- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02355938
Use Of Oral Fidaxomicin Vs. Oral Vancomycin For Clostridium Difficile Infection In Patients With Spinal Cord Injury
October 12, 2016 updated by: Rabih Darouiche, Baylor College of Medicine
Role of Fidaxomicin in a Patient Population With Problematic Clostridium Difficile Infection
The primary purpose of this study is to compare the clinical outcomes of cure and recurrence of Clostridium difficile infection in spinal cord injured patients who are treated with oral Fidaxomicin vs. oral Vancomycin.
The secondary aim of this study is to compare the overall costs of treatment of Clostridium difficile infection in the two study groups.
Study Overview
Status
Terminated
Conditions
Intervention / Treatment
Detailed Description
In recent clinical trials, comparing oral Vancomycin versus oral Fidaxomicin to treat Clostridium difficile, oral Fidaxomicin was shown to be the same in effectiveness as oral Vancomycin, but showed a decrease in recurrence of Clostridium difficile by ten percentage points.
Based on experience with patients in our 40-bed spinal cord injury unit at the Michael E. DeBakey VA Medical Center (MEDVAMC), Clostridium difficile infection is more problematic in patients with spinal cord injury than in the general hospitalized patient population.
Compared to the general population of hospitalized patients, patients with spinal cord injury are more likely to have: (1) a higher transmission of Clostridium difficile from one patient to another often via the health care worker due to their having a neurogenic bowel (2) a longer and more complicated course of Clostridium difficile infection-associated diarrhea since neurogenic bladder may delay excretion of toxins and predispose to bowel accidents; and (3) a higher overall cost of treatment in terms of extended hospitalization (most patients with spinal cord injury who suffer from Clostridium difficile infection do not get discharged from the hospital until the symptoms of course of Clostridium difficile infection are resolved.
Fidaxomicin is the first in a new class of narrow spectrum macrocyclic antibiotic drugs.
It is a non-systemic, meaning it is minimally absorbed into the bloodstream, and it is bactericidal, meaning it attacks and kills the bacteria it comes in contact with.
It has demonstrated selective eradication of pathogenic Clostridium difficile with minimal disruption to the numerous species of bacteria that make up the normal, healthy intestinal flora.
The maintenance of normal physiological conditions in the colon can reduce the probability of recurrence of a Clostridium difficile infection.
Since clearance of Clostridium difficile infections is problematic in the spinal cord injured patients, this antimicrobial agent may show a trend for clinical superiority and a reduction in recurrence of infection within the spinal cord injury population resulting in a shorter hospital stays and reduced costs.
Study Type
Interventional
Enrollment (Actual)
12
Phase
- Phase 4
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
-
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Texas
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Houston, Texas, United States, 77030
- Michael E. DeBakey VA Medical Center
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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 and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Ability of subject to provide an informed consent
- Legally Authorized Representative-Adult must provide consent in case the subject is unable to consent
- Diagnosis of Clostridium difficile disease based on clinical manifestations (change in bowel habits, at least 2 more unformed bowel movements as compared to baseline neurogenic bowel function in the same patient in the 24-hour period prior to randomization)
- Lab data (positive polymerase chain reaction test for Clostridium difficile in a stool specimen obtained within 72 hours before randomization)
- Patient has not received antibiotics that are active against Clostridium difficile for any more than 24 hours prior to being screened for this study.
Exclusion Criteria:
- Receipt of agents (oral Vancomycin, oral or IV Metronidazole, oral rifamdin, oral bacitracin, or oral fusidic acid) that are active against Clostridium difficile for longer than 24 hours after randomization
- Life-threatening or fulminant Clostridium difficile infection, presence of toxic megacolon, and history of inflammatory bowel disease (Crohn's disease and ulcerative colitis)
- Allergy to study medications.
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 Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Fidaxomicin Arm
Oral Fidaxomicin 200 mg every 12 hours (Placebo for 2 doses) for 10 days
|
Fidaxomicin 200 mg every 12 hours
Other Names:
1 dose of placebo every 6 hours x 2 doses
Other Names:
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Active Comparator: Vancomycin Arm
Oral Vancomycin 125 mg every 6 hours for 10 days
|
Vancomycin 125 mg every 6 hours
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Cure of Clostridium Difficile
Time Frame: 10 Days
|
Decrease in number and frequency of loose stools
|
10 Days
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Cost Benefit Analysis
Time Frame: Hospitalization cost 6 months before and 6 months after treatment
|
Hospitalization cost 6 months before and 6 months after treatment
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Investigators
- Principal Investigator: Rabih O Darouiche, MD, Michael E. DeBakey VA Medical Center
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
February 1, 2014
Primary Completion (Actual)
October 1, 2016
Study Completion (Actual)
October 1, 2016
Study Registration Dates
First Submitted
January 30, 2015
First Submitted That Met QC Criteria
January 30, 2015
First Posted (Estimate)
February 4, 2015
Study Record Updates
Last Update Posted (Estimate)
October 13, 2016
Last Update Submitted That Met QC Criteria
October 12, 2016
Last Verified
October 1, 2016
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Central Nervous System Diseases
- Nervous System Diseases
- Infections
- Wounds and Injuries
- Bacterial Infections
- Bacterial Infections and Mycoses
- Gram-Positive Bacterial Infections
- Trauma, Nervous System
- Spinal Cord Diseases
- Spinal Cord Injuries
- Clostridium Infections
- Anti-Infective Agents
- Anti-Bacterial Agents
- Vancomycin
- Fidaxomicin
Other Study ID Numbers
- IIS-000116
- H-32358 (Other Identifier: Baylor College of Medicine)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
IPD Plan Description
Enrollment to low for statistical analysis.
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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