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Chloramphenicol Versus Ampicillin for Community Acquired Very Severe Pneumonia by Rai Asgar

By Edited May 11, 2015 0 1

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



Sep 14, 2009 10:28am
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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