) outpatient beta-lactam therapy at Outcome Assessment Visits #1 and #2; 4) To compare solicited events (a component of DOOR) among children 6-71 months of age with CAP assigned to a strategy of short course (5 days) vs standard course (10 days) outpatient beta-lactam therapy at Outcome Assessment Visits #1 and #2; 5) To compare medically attended visits to Emergency Departments (ED) or outpatient clinics, hospitalizations, surgical procedures, and receipt of non-study systemic antibiotics (components of the clinical response) among children 6-71 months of age with CAP assigned to a strategy of short course (5 days) vs standard course (10 days) outpatient beta-lactam therapy at Outcome Assessment Visits #1 and #2
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
385
Amoxicillin is an aminopenicillin antibiotic
A fixed-ratio combination of amoxicillin trihydrate, an aminopenicillin, and potassium clavulanate, a beta-lactamase inhibitor, used to treat a broad-spectrum of bacterial infections, especially resistant strains.
Cefdinir is a cephalosporin antibiotic used to treat bacterial infections in many different parts of the body.
Placebo
University of Alabama - Children's of Alabama - Infectious Diseases/Virology
Birmingham, Alabama, United States
Arkansas Children's Hospital - Infectious Diseases
Little Rock, Arkansas, United States
University of Louisville School of Medicine - Norton Children's Hospital - Infectious Diseases
Louisville, Kentucky, United States
Washington University School of Medicine in St. Louis - Infectious Diseases
St Louis, Missouri, United States
Duke Human Vaccine Institute - Duke Vaccine and Trials Unit
Durham, North Carolina, United States
Cincinnati Children's Hospital Medical Center - Infectious Diseases
Cincinnati, Ohio, United States
Children's Hospital of Philadelphia - The Center for Pediatric Clinical Effectiveness
Philadelphia, Pennsylvania, United States
Children's Hospital of Pittsburgh of UPMC - General Academic Pediatric
Pittsburgh, Pennsylvania, United States
Vanderbilt University - Pediatric - Vanderbilt Vaccine Research Center
Nashville, Tennessee, United States
Desirability of Outcome Ranking (DOOR)
DOOR is a composite endpoint created using clinical outcomes from the first 5 days and at Outcome Assessment Visit #1 (OAV #1). It is based on adequate clinical response at OAV #1, solicited symptoms from first 5 days and number of days of antibiotics use for worsening pneumonia from the first 5 days of the study.
Time frame: Outcome Assessment Visit 1 (Study Day 8 +/- 2 days)
Desirability of Outcome Ranking (DOOR)
DOOR is a composite endpoint created using clinical outcomes from the first 18 days and at Outcome Assessment Visit #2 (OAV #2). It is based on adequate clinical response at OAV #2, solicited symptoms from first 18 days and number of days of antibiotics use for worsening pneumonia from the first 18 days of the study.
Time frame: Outcome Assessment Visit 2 (Study Day 22 +/- 3 days)
Resolution of Symptoms (a Component of DOOR)
This table provides number and percentage of subjects who experienced lack of resolution of symptoms by their OAV #1.
Time frame: Outcome Assessment Visit 1 (Study Day 8 +/- 2 days)
Resolution of Symptoms (a Component of DOOR)
This table provides number and percentage of subjects who experienced lack of resolution of symptoms by their OAV #2.
Time frame: Outcome Assessment Visit 2 (Study Day 22 +/- 3 days)
Adequate Clinical Response Rates (a Component of DOOR)
Lack of adequate clinical response at OAV #1 is defined as the presence of a medically attended visit to an Emergency Department (ED) or outpatient clinic or hospitalization or receipt of non-study antibiotics or surgical procedures for persistent or worsening pneumonia from Day 1 to Day 5.
Time frame: Outcome Assessment Visit 1 (Study Day 8 +/- 2 days)
Adequate Clinical Response Rates (a Component of DOOR)
Lack of adequate clinical response at OAV #2 is defined as the presence of a medically attended visit to an ED or outpatient clinic or hospitalization or receipt of non-study antibiotics or surgical procedures for persistent or worsening pneumonia from Day 1 to Day 18.
Time frame: Outcome Assessment Visit 2 (Study Day 22 +/- 3 days)
Number of Participants Reporting Solicited Symptoms
This table summarizes the number and percentage of subjects experiencing any solicited events of mild, moderate or severe severity from Day 1 to Day 5
Time frame: Outcome Assessment Visit 1 (Study Day 8 +/- 2 days)
Number of Participants Reporting Solicited Symptoms
This table summarizes the number and percentage of subjects experiencing any solicited events of mild, moderate or severe severity from Day 1 to Day 18
Time frame: Outcome Assessment Visit 2 (Study Day 22 +/- 3 days)
Number of Participants Receiving Non-study Systemic Antibiotics for Persistent or Worsening Pneumonia During Medically Attended Visits
This table provides number and percentage of subjects who received non-study antibiotics for any use from Day 1 to Day 5
Time frame: Outcome Assessment Visit 1 (Study Day 8 +/- 2 days)
Number of Participants Receiving Non-study Systemic Antibiotics for Persistent or Worsening Pneumonia During Medically Attended Visits
This table provides number and percentage of subjects who received non-study antibiotics for any use from Day 1 to Day 18
Time frame: Outcome Assessment Visit 2 (Study Day 22 +/- 3 days)
Number of Participants Receiving Non-study Systemic Antibiotics for All Causes During Medically Attended Visits
This table provides number and percentage of subjects who received non-study antibiotics for any reason from Day 1 to Day 5
Time frame: Outcome Assessment Visit 1 (Study Day 8 +/- 2 days)
Number of Participants Receiving Non-study Systemic Antibiotics for All Causes During Medically Attended Visits
This table provides number and percentage of subjects who received non-study antibiotics for any reason from Day 1 to Day 18
Time frame: Outcome Assessment Visit 2 (Study Day 22 +/- 3 days)
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