- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00304356
Compassionate Use of Nitazoxanide for the Treatment of Clostridium Difficile Infection
Compassionate Use of Nitazoxanide for the Treatment of Clostridium Difficile Colitis in Patients Who Have Failed Conventional Therapy
Study Overview
Status
Intervention / Treatment
Detailed Description
Clostridium difficile is the leading cause of nosocomial diarrheal disease associated with antibiotic therapy. This is a debilitating condition with substantial morbidity and a mortality that may be around 2-3%. There has been an enormous increase in this disease at the VA Medical Center during the past two years, just as has occurred at other hospitals throughout the United States.
Currently recommended therapy for this condition is metronidazole, given orally. About 15-20% of patients fail to respond to initial therapy with metronidazole, and another 20% relapse after treatment. Relapses may be treated with another course of metronidazole; about one-half will respond to this therapy. The failures are treated with oral vancomycin, but this drug also has a failure rate of 10-20%. There is, at present, no other accepted therapy (although some articles in the literature favor vancomycin with ingested bacteria from benign species). Furthermore, there is a strong risk to the emergence of resistant bacteria when hospitalized patients are treated with oral vancomycin.
Nitazoxanide is an FDA approved drug that is marketed in the U.S. and has been widely used throughout the world to treat parasitic diseases of the gastrointestinal tract; several million children have been treated with this drug during the past decade. Nitazoxanide has been approved as an antiprotozoal agent for oral administration in pediatric patients, ages 1 through 11, with diarrhea. The drug acts by interfering with anaerobic metabolic pathways, and it has been shown to have excellent in vitro activity against C. difficile. We hypothesized that this drug was both safe and effective as an alternative in patients who have diarrheal disease caused by C. difficile. The IRB approved a double-blind protocol to compare metronidazole with nitazoxanide, and we have treated a total of 16 patients so far under this protocol.
In our IRB-approved double blind study (by design, two thirds of the subjects have been randomized to the nitazoxanide), our patients have appeared to have a good response rate -- so good, in fact, that we think that nitazoxanide may be a better drug to treat this infection than either metronidazole or vancomycin.
Study Type
Enrollment (Actual)
Phase
- Phase 3
Contacts and Locations
Study Locations
-
-
Texas
-
Houston, Texas, United States, 77030
- Baylor College of Medicine
-
Houston, Texas, United States, 77030
- Michael E. DeBakey VA Medical Center
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Patient must be > 18 years of age
- Clinical diagnosis of C. difficile associated disease, based on the new onset of diarrhea, abdominal discomfort, or otherwise unexplained fever or leukocytosis
- Diagnosis of C. difficile colitis proven by positive assay for C. difficile toxin in feces
- Disease has been treated, and the symptoms failed to respond to treatment with metronidazole or vancomycin, or symptoms promptly relapsed after completing a course of therapy with either of these drugs
- Able to take oral medication
Exclusion Criteria:
- Patients with other recognized causes of diarrhea or colitis
- Women of child bearing age who are pregnant, breast feeding, or not using birth control
- Patients taking coumadin, phenytoin, celecoxib, or losartan
- Patients with renal insufficiency (BUN or creatinine >2 times baseline)
- Serious systemic disorder incompatible with the study
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Other: active drug
500 mg nitazoxanide bid given to patient
|
500 mg bid
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Nitazoxanide
Time Frame: 30 days
|
stopping of diarrhea
|
30 days
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Daniel M Musher, M.D., Baylor College of Medicine, Houston VA Medical Center
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Digestive System Diseases
- Infections
- Gastrointestinal Diseases
- Gastroenteritis
- Colonic Diseases
- Intestinal Diseases
- Bacterial Infections
- Bacterial Infections and Mycoses
- Gram-Positive Bacterial Infections
- Clostridium Infections
- Enterocolitis
- Colitis
- Enterocolitis, Pseudomembranous
- Anti-Infective Agents
- Antiparasitic Agents
- Nitazoxanide
Other Study ID Numbers
- H-15601
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Clostridium Enterocolitis
-
Michael E. DeBakey VA Medical CenterBaylor College of MedicineCompletedClostridium Enterocolitis | Pseudomembranous Colitis | Antibiotic-Associated ColitisUnited States
-
José María Aguado García, MD, PhDMerck Sharp & Dohme LLC; Hospital Universitario 12 de OctubreCompletedEnterocolitis, Pseudomembranous | Clostridium DifficileSpain
-
Genzyme, a Sanofi CompanyCompletedDiarrhea | Clostridium EnterocolitisAustralia, Belgium, France, Spain, Germany, Portugal, Switzerland, Austria, United Kingdom, Ireland, Czech Republic, Denmark, Norway, Sweden
-
Jewish General HospitalTerminatedFulminant Clostridium Difficile ColitisCanada
-
Genzyme, a Sanofi CompanyCompletedClostridium Difficile-Associated Diarrhea | Antibiotic-associated Diarrhea | Clostridium Enterocolitis | Clostridium Difficile Diarrhea | Antibiotic-associated ColitisUnited States, Canada, United Kingdom, Puerto Rico
-
William Beaumont HospitalsTerminatedClostridium Difficile ColitisUnited States
-
McMaster UniversityThe Physicians' Services Incorporated FoundationCompletedAntibiotic-Associated Diarrhea | Clostridium Enterocolitis | Pseudomembranous Colitis | Pseudomembranous Enterocolitis | Pseudomembranous EnteritisCanada
-
Massachusetts General HospitalTerminatedClostridium Difficile ColitisUnited States
-
Duke UniversityRecruitingClostridium Difficile ColitisUnited States
-
William Beaumont HospitalsBeaumont HospitalWithdrawnClostridium Difficile ColitisUnited States
Clinical Trials on Nitazoxanide
-
Telethon Kids InstituteWithdrawn
-
Azidus BrasilFarmoquimica S.A.; Hospital Vera Cruz; Hospital Casa de Saúde - Vera Cruz - Campinas... and other collaboratorsCompleted
-
Romark Laboratories L.C.CompletedRotavirus Infection | Norovirus Infection | Adenoviridae Infection
-
Azidus BrasilFarmoquimica S.A.Recruiting
-
Pinnacle Clinical Research, PLLCCompletedFatty Liver | Fibrosis, Liver | Compensated Cirrhosis | Non-alcoholic SteatohepatitisUnited States
-
Romark Laboratories L.C.CompletedRhinovirus | EnterovirusUnited States, Puerto Rico
-
Maha TalaabCompleted
-
Materno-Perinatal Hospital of the State of MexicoLaboratorios LiomontCompletedCoronavirus InfectionMexico
-
International Centre for Diarrhoeal Disease Research...University of VirginiaCompleted
-
Sadat City UniversityRecruitingIrritable Bowel Syndrome With DiarrheaEgypt