Trial reportBMJ (Clinical research ed.)2008
Chloramphenicol versus ampicillin plus gentamicin for community acquired very severe pneumonia among children aged 2-59 months in low resource settings: multicentre randomised controlled trial (SPEAR study).
Trial report in BMJ (Clinical research ed.), 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 44 papers, 6 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
44 citing papers in PubMed, 6 syntheses or guidelines pooled it, 94 citations in OpenAlex.
- Hypoxaemia and mortality in children with lower respiratory infection in low-income and middle-income countries: systematic review and meta-analysis.The Lancet. Global health · 2026Pooled it
- Emergency care interventions for paediatric severe acute respiratory infections in low- and middle-income countries: A systematic review and narrative synthesis.Journal of global health · 2023Pooled it
- Prevalence of hypoxaemia in children with pneumonia in low-income and middle-income countries: a systematic review and meta-analysis.The Lancet. Global health · 2022Pooled it
- Burden of invasive pneumococcal disease in children aged 1 month to 12 years living in South Asia: a systematic review.PloS one · 2014Pooled it
- Antibiotics for community-acquired pneumonia in children.The Cochrane database of systematic reviews · 2013Pooled it
- The effect of case management on childhood pneumonia mortality in developing countries.International journal of epidemiology · 2010Pooled it
- Stunting is associated with poor outcomes in childhood pneumonia.Tropical medicine & international health : TM & IH · 2015Trial
- Childhood anemia at high altitude: risk factors for poor outcomes in severe pneumonia.Pediatrics · 2013Trial
- Prevalence and determinants of nasal carriage of penicillin non-susceptibleThe Lancet regional health. Western Pacific · 2025Article
- In-hospital mortality risk stratification in children aged under 5 years with pneumonia with or without pulse oximetry: A secondary analysis of the Pneumonia REsearch Partnership to Assess WHO REcommendations (PREPARE) dataset.International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2023Article
- Article
- Derivation and validation of a novel risk assessment tool to identify children aged 2-59 months at risk of hospitalised pneumonia-related mortality in 20 countries.BMJ global health · 2022Article
- The global burden of hospitalisation due to pneumonia caused byEClinicalMedicine · 2022Article
- External validation of the RISC, RISC-Malawi, and PERCH clinical prediction rules to identify risk of death in children hospitalized with pneumonia.Journal of global health · 2021Article
- Time to Recovery from Severe Pneumonia and Its Predictors Among Children 2-59 Months of Age Admitted to Pediatric Ward of Nigist Eleni Mohammed Memorial Comprehensive Specialized Hospital, Hossana, Ethiopia: Retrospective Cohort Study.Pediatric health, medicine and therapeutics · 2021Article
- Article
- Antimicrobial Therapy in Community-Acquired Pneumonia in Children.Current infectious disease reports · 2018Review
- Childhood community-acquired pneumonia: A review of etiology- and antimicrobial treatment studies.Paediatric respiratory reviews · 2018Review
- Mortality after Inpatient Treatment for Severe Pneumonia in Children: a Cohort Study.Paediatric and perinatal epidemiology · 2017Observational
- Child pneumonia - focus on the Western Pacific Region.Paediatric respiratory reviews · 2017Review
Corrections and comments
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Authors and funding
19 authors at 13 institutions in 10 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo evaluate whether five days' treatment with injectable ampicillin plus gentamicin compared with chloramphenicol reduces treatment failure in children aged 2-59 months with community acquired very severe pneumonia in low resource settings.
designOpen label randomised controlled trial.
settingInpatient wards within tertiary care hospitals in Bangladesh, Ecuador, India, Mexico, Pakistan, Yemen, and Zambia.
participantsChildren aged 2-59 months with WHO defined very severe pneumonia.
interventionChloramphenicol versus a combination of ampicillin plus gentamicin.
main outcome measuresPrimary outcome measure was treatment failure at five days. Secondary outcomes were treatment failure defined similarly among all participants evaluated at 48 hours and at 10 and 21 days.
resultsMore children failed treatment with chloramphenicol at day 5 (16% v 11%; relative risk 1.43, 95% confidence interval 1.03 to 1.97) and also by days 10 and 21. Overall, 112 bacterial isolates were obtained from blood and lung aspirates in 110 children (11.5%), with the most common organisms being Staphylococcus aureus (n=47) and Streptococcus pneumoniae (n=22). In subgroup analysis, bacteraemia with any organism increased the risk of treatment failure at 21 days in the chloramphenicol group (2.09, 1.41 to 3.10) but not in the ampicillin plus gentamicin group (1.12, 0.59 to 2.13). Similarly, isolation of S pneumoniae increased the risk of treatment failure at day 21 (4.06, 2.73 to 6.03) and death (5.80, 2.62 to 12.85) in the chloramphenicol group but not in the ampicillin plus gentamicin group. No difference was found in treatment failure for children with S aureus bacteraemia in the two groups, but the power to detect a difference in this subgroup analysis was low. Independent predictors of treatment failure by multivariate analysis were hypoxaemia (oxygen saturation <90%), receiving chloramphenicol, being female, and poor immunisation status.
conclusionInjectable ampicillin plus gentamicin is superior to injectable chloramphenicol for the treatment of community acquired very severe pneumonia in children aged 2-59 months in low resource settings.
trial registrationCurrent Controlled Trials ISRCTN39543942.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.