Chloramphenicol Versus Ampicillin for Community Acquired Very Severe Pneumonia by Rai Asgar
Experiment Title: 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) by Rai Asgar and others.
The experiment conducted was designed to determine
whether ampicillin (with gentamicin) is a better drug than chloramphenicol for
community acquired very severe pneumonia among children aged 2-59 months old in low
resource settings, and will be tested in such a way that the drug injected
will randomly vary from child to child.
The experimental design is that of
a randomized controlled trial. More or less, the experiment occurs in a real
life setting and the control is very minimally utilized. The control itself is
the randomization of the drugs injected, which allows the researchers to
accurately study both of the drugs effects without bias. The study is also not
blind (or double-blind), due to the fact that all parties involved are aware
that they are injecting/being injected with either chloramphenicol or
ampicillin (with gentamicin). The experiment's length was 21 days total. The
main measurable outcomes included treatment failure at five days, treatment
failure defined similarly among all participants evaluated at 48 hours, and
treatment failure at 10 and 21 days. The "sample size of 1182 children aged
2-59 months with community acquired very severe pneumonia in low resource
settings" throughout the world, specifically within the countries of
Bangladesh, Ecuador, India, Mexico, Pakistan, Yemen, and Zambia; was utilized
(Asghar). A placebo was not utilized in the course of this experiment.
As a whole, the results support the
hypothesis very well. The main reason (I presume) researchers chose to
experiment with these drugs is because they had reason to believe that
ampicillin (with gentamicin) is a superior drug in comparison to
chloramphenicol. The results show that more children failed treatment with
chloramphenicol at day 5, 10, and 21 ((Asghar). Only in the study of specific
bacteria did the hypothesis somewhat falter, as there was no difference between
chloramphenicol and ampicillin (with gentamicin) in the treatment of S aureus
bacteria; however an independent study (and experiment) would need to be done
to test these drugs properly with S aureus bacteria due to other factors
needing to be controlled (such as immunization status and gender) (Asghar). The
researchers concluded their study by stating: "Injectable ampicillin plus
gentamicin is superior to injectable chloramphenicol for the treatment of community
acquired very severe pneumonia in children aged 2-50 months in low resource
settings." (Asghar)
Overall, I would say this is a very
professional and well conducted experiment. As far as I can tell, the study had
no flaws. Bias was removed by sealing the injections in randomly unlabelled
envelopes (so the doctors would not know what is being injected until opened).
The single control also seems to be very effective, despite its simplicity. The
sample size was also acceptable, as it spanned several countries (in similar
conditions) and was large enough that any co-incidental failures (or
recoveries) would have little effect on the study. Despite this study not
having any faults (as defined by those listed by Professor Tabery), my largest
concern is that the experiment puts aside the right for each child to continue
living for research purposes. Upon reading the research article, I was fairly
surprised to learn that "failed treatment" generally meant death. I understand
that with pneumonia, the likeliness for people living in such regions in poor
living conditions to survive in very low; however, from what I have read, it
does not appear that the researchers made it clear to those involved that their
children could potentially die from the injection. I understand that some death
(in the name of science) was necessary, and from the conclusion I would imagine
chloramphenicol would not be used to treat severe pneumonia (which causes these
deaths to be for the greater good). The experiment pushed the lines of "good"
taste and ethics; however I still find it to be acceptable considering my own
moral guideline (which more or less enables me to feel okay about people dying
in such a way as this).
Works Cited:
Asghar, Rai. "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) -- Asghar et al. 336 (7635): 80 -- BMJ." British Medical Journal. 12 Jan. 2008. 12 Feb. 2009
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Comments
chris....go through the 'edit' button and break-up these paragraphs...it would read better that way :).....I know it was a paper, but it may look better if you take out the paragraph indents....
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