Doxycycline vs. Macrolide for MRMP (DOMINO)

NCT ID: NCT07306234

Last Updated: 2025-12-29

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

PHASE4

Total Enrollment

208 participants

Study Classification

INTERVENTIONAL

Study Start Date

2026-03-01

Study Completion Date

2029-02-28

Brief Summary

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The goal of this clinical trial is to learn if doxycycline works to treat pneumonia in children. It focuses on children with Mycoplasma pneumoniae infection that may not respond to standard medicines. The main questions it aims to answer are:

* Does doxycycline stop fevers faster than azithromycin?
* Is doxycycline safe for children, specifically regarding tooth color changes?

Researchers will compare doxycycline to azithromycin to see if doxycycline works better to treat this type of pneumonia.

Participants will:

* Take either doxycycline or azithromycin by mouth for 7 to 14 days.
* Check their body temperature to see when their fever goes away.
* Visit the hospital to check for any medical problems.
* Have their teeth checked for color changes 28 days after starting the medicine.

Detailed Description

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Conditions

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Mycoplasma Pneumoniae Mycoplasma Pneumoniae Pneumonia

Keywords

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Mycoplasma pneumoniae Macrolide resistance Children

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Intervention Group (Doxycycline)

Participants will receive oral doxycycline (4 mg/kg/day divided into 2 doses for weight ≤45 kg; 100 mg BID for weight \>45 kg). The standard treatment duration is 7 days, which may be extended up to 14 days based on clinical response.

Group Type EXPERIMENTAL

Doxycycline

Intervention Type DRUG

Intervention Group (Doxycycline): Participants will receive oral doxycycline (4 mg/kg/day divided into 2 doses for weight ≤45 kg; 100 mg BID for weight \>45 kg). The standard treatment duration is 7 days, which may be extended up to 14 days based on clinical response.

Control Group (Azithromycin)

Participants will receive oral azithromycin according to the standard 5-day regimen (10 mg/kg on Day 1, followed by 5 mg/kg on Days 2-5).

Group Type ACTIVE_COMPARATOR

Azithromycin

Intervention Type DRUG

Control Group (Azithromycin): Participants will receive oral azithromycin according to the standard 5-day regimen (10 mg/kg on Day 1, followed by 5 mg/kg on Days 2-5).

Rescue Therapy Protocol: To ensure patient safety, a standardized "rescue therapy" protocol is implemented. Participants in the Control group who fail to demonstrate clinical improvement at the 48-72 hour assessment-defined as persistent fever (≥38.0°C) or clinical deterioration-will be immediately switched to doxycycline. Consistent with the intention-to-treat principle, these cases will be classified as treatment failures for the primary efficacy analysis.

Interventions

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Doxycycline

Intervention Group (Doxycycline): Participants will receive oral doxycycline (4 mg/kg/day divided into 2 doses for weight ≤45 kg; 100 mg BID for weight \>45 kg). The standard treatment duration is 7 days, which may be extended up to 14 days based on clinical response.

Intervention Type DRUG

Azithromycin

Control Group (Azithromycin): Participants will receive oral azithromycin according to the standard 5-day regimen (10 mg/kg on Day 1, followed by 5 mg/kg on Days 2-5).

Rescue Therapy Protocol: To ensure patient safety, a standardized "rescue therapy" protocol is implemented. Participants in the Control group who fail to demonstrate clinical improvement at the 48-72 hour assessment-defined as persistent fever (≥38.0°C) or clinical deterioration-will be immediately switched to doxycycline. Consistent with the intention-to-treat principle, these cases will be classified as treatment failures for the primary efficacy analysis.

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Age: 3 to 17 years at the time of enrollment.
* Diagnosis: Clinically diagnosed CAP characterized by respiratory symptoms (e.g., fever, cough, auscultatory findings) and chest X-ray confirming pulmonary infiltrates.
* Pathogen: Confirmed MP M. pneumoniae infection via PCR OR strongly suspected infection based on clinical features and epidemiological grounds (e.g., outbreaks among classmates, poor response to prior non-macrolide antibiotics).
* Resistance: Suspected macrolide-resistant M. pneumoniae (MRMP) infection (e.g., during a reported local epidemic of MRMP).
* Timing: Ability to register and initiate the study drug within 72 hours of symptom onset.

Exclusion Criteria

* Prior use of tetracyclines, macrolides, or quinolones for the current illness.
* Complicated pneumonia (e.g., necrosis, empyema, lung abscess) or severe pneumonia requiring immediate intensive care or exhibiting hypoxia (SpO₂ \<90%).
* Hypersensitivity or contraindications to macrolides or tetracyclines.
* Severe immunocompromised state or severe underlying lung disease.
* Severe hepatic impairment (AST/ALT \>3x upper limits) or severe renal impairment.
Minimum Eligible Age

3 Years

Maximum Eligible Age

17 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Korea Society of Pediatric Infectious Diseases

UNKNOWN

Sponsor Role collaborator

Korea National Institute of Health

UNKNOWN

Sponsor Role collaborator

Korea Disease Control and Prevention Agency

UNKNOWN

Sponsor Role collaborator

DT&CRO

UNKNOWN

Sponsor Role collaborator

Young June Choe

OTHER

Sponsor Role lead

Responsible Party

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Young June Choe

Professor

Responsibility Role SPONSOR_INVESTIGATOR

Locations

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Department of Pediatrics, Pusan National University School of Medicine, Pusan National University Children's Hospital, Yangsan, Republic of Korea

Busan, , South Korea

Site Status

Department of Pediatrics, Gyeongsang National University College of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea

Changwon, , South Korea

Site Status

Department of Pediatrics, Chosun University College of Medicine, Chosun University Hospital, Gwangju, Republic of Korea

Gwangju, , South Korea

Site Status

Department of Pediatrics, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, Republic of Korea

Jeju City, , South Korea

Site Status

Department of Pediatrics, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam, Republic of Korea

Seongnam, , South Korea

Site Status

Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea

Seongnam, , South Korea

Site Status

Department of Pediatrics, College of Medicine, The Catholic University of Korea, Eunpyeong St. Mary's Hospital, Seoul, Republic of Korea

Seoul, , South Korea

Site Status

Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Republic of Korea

Seoul, , South Korea

Site Status

Department of Pediatrics, Eulji University School of Medicine, Eulji University Hospital, Seoul, Republic of Korea

Seoul, , South Korea

Site Status

Department of Pediatrics, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea

Seoul, , South Korea

Site Status

Department of Pediatrics, Korea University College of Medicine, Korea University Guro Hospital, Seoul, Republic of Korea

Seoul, , South Korea

Site Status

Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, Republic of Korea

Seoul, , South Korea

Site Status

Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, Republic of Korea

Seoul, , South Korea

Site Status

Department of Pediatrics, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea

Seoul, , South Korea

Site Status

Countries

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South Korea

Central Contacts

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Young June Choe, MD

Role: CONTACT

Phone: +82-10-5943-0133

Email: [email protected]

Facility Contacts

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Kyo Jin Jo, MD

Role: primary

Kyung-Ran Kim, MD

Role: primary

Gahee Kim, MD

Role: primary

Jae Hong Choi, MD

Role: primary

Taek Jin Lee, MD

Role: primary

Hyunju Lee, MD

Role: primary

Ui Yoon Choi, MD

Role: primary

Hyun Mi Kang, MD

Role: primary

Byung Wook Eun, MD

Role: primary

Youn Young Choi, MD

Role: primary

Yoon Sun Yoon, MD

Role: primary

Ki Wook Yun, MD

Role: primary

Bin Ahn, MD

Role: primary

Doo Ri Kim, MD

Role: primary

References

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Other Identifiers

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KNIH

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

DOMINO

Identifier Type: -

Identifier Source: org_study_id