Severe Community Acquired Pneumonia (severe CAP) is a major cause of mortality. The REMAP-CAP Trial is a multi-centre randomised controlled platform trial utilising Bayesian adaptive methods for 2800 Australian and New Zealand ICU patients with severe CAP to be analysed in conjunction with patients enrolled in other locations.


  • Background

    • Community-acquired pneumonia (CAP), that is of sufficient severity to require admission to an Intensive Care Unit (ICU), is associated with substantial mortality.
    • In Australia, CAP is responsible for more than 7000 ICU admissions and 1400 deaths each year. The annual direct cost of ICU care of these patients is in the order of $200 million.
    • All patients with severe pneumonia who are treated in an ICU will receive therapy that consists of a combination of multiple different treatments.
    • The existing evidence-base, for treatment of patients with Severe CAP is limited, reflected in variation in Australian and international guidelines as well as variation in practices including choice of antibiotic, choice of ventilator strategy, and use of immune modulating agents.



    To determine the impact on 90-day mortality of:

    • Alternative antibacterial strategies;
    • Administration of azithromycin, acting as an immunomodulatory agent;
    • Administration of a Corticosteroid;

    A key benefit of the design is that additional questions can be asked over the lifetime of the platform.


    To provide Australia and New Zealand’s contribution to the pre-prepared global research response to future pandemics of Severe Acute Respiratory Illness (SARI) by seamlessly and rapidly (within days) adapting the platform to test the most promising interventions for pandemic infection and providing trial results during the first wave of a pandemic.


    • The study will enrol adult patients with severe CAP who are admitted to ICUs using a design known as a REMAP, which is a type of platform trial.
    • Eligible participants will be randomised to receive one intervention in each of one or more domains.
    • This REMAP uses an adaptive design, relying on pre-specified criteria for adaptation, that:
      • avoids indeterminate results
      • concludes an answer to a question when sufficient data have accrued (not when a pre-specific sample is reached)
      • evaluates the effect of treatment options in pre-defined subgroups of patients (termed strata)
      • utilizes already accrued data to increase the likelihood that patients within the trial are randomized to treatments that are more likely to be beneficial
      • is multifactorial, evaluating multiple questions simultaneously
      • is intended to be perpetual (or at least open-ended), substituting new questions in series as initial questions are answered
      • can evaluate the interaction between interventions in different domains.
    • Bayesian statistical methods will be used to establish the superiority, inferiority, or equivalence of interventions within a domain. Interventions determined to be superior will be incorporated into standard care within the ongoing REMAP. Interventions determined to be inferior will be discontinued. 

Supported by:

  • National Health and Medical Research Council, (NHMRC) Australia 
  • The Health Research Council (HRC) of New Zealand
  • European funding through the PREPARE consortium

Coordinating centre:

  • The Australia and New Zealand Intensive Care Research Centre
  • The Medical Research Institute of New Zealand
  • University Medical Center Utrecht 


To find out more about REMAP-CAP please contact:
  • Cameron Green, Project Manager, The ANZIC Research Centre, Monash University.  +
  • Anne Turner, Project Manager, The Medical Research Institute of New Zealand. +64 4 805 0147
  • Professor Steve Webb, ANZ Executive Director, Department of Epidemiology and Preventive Medicine School of Public Health and Preventive Medicine, Monash University. +61 3 9903 0343 

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Read more about this study on the study website.


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