Prof. Abdullah H Baqui, DrPH, Prof. Samir K Saha, PhD, A S M Nawshad Uddin Ahmed, FCPS, Prof. Mohammad Shahidullah, FCPS, Iftekhar Quasem, MBBS, Daniel E Roth, PhD, A K M Samsuzzaman, DCH, Wazir Ahmed, DCH, Prof. S M Shahnawaz Bin Tabib, FCPS, Dipak K Mitra, PhD, Nazma Begum, MA, Maksuda Islam, BA, Arif Mahmud, MBBS, Mohammad Hefzur Rahman, MBBS, Mamun Ibne Moin, MA, Luke C Mullany, PhD, Prof. Simon Cousens, PhD, Shams El Arifeen, DrPH, Stephen Wall, MD, Neal Brandes, MA, Prof. Mathuram Santosham, MD, and Prof. Robert E Black, MD
Background: Severe infections remain one of the main causes of neonatal deaths worldwide. Possible severe infection is diagnosed in young infants (aged 0–59 days) according to the presence of one or more clinical signs. The recommended treatment is hospital admission with 7–10 days of injectable antibiotic therapy. In low-income and middle-income countries, barriers to hospital care lead to delayed, inadequate, or no treatment for many young infants. We aimed to identify effective alternative antibiotic regimens to expand treatment options for situations where hospital admission is not possible. Methods: We did this randomised, open-label, equivalence trial in four urban hospitals and one rural field site in Bangladesh to determine whether two alternative antibiotic regimens with reduced numbers of injectable antibiotics combined with oral antibiotics had similar efficacy and safety to the standard regimen, which was also used as outpatient treatment. We randomly assigned infants who showed at least one clinical sign of severe, but not critical, infection (except fast breathing alone), whose parents refused hospital admission, to one of the three treatment regimens. We stratified randomisation by study site and age (