- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01039545
Symptomatic Therapy of Uncomplicated Lower Urinary Tract Infections in the Ambulatory Setting.
Symptomatic Therapy of Uncomplicated Lower Urinary Tract Infections in the Ambulatory Setting. A Randomized, Double Blind Trial
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Background
Urinary tract infection (UTI) is the most frequent bacterial infection diagnosed and treated by general practitioners and accounts for about 15% of antibiotic prescriptions in ambulatory medicine. World-wide raise of antibiotic resistance among uropathogens, most commonly Escherichia coli, threatens treatment of UTI. Uncomplicated UTI, the most frequent manifestation of UTI, is a benign, self-limited disease and the primary goal of treatment is symptom relief not cure. Antibiotic treatment reduces the duration of symptoms by 1-2 days from 5-6 days to 3-4 days. Symptoms of cystitis are the result of an inflammation evoked by bacterial products which stimulate the production of prostaglandins by a cyclooxygenase dependent mechanism. Therefore, we propose that symptom control with a non-steroidal anti-inflammatory drug (NSAID), an inhibitor of cyclooxygenase 1 and 2, may be equally effective for symptom control as standard antibiotic therapy in non-complicated UTI and may therefore help to reduce antibiotic consumption.
Objective
The primary objective is to determine whether initial symptomatic treatment followed by optional delayed antibiotic treatment (experimental intervention) is non-inferior to immediate antibiotic treatment followed by optional delayed antibiotic treatment (control intervention) in terms of symptom resolution.
The secondary objective is to determine whether the experimental intervention is superior to control in reducing the proportion of patients undergoing antibiotic treatment.
Methods
Randomized controlled patient and assessor blind trial performed in general practices. Study population are women between the ages of 18 to 70 years with acute uncomplicated UTI. The experimental intervention will consist of symptomatic treatment with diclofenac 75mg twice daily, followed by optional, delayed antibiotic treatment with single dose of 3g fosfomycin if deemed necessary by the patient. The control intervention will consist of immediate antibiotic treatment with norfloxacin 400mg twice daily for three days, followed by optional, delayed antibiotic treatment with single dose of 3g fosfomycin if deemed necessary by the patient. Patients will use a diary to describe symptoms for 10 days. A follow-up telephone interview will be performed on day 10 and 30.
Study Type
Enrollment (Actual)
Phase
- Phase 4
Contacts and Locations
Study Locations
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-
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Berne, Switzerland, 3010
- Institute for Infectious Diseases, University of Berne
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Female
- Age between 18 and 70 years
- Written informed consent
- At least one typical symptom of acute, lower urinary tract infection out of dysuria, frequency, macrohaematuria, cloudy or smelly urine or self-diagnosed cystitis
- A urine dipstick test should be indicative of UTI by positive nitrite or leucocyturia
Exclusion Criteria
- Duration of UTI symptoms for more than 7 days before physician's visit
- Clinical signs of invasiveness such as fever (axillary body temperature >38 degrees Celsius), costovertebral pain or tenderness, rigors, nausea or vomiting
- Known or suspicion of anatomical or functional abnormality of the urinary tract
- Vaginal symptoms: discharge, irritation
- Diabetes mellitus
- Immunosuppression (e.g. prednisone equivalent >10mg per day for >14 days, chemotherapy, radiotherapy, immunomodulators, HIV infection, neutropenia)
- Any other serious comorbidity as judged by the treating physician
- Bladder catheter in situ or during the past 30 days
- Pregnancy
- Recurrent urinary tract infection (more than 3 infections during the last 12 months)
- Antibiotic treatment during the last 4 weeks
- Hypersensitivity to one of the study medications
- Psychiatric illness or dementia
- Unable to communicate in German or French language
- Documented coagulopathy (including therapy with coumarine derivatives) or documented history of gastric or duodenal ulcer disease
- Documented renal insufficiency grade III or higher (calculated GFR <60) or known congestive heart failure (NYHA III or higher)
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: antibiotic
Norfloxacin for three days, followed by fosfomycin on day 4 if deemed necessary
|
Norfloxacin 400mg twice daily for 3 days, followed by fosfomycin 3g single dose on day 4 if deemed necessary
|
Experimental: symptomatic
Diclofenac retard for three days, followed by fosfomycin on day 4 if deemed necessary
|
Diclofenac retard 75mg twice daily for 3 days, followed by fosfomycin 3g single dose on day 4 if deemed necessary
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
The proportion of patients with resolution of symptoms on day 4
Time Frame: one month
|
one month
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
The proportion of patients ever on antibiotics between randomization at day 1 and follow-up at day 30
Time Frame: one month
|
one month
|
The proportion of patients using single dose fosfomycin on day 4
Time Frame: one month
|
one month
|
The proportion of patients with re-consultations because of UTI within 30 days
Time Frame: one month
|
one month
|
The mean composite symptom scores on days 4, 7 and 30
Time Frame: one month
|
one month
|
The proportion of patients with resolution of symptoms on day 7
Time Frame: one month
|
one month
|
The proportion of patients with complete resolution of symptoms on days 4 and 7
Time Frame: one month
|
one month
|
The time until resolution of symptoms
Time Frame: one month
|
one month
|
The proportion of patients with adverse events
Time Frame: one month
|
one month
|
Mean overall patient stratification
Time Frame: one month
|
one month
|
Health-related quality of life on day 4
Time Frame: one month
|
one month
|
Number of working days lost
Time Frame: one month
|
one month
|
Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Andreas Kronenberg, University of Bern
Publications and helpful links
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
Additional Relevant MeSH Terms
- Pathologic Processes
- Urologic Diseases
- Disease Attributes
- Infections
- Communicable Diseases
- Urinary Tract Infections
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Anti-Infective Agents
- Peripheral Nervous System Agents
- Enzyme Inhibitors
- Analgesics
- Sensory System Agents
- Anti-Inflammatory Agents, Non-Steroidal
- Analgesics, Non-Narcotic
- Anti-Inflammatory Agents
- Antirheumatic Agents
- Cyclooxygenase Inhibitors
- Antineoplastic Agents
- Topoisomerase II Inhibitors
- Topoisomerase Inhibitors
- Anti-Bacterial Agents
- Cytochrome P-450 Enzyme Inhibitors
- Cytochrome P-450 CYP1A2 Inhibitors
- Diclofenac
- Norfloxacin
Other Study ID Numbers
- 254/09
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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