Efficacy of Daptomycin Plus Fosfomycin Versus Daptomycin for Treatment of MRSA Bacteremia

January 16, 2018 updated by: Miquel Pujol

Randomized Multicenter Study to Assess Efficacy of Daptomycin Plus Fosfomycin Versus Daptomycin Monotherapy for Treatment of Methicillin Resistant Staphylococcus Aureus Bacteremia in Hospitalized Patients

To demonstrate that the combination of daptomycin and fosfomycin is superior to daptomycin alone in the treatment of methicillin resistant Staphylococcus aureus (MRSA) bacteremia.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

The mortality associated to MRSA bacteremia remains higher than 30% of episodes despite the availability of new antibiotics. Objective: To demonstrate that the combination of daptomycin and fosfomycin is superior to daptomycin alone in the treatment of methicillin resistant Staphylococcus aureus (MRSA) bacteremia. Design: Randomized, open-label and multicenter study. Intervention: Patients with MRSA bacteremia will be randomized (1:1) in Group 1: daptomycin 10mg/Kg/24h intravenous (iv) and Group 2: daptomycin 10 mg/kg/24 iv plus fosfomycin and 2g/6h iv. Duration of therapy will be 10-14 days for uncomplicated bacteremia and up to 42 days for complicated bacteremia. Follow up: There will be a clinical and microbiological evaluation at baseline, during treatment and at week 6 after the end of therapy (test of cure visit, TOC). Complicated bacteremia was considered if: a) persistence of a positive blood culture at 72-96 h from the start of antibiotic, b) evidence of spread of infection (metastatic infection) c) infection involving a non-removable device in less than 4 days. Sample size: Assuming 60% cure rate with daptomycin and a 20% difference in cure rates between both groups, we estimated that 103 patients will be needed for each group (α:0.05, ß: 0.2). Main endpoint: clinical and microbiological response at the TOC visit. Treatment success was defined as the resolution of clinical signs and symptoms and negative blood culture. Treatment failure was defined if any of the following situations: a) lack of clinical response at 72 h or more after initiation of the study therapy b) persistent bacteremia (positive blood culture on day 7 after randomization), c) withdrawal of treatment due to adverse effects or for any other reason based on clinical judgment. d) relapse of MRSA bacteremia before the TOC visit e) death for any reason before the TOC visit. Secondary endpoints: evaluation in both groups of clinical and microbiological response at end of therapy (EOT visit); mortality at EOT and TOC visit; persistent MRSA bacteremia; recurrence of MRSA bacteremia (positive blood culture when previous ones were negative); emergence of daptomycin or fosfomycin resistance and severe adverse effects.

Study Type

Interventional

Enrollment (Actual)

167

Phase

  • Phase 3

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Spain
      • Barakaldo, Spain, 48903
        • Hospital Universitario de Cruces
      • Barcelona, Spain, 08035
        • Hospital Vall d'Hebron
      • Barcelona, Spain, 08036
        • Hospital Clínic
      • Barcelona, Spain, 08025
        • Hospital de la Santa Creu i Sant Pau
      • Barcelona, Spain, 08003
        • Hospital del Mar- Parc de Salut Mar
      • Granada, Spain, 18014
        • Hospital Universitario Virgen de las Nieves
      • Lleida, Spain, 25198
        • Hospital Universitari Arnau de Vilanova
      • Lugo, Spain, 27004
        • Hospital Universitario Lucus Augusti
      • Madrid, Spain, 28041
        • Hospital Universitario 12 de octubre
      • Madrid, Spain, 28034
        • Hospital Ramón y Cajal
      • Madrid, Spain, 28007
        • Hospital General Gregorio Maranon
      • Palma de Mallorca, Spain, 07120
        • Complejo Asistencial Son Espases
      • Sevilla, Spain, 41071
        • Hospital Virgen Macarena
      • Tarragona, Spain, 43007
        • Hospital Universitari Joan Xxiii
    • Barcelona
      • Hospitalet de Llobregat, Barcelona, Spain, 08907
        • Hospital Universitari de Bellvitge
      • Sabadell, Barcelona, Spain, 08208
        • Hospital Parc Tauli
      • Terrassa, Barcelona, Spain, 08227
        • Hospital de Terrassa
      • Terrassa, Barcelona, Spain, 08221
        • Hospital Universitari Mutua de Terrassa

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 99 years (ADULT, OLDER_ADULT)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Patients with at least 1 positive blood culture to MRSA within 72h up to randomization
  • Adult patients, equal or older than 18 years old
  • Signed informed consent
  • Mandatory use of contraception methods for fertile women during the study period and for 6 months after stopping antibiotic therapy

Exclusion Criteria:

  • Polymicrobial bacteremia
  • Pneumonia associated to the bacteremia
  • Severe clinical status with expected survival of less than 24 hours
  • Allergy to daptomycin or fosfomycin
  • A positive pregnancy test at the time of inclusion
  • Any clinical condition that requires additional antibiotic therapy with microbiological activity against MRSA
  • Patient already included in another clinical trial
  • Prior history of eosinophilic pneumonia

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: TREATMENT
  • Allocation: RANDOMIZED
  • Interventional Model: PARALLEL
  • Masking: NONE

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
EXPERIMENTAL: Fosfomycin and Daptomycin
fosfomycin 2gr/6h + 10mg/kg/24h iv during 14 or 28 days
Drug: Fosfomycin 2gr/6h iv
Drug: Daptomycin 10mg/kg/24h iv
ACTIVE_COMPARATOR: Daptomycin
daptomycin 10mg/kg/cada 24h iv during 14 or 28 days
Drug: Fosfomycin 2gr/6h iv

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Therapy response
Time Frame: at week 6 after end of therapy (an average of 8 to 12 weeks from the beginnig of therapy)
Therapy response is considered if clinical and microbiological response is achieved at week 6 after end of therapy
at week 6 after end of therapy (an average of 8 to 12 weeks from the beginnig of therapy)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Mortality
Time Frame: participants will be followed an average of 8 to 12 weeks from the begining of therapy
participants will be followed an average of 8 to 12 weeks from the begining of therapy
Severe adverse effects
Time Frame: participants will be followed an average of 8 to 12 weeks from the begining of therapy
whatever
participants will be followed an average of 8 to 12 weeks from the begining of therapy
Number of persistent bacteremia
Time Frame: participants will be followed an average of 8 to 12 weeks from the begining of therapy
Defined as a positive blood culture on day 7 after starting the study therapy
participants will be followed an average of 8 to 12 weeks from the begining of therapy
Bacteremia recurrence
Time Frame: participants will be followed an average of 8 to 12 weeks from the begining of therapy
Defined as a positive blood culture to MRSA when previous ones were negative
participants will be followed an average of 8 to 12 weeks from the begining of therapy
Therapy response at end of therapy (EOT visit)
Time Frame: at end of therapy
Success is considered if clinical resolution and negative blood culture at end of therapy.
at end of therapy

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Miquel Pujol

Collaborators

Hospital Universitari de Bellvitge

Investigators

  • Study Director: Miquel Pujol, MD, PhD, (Infectious Diseases Service) Hospital Universitari de Bellvitge

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

December 1, 2013

Primary Completion (ACTUAL)

January 10, 2018

Study Completion (ACTUAL)

January 10, 2018

Study Registration Dates

First Submitted

July 2, 2013

First Submitted That Met QC Criteria

July 9, 2013

First Posted (ESTIMATE)

July 12, 2013

Study Record Updates

Last Update Posted (ACTUAL)

January 17, 2018

Last Update Submitted That Met QC Criteria

January 16, 2018

Last Verified

January 1, 2018

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • BACSARM
  • 2013-000586-37 (EUDRACT_NUMBER)

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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