{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T21:07:54Z","timestamp":1765832874423,"version":"3.48.0"},"reference-count":50,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,1,8]]},"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Early childhood pneumonia is a common problem globally with long-term complications that include bronchiectasis and chronic obstructive pulmonary disease. It is biologically plausible that these long-term effects may be minimised in young children at increased risk of such sequelae if any residual lower airway infection and inflammation in their developing lungs can be treated successfully by longer antibiotic courses. In contrast, shortened antibiotic treatments are being promoted because of concerns over inducing antimicrobial resistance. Nevertheless, the optimal treatment duration remains unknown. Outcomes from randomised controlled trials (RCTs) on paediatric pneumonia have focused on short-term (usually &lt;2 weeks) results. Indeed, no long-term RCT-generated outcome data are available currently. We hypothesise that a longer antibiotic course, compared with the standard treatment course, reduces the risk of chronic respiratory symptoms\/signs or bronchiectasis 24 months after the original pneumonia episode.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This multicentre, parallel, double-blind, placebo-controlled randomised trial involving seven hospitals in six cities from three different countries commenced in May 2016. Three-hundred-and-fourteen eligible Australian Indigenous, New Zealand M\u0101ori\/Pacific and Malaysian children (aged 0.25 to 5 years) hospitalised for community-acquired, chest X-ray (CXR)-proven pneumonia are being recruited. Following intravenous antibiotics and 3 days of amoxicillin-clavulanate, they are randomised (stratified by site and age group, allocation-concealed) to receive either: (i) amoxicillin-clavulanate (80 mg\/kg\/day (maximum 980 mg of amoxicillin) in two-divided doses or (ii) placebo (equal volume and dosing frequency) for 8 days. Clinical data, nasopharyngeal swab, bloods and CXR are collected. The primary outcome is the proportion of children without chronic respiratory symptom\/signs of bronchiectasis at 24 months. The main secondary outcomes are \u2018clinical cure\u2019 at 4 weeks, time-to-next respiratory-related hospitalisation and antibiotic resistance of nasopharyngeal respiratory bacteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The Human Research Ethics Committees of all the recruiting institutions (Darwin: Northern Territory Department of Health and Menzies School of Health Research; Auckland: Starship Children\u2019s and KidsFirst Hospitals; East Malaysia: Likas Hospital and Sarawak General Hospital; Kuala Lumpur: University of Malaya Research Ethics Committee; and Klang: Malaysian Department of Health) have approved the research protocol version 7 (13 August 2018). The RCT and other results will be submitted for publication.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>ACTRN12616000046404.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2018-026411","type":"journal-article","created":{"date-parts":[[2019,4,25]],"date-time":"2019-04-25T06:07:21Z","timestamp":1556172441000},"page":"e026411","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["HOspitalised Pneumonia Extended (HOPE) Study to reduce the long-term effects of childhood pneumonia: protocol for a multicentre, double-blind, parallel, superiority randomised controlled trial"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1331-3706","authenticated-orcid":false,"given":"Anne B","family":"Chang","sequence":"first","affiliation":[{"name":"Child Health Division, Menzies School of Health Research, Charles Darwin Univ, Darwin, Northern Territory, Australia"},{"name":"Qld Children\u2019s Hospital, Brisbane, Queensland, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siew Moy","family":"Fong","sequence":"additional","affiliation":[{"name":"Hospital Likas, Kota Kinabalu, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tsin Wen","family":"Yeo","sequence":"additional","affiliation":[{"name":"Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert S","family":"Ware","sequence":"additional","affiliation":[{"name":"School of Population Health, The University of Queensland, Brisbane, Queensland, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabrielle B","family":"McCallum","sequence":"additional","affiliation":[{"name":"Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna M","family":"Nathan","sequence":"additional","affiliation":[{"name":"University of Malaya, Kuala Lumpur, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mong H","family":"Ooi","sequence":"additional","affiliation":[{"name":"Universiti Malaysia Sarawak, Kuching, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessie","family":"de Bruyne","sequence":"additional","affiliation":[{"name":"Paediatrics, Univeristy of Malaya, Kuala Lumpur, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherine A","family":"Byrnes","sequence":"additional","affiliation":[{"name":"Starship Children\u2019s Hospital, Auckland, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bilawara","family":"Lee","sequence":"additional","affiliation":[{"name":"Charles Darwin University, Darwin, Northern Territory, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nachal","family":"Nachiappan","sequence":"additional","affiliation":[{"name":"Tengku Ampuan Rahimah Hospital, Klang, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noorazlina","family":"Saari","sequence":"additional","affiliation":[{"name":"Tengku Ampuan Rahimah Hospital, Klang, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Torzillo","sequence":"additional","affiliation":[{"name":"Prince Alfred Hospital, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heidi","family":"Smith-Vaughan","sequence":"additional","affiliation":[{"name":"Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter S","family":"Morris","sequence":"additional","affiliation":[{"name":"Menzies School of Health Research, Darwin, Northern Territory, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John W","family":"Upham","sequence":"additional","affiliation":[{"name":"School of Medicine, The University of Queensland, Brisbane, Queensland, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keith","family":"Grimwood","sequence":"additional","affiliation":[{"name":"Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,4,24]]},"reference":[{"unstructured":"WHO. 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