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Infant Severe Sepsis and Bacterial Meningitis in Malawi (Infaseme)

The recruitment status of this study is unknown because the information has not been verified recently.
Verified January 2014 by University of Malawi College of Medicine.
Recruitment status was  Active, not recruiting
Information provided by (Responsible Party):
Elizabeth Molyneux, University of Malawi College of Medicine Identifier:
First received: January 14, 2010
Last updated: January 15, 2014
Last verified: January 2014

This study aims to improve the outcome of infants (<2 months) with severe sepsis and meningitis at the Queen Elizabeth Central Hospital, Blantyre, Malawi.

Currently WHO recommends the treatment of infant severe sepsis and bacterial meningitis with 14 to 21 day course of penicillin and gentamicin as first line. The second line treatment is cefotaxime or ceftriaxone.

Severe bacterial infections are common in infants under 2 months of age and the mortality is very high (~50%). There are several reasons for this; one is that the first line antibiotics used are no longer as effective as they used to be. Bacterial resistance to the first line antibiotics has increased and some infections especially of the central nervous system may only be partly treated and not eradicated by present therapy. First line treatment is cheap and available but requires 4 injections a day, for at least 14 days, a total of 58 injections. Many mothers find this number too much and abscond. The investigators second line therapy is ceftriaxone which is also available and cheap and the advantage of being given as a daily injection. The disadvantage is that it can cause (reversible) jaundice particularly in premature babies and it must not be given with calcium products. The investigators do not give calcium to the investigators infants as the investigators cannot routinely check electrolytes. All the most common causes of bacterial meningitis in this age group in the investigators setting are sensitive to ceftriaxone.

The investigators wish to undertake an open randomized trial of penicillin and gentamicin v ceftriaxone as first line treatment for infant meningitis. The investigators are able to monitor for side effects.

The investigators hypothesise that the ceftriaxone arm will have 20% less deaths that the penicillin and gentamicin group.

Condition Intervention Phase
Infant Bacterial Meningitis
Drug: Ceftriaxone v penicillin and gentamicin
Phase 4

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: An Open Randomised Trial of Ceftriaxone v Penicillin and Gentamicin in Infant Severe Sepsis and Bacterial Meningitis in Malawi

Resource links provided by NLM:

Further study details as provided by University of Malawi College of Medicine:

Primary Outcome Measures:
  • Recovery v death or severe residual neurological sequelae at hospital discharge, 1 month and 6 months post discharge. [ Time Frame: 3 years ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Outcome by causative bacterial agent, recovery v death or severe residual neurological sequelae at hospital discharge, 1 month and 6 months post discharge. [ Time Frame: 3 years ] [ Designated as safety issue: Yes ]

Estimated Enrollment: 238
Study Start Date: April 2010
Estimated Study Completion Date: April 2015
Estimated Primary Completion Date: February 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Ceftriaxone v penicillin and gentamicin
Ceftriaxone (one arm) v penicillin and gentamicin (second arm) in the treatment of infant meningitis
Drug: Ceftriaxone v penicillin and gentamicin
Ceftriaxone v the standard treatment of infant meningitis (penicillin and gentamicin). Ceftriaxone will be given at a dose of 80mg/kg once a day for at least 14 days.


Ages Eligible for Study:   up to 2 Months   (Child)
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Children less than 2 months
  • Suspicion of bacterial meningitis
  • Parental/guardian informed consent

Exclusion Criteria:

  • Infant with hyperbilirubinaemia
  • Infant requiring calcium
  • Infant know to be hypersensitive to any of the three drugs
  • Infant who has been an inpatient for more than 72 hours
  • Infant with congenital central nervous system abnormalities
  Contacts and Locations
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Please refer to this study by its identifier: NCT01247909

Queen Elizabeth Central Hospital/ College of Medicne
Private Bag 360 Blantyre, Malawi, 3
Sponsors and Collaborators
University of Malawi College of Medicine
Principal Investigator: Elizabeth Molyneux, FRCPCH Malawi College of Medicine, Paediatrics Department
  More Information

Responsible Party: Elizabeth Molyneux, Professor of Paediatircs, University of Malawi College of Medicine Identifier: NCT01247909     History of Changes
Other Study ID Numbers: Infaseme 
Study First Received: January 14, 2010
Last Updated: January 15, 2014
Health Authority: Malawi: College of Medicine Research and Ethics Committee

Additional relevant MeSH terms:
Meningitis, Bacterial
Central Nervous System Diseases
Nervous System Diseases
Systemic Inflammatory Response Syndrome
Pathologic Processes
Central Nervous System Bacterial Infections
Bacterial Infections
Central Nervous System Infections
Anti-Bacterial Agents
Anti-Infective Agents
Protein Synthesis Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action processed this record on October 25, 2016