- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00304889
Vancomycin vs. Nitazoxanide to Treat Recurrent C. Difficile Colitis
Vancomycin Vs. Nitazoxanide to Treat Clostridium Difficile Colitis That Has Failed Therapy With Metronidazole
Study Overview
Status
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 used to be said to be around 2-3%, but that has recently been shown by us (Clin Infect. Dis, July, 2005) and others (Pepin et al, Clin. Infect. Dis., July, 2005) to be substantially higher -- approximately 15-20%. 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 and the developed world.
Although orally administered vancomycin was the first drug to be approved in treating C. difficile colitis, and remains the only one with the official approval by the Food and Drug Administration, the currently recommended therapy for this condition is metronidazole, given orally. This drug was recommended because: (1) the cost of vancomycin was exceedingly high; (2) there was concern that vancomycin-resistant bacteria might appear in hospitals if the drug was used to treat large number of patients; and (3) these recommendations were made at a time that the cure rate from metronidazole was thought to approach 100%.
We have recently shown that 23% of patients fail to respond to initial therapy with metronidazole, and another 27% relapse after treatment (Musher et al, Clin Infect Dis, July, 2005). Others have confirmed these observations (Pepin et al, Clin Infect Dis, July 2005). The options for treating failure or relapse are limited. Another course of metronidazole may cure about one-half of patients. Oral vancomycin may be used, but this drug also has a failure rate of 10-20% and the concerns about its use remain.
Based on this background, we became interested in studying nitazoxanide. This is an FDA approved drug, marketed in the United States and 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. 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 completed that trial.
The results of this study were very favorable. A 10-day course of oral nitazoxanide produced a cure of symptoms at 7 days of about 90% and a cure without relapse at 31 days of about 79% compared to 84% and 56%, respectively, for metronidazole. Because of the small numbers of subjects, these differences were not statistically significant, but the results certainly appeared promising. A manuscript has just been submitted to Clin Infect Dis describing this study.
We now propose to compare nitazoxanide to vancomycin in the group of patients most in need of alternative therapy, namely those who have been treated with metronidazole and have failed or have had a recurrence of disease after an initial response.
Study Type
Enrollment (Actual)
Contacts and Locations
Study Locations
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Texas
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Houston, Texas, United States, 77030
- Michael E. DeBakey Veterans Affairs Medical Center
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Description
Inclusion Criteria:
- Patients >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 symptoms recurred after the patient has completed a course of metronidazole therapy
- 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 of known causes of diarrhea, such as inflammatory bowel disease
- patients in whom diarrhea can not be evaluated, such as those with colostomy
- patients with renal insufficiency (BUN or creatinine >3.0 times baseline)
- patients who are medically unstable, for example in an ICU and on medications to maintain blood pressure
- patients who are regarded as unlikely to survive for 3 months
Study Plan
How is the study designed?
Design Details
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Days to symptom resolution
Time Frame: observation
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Number of day to resolution to three formed or loose stools per day
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observation
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
side effects
Time Frame: observational
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number of side effects from medication
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observational
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Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Daniel M Musher, M.D., Houston VA Medical Center, Baylor College of Medicine
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 (ESTIMATE)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- H-18736
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.
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