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The desirability of outcome ranking (DOOR) and response adjusted for duration of antibiotic risk (RADAR) outcome encompass clinical benefit and adverse effects, while also accounting for antibiotic exposure. We evaluated DOOR and RADAR (DOOR\/RADAR) through simulations and compared sample-size considerations to noninferiority designs in a hypothetical trial comparing antibiotics and no antibiotics (ie, placebo) for children with mild CAP. We also evaluated a trial comparing different durations of antibiotic therapy. Three scenarios were considered: 1 with no difference in DOOR between the 2 groups, 1 in which placebo is more efficacious, and another in which amoxicillin is more efficacious than placebo. The power to detect a difference between arms was greater using DOOR\/RADAR compared with DOOR alone. Assuming a sample size of 200, DOOR had 2.5%, 50%, and 65% power to detect a statistical difference between arms for scenarios 1-3, respectively, significantly less than DOOR\/RADAR. Importantly, DOOR\/RADAR incorrectly identified placebo as superior in scenario 3, where amoxicillin was truly efficacious. Sample size requirements for noninferiority designs were larger to achieve similar levels of power as DOOR and DOOR\/RADAR. DOOR\/RADAR has the potential to lead to an incorrect conclusion declaring placebo superior when amoxicillin is efficacious.<\/jats:p>","DOI":"10.1093\/aje\/kwae237","type":"journal-article","created":{"date-parts":[[2024,7,25]],"date-time":"2024-07-25T05:15:36Z","timestamp":1721884536000},"page":"1090-1096","source":"Crossref","is-referenced-by-count":3,"title":["Evaluating the desirability of outcome ranking and response adjusted for duration of antibiotic risk for clinical trials of antibiotics in pediatric pneumonia"],"prefix":"10.1093","volume":"194","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1350-5764","authenticated-orcid":false,"given":"John M","family":"VanBuren","sequence":"first","affiliation":[{"name":"Division of Critical Care, Department of Pediatrics, University of Utah , Salt Lake City, UT ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russell K","family":"Banks","sequence":"additional","affiliation":[{"name":"Division of Critical Care, Department of Pediatrics, University of Utah , Salt Lake City, UT ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7854-4943","authenticated-orcid":false,"given":"Nathan","family":"Kuppermann","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine , George Washington University School of Medicine and Health Sciences, Washington, DC ,","place":["United States"]},{"name":"Department of Pediatrics , George Washington University School of Medicine and Health Sciences, Washington, DC ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3076-3186","authenticated-orcid":false,"given":"Jeffrey S","family":"Gerber","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania , Philadelphia, PA ,","place":["United States"]},{"name":"Division of Infectious Diseases, Children\u2019s Hospital of Philadelphia , Philadelphia, PA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2158-0983","authenticated-orcid":false,"given":"Richard M","family":"Ruddy","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Cincinnati Children\u2019s Hospital Medical Center, University of Cincinnati College of Medicine , Cincinnati, OH ,","place":["United States"]},{"name":"Department of Pediatrics, University of Cincinnati College of Medicine , Cincinnati, OH ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7512-1294","authenticated-orcid":false,"given":"T Charles","family":"Casper","sequence":"additional","affiliation":[{"name":"Division of Critical Care, Department of Pediatrics, University of Utah , Salt Lake City, UT ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4387-2605","authenticated-orcid":false,"given":"Todd A","family":"Florin","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Ann and Robert H. Lurie Children\u2019s Hospital of Chicago , Chicago, IL ,","place":["United States"]},{"name":"Department of Pediatrics, Northwestern University Feinberg School of Medicine , Chicago, IL ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Pediatric Emergency Care Applied Research Network (PECARN)","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,7,24]]},"reference":[{"issue":"24","key":"2025050807212638200_ref1","doi-asserted-by":"publisher","first-page":"2382","DOI":"10.1056\/NEJMc1511751","article-title":"Community-acquired pneumonia requiring hospitalization","volume":"373","author":"Jain","year":"2015","journal-title":"N Engl J Med"},{"key":"2025050807212638200_ref2","volume-title":"Healthcare Cost and Utilization Project (HCUP) Statistical 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