Contact information
Type
Scientific
Primary contact
Prof Heikki Peltola
ORCID ID
Contact details
POB 281
Hospital for Children and Adolescents
Helsinki
00290
Finland
heikki.peltola@hus.fi
Additional identifiers
EudraCT number
ClinicalTrials.gov number
Protocol/serial number
1
Study information
Scientific title
Acronym
BOL/INFLU-PARA/PLA
Study hypothesis
1. Can the prognosis of childhood Bacterial Meningitis (BM) be improved by instituting beeta-lactam such as cefotaxime with a slow infusion, instead of giving traditionally large doses intermittently from the early beginning?
2. Can the prognosis be further improved by large doses of paracetamol?
3. To which extent is the prognosis of BM affected by the host response and Cerebrospinal Fluid (CSF) genome count and serotype, paying special attention to Streptococcus pneumoniae?
Please note that as of 22nd January 2008 an update has been performed on this trial record. Any changes to the trial record can be found under the date 22/01/2008 in the specific section.
Ethics approval
Added as of 22/01/2008:
Approval of the protocol: June 2005
Approval of the amended protocol: 21 December 2007
The data Safety and Monitoring Board is formed by Dr Heinz-J. Schmitt, Professor of Pediatric Infectious Diseases at Johannes Gutenberg University, Mainz, and two clinical statisticians, Dr R¨¹diger von Kries, Professor of Pediatrics and Chief of the Department of Pediatric and Adolescent Epidemiology, Ludwig Maximilian University, Munich, and Dr Jean Baptiste du Prel, Johannes Gutenberg University, Mainz. The Board's responsibility is to follow-up the study from the ethical and scientific points of view, and it has an access to the treatment codes at any time. If an indisputable significance between groups is met before the study ends, the team interrupts the trial for ethical reasons.
After the first 50 - 100 enrolled patients, the Board will check the accuracy of the study. Thereafter, the situation is checked every six months.
Study design
Randomised controlled trial
Primary study design
Interventional
Secondary study design
Randomised controlled trial
Trial setting
Hospitals
Trial type
Treatment
Patient information sheet
Condition
Childhood bacterial meningitis
Intervention
All children will receive cefotaxime 250 mg/kg/day for seven days, except salmonella meningitis for which antimicrobial treatment should last for 14 days or more. Regardless of etiology, the children are randomised in a double-blind fashion in two groups for the first 24 hours: 50% receive cefotaxime in two 12-hour infusions, the other 50% getting cefotaxime in four boluses.
Added as of 22/01/2008:
In addition to the intervention of cefotaxime bolus versus cefotaxime infusions:
During the first 48 hours, 50% of the patients are randomised to receive high dose paracetamol (first dose 30 mg/kg, then 20 mg/kg every six hours for 42 hours) and the other 50% an oral placebo.
Thus the four treatment alternatives are:
1. Cefotaxime boluses + oral high dose paracetamol
2. Cefotaxime boluses + oral placebo
3. Cefotaxime infusions + oral high dose paracetamol
4. Cefotaxime infusions + oral placebo
Analysis plan:
Analysis by intention to treat will include all children in whom bacterial meningitis was suggested and a study medication was instituted. The patients in whom meningitis was confirmed (greater than or equal to 1 diagnostic criterium fulfilled) will be analysed per protocol.
Chi square test is used to test potential differences in the primary endpoints comparing the groups of infusion versus bolus dosing, and those receiving versus not receiving paracetamol. The secondary endpoints are examined similarly.
Intervention type
Drug
Phase
Not Specified
Drug names
Cefotaxime, paracetamol
Primary outcome measure
Current primary endpoints as of 22/01/2008:
1. Death (measuring the exact time from institution of antimicrobial) OR severe neurological sequelae (blindness, quadriplegia, hydrocephalus requiring a shunt, or severe psychomotor retardation) at discharge
2. Profound hearing loss (more than 80 dB in both ears) at discharge
Previous primary endpoints:
1. Death (measuring the exact time from institution of antimicrobial)
2. Severe neurological sequelae (blindness, quadriplegia, hydrocephalus requiring a shunt, or severe psychomotor retardation)
3. Profound hearing loss (more than 80 dB in both ears), as found at discharge from hospital and dismal outcome denotes death, severe neurological sequelae and/or profound hearing loss.
Because severe neurological sequelae and death may form a continuum, their combination is taken as a composite endpoint. Various patient characteristics are taken into account as covariates, those being essentially the age, etiology (pneumococcus, Hib, meningococcus, other agents, and unidentified etiology), blood hemoglobin level, potential HIV- and/or malaria-infection, and the presenting status. This is graded by Glasgow Coma Scale (adjusted for age), the Blantyre Coma Scale, and the Herson-Todd Score. Also blood hemoglobin concentration will be related to the outcome, which is assessed with the modified Glasgow Outcome Scale.
Secondary outcome measures
Current secondary endpoints as of 22/01/2008:
1. Death or any audiological or any neurological sequelae: any neurological sequelae are, in addition to severe neurological sequelae : hemiparesis, monoparesis moderate psychomotor retardation, or ataxia. Psychomotor retardation is graded by (according to the Denver-II developmental screening test). Hearing is deemed impaired if a threshold of 40 dB remains unrecognized by the better ear, the cut-off levels for moderate and severe hearing impairment being 60 dB and 80 dB, respectively
2. Glasgow Outcome Scale
3. Potential differences in the indices of inflammation such as serum C-reactive protein (CRP) will also be examined
Previous secondary endpoints:
The secondary endpoints comprise any audiological or neurological sequelae (according to
the Denver-II developmental screening test). Hearing is deemed impaired if a threshold of 40 dB is not recognized by the better ear. The cut-off levels for moderate and severe hearing impairment are 60 dB and 80 dB, respectively. Potential differences in the indices of inflammation such as serum C-Reactive Protein (CRP) will also be examined.
Overall trial start date
27/06/2005
Overall trial end date
30/12/2008
Reason abandoned (if study stopped)
Eligibility
Participant inclusion criteria
[Added as of 22/01/2008: All children aged at least 2 months with suspected or confirmed bacterial meningitis.]
Diagnosis:
BM is defined as a case with:
1. Positive CSF culture, or
2. Symptoms and signs compatible with bacterial meningitis, and positive blood culture, or
3. Symptoms and signs compatible with bacterial meningitis, and at least two of the following criteria:
3.1. CSF pleocytosis more than or equal to 100 cells/mm^3
3.2. A positive Gram-stain result
3.3. Positive latex agglutination test
3.4. Serum C-Reactive Protein (CRP) more than or equal to 40 mg/l, or
4. Symptoms and signs compatible with bacterial meningitis, and positive CSF antigen detection by Polymerase Chain Reaction (PCR)
Participant type
Patient
Age group
Child
Gender
Both
Target number of participants
750 (No. of patients enrolled 05/10/07: 600)
Participant exclusion criteria
The exclusion criteria comprise the age less than two months, trauma, or relevant underlying illness such as intracranial shunt, previous neurological disease (cerebral palsy, Down's syndrome, meningitis), previous hearing impairment if known, and immunosuppression, except Human Immunodeficiency Virus (HIV) infection.
Recruitment start date
27/06/2005
Recruitment end date
30/12/2008
Locations
Countries of recruitment
Angola
Trial participating centre
POB 281
Helsinki
00290
Finland
Sponsor information
Organisation
Luanda Hospital (Angola)
Sponsor details
Hospital Pediatrico
Universidade Agostinho Neto
Faculdade de Medicina
Departamento de Pediatria
Luanda
C.P. 3067
Angola
+88 244 924 181 555
lbernandino@netangola.com
Sponsor type
Hospital/treatment centre
Website
Funders
Funder type
Research organisation
Funder name
The Pediatric Research Foundation (Finland)
Alternative name(s)
Funding Body Type
Funding Body Subtype
Location
Funder name
Sigrid Juselius Foundation (Finland)
Alternative name(s)
Funding Body Type
Funding Body Subtype
Location
Funder name
Helsinki University Central Hospital Research (Finland)
Alternative name(s)
Funding Body Type
Funding Body Subtype
Location
Results and Publications
Publication and dissemination plan
Not provided at time of registration
Intention to publish date
Participant level data
Not provided at time of registration
Basic results (scientific)
Publication list
2011 results in http://www.ncbi.nlm.nih.gov/pubmed/21550313
Publication citations
-
Results
Pelkonen T, Roine I, Cruzeiro ML, Pitkäranta A, Kataja M, Peltola H, Slow initial β-lactam infusion and oral paracetamol to treat childhood bacterial meningitis: a randomised, controlled trial., Lancet Infect Dis, 2011, 11, 8, 613-621, doi: 10.1016/S1473-3099(11)70055-X.