Randomized, Multicenter, Non-inferiority Trial Comparing the Efficacy of Fosfomycin Versus Fluoroquinolones or Cotrimoxazole as Oral Follow-up Treatment in Febrile Urinary Tract Infections in Men Caused by Susceptible Enterobacteria (FOSFORMEN)
Essai randomisé, Multicentrique, de Non-infériorité Comparant l'efficacité d'un Traitement Par Fosfomycine Versus Fluoroquinolones ou Cotrimoxazole en Relais Oral Dans Les Infections Urinaires Masculines fébriles Dues à Escherichia Coli
The fosfomycin-trometamol (FT) combination demonstrates microbiological efficacy against the vast majority of Escherichia coli strains responsible for urinary tract infections (UTIs). Moreover, approximately 99% of strains exhibiting multidrug resistance remain suceptible to fosfomycin.
The clinical tolerance profile of this molecule is excellent and has been well established since its market authorization in 1989 for the treatment of cystitis in women.
Its pharmacokinetic and pharmacodynamic properties are compatible with its use in the treatment of UTIs in men.
However, the clinical efficacy of FT (oral fosfomycin) in the treatment of febrile UTIs in men has never been evaluated in prospective trials. FT could represent an innovative treatment option in such cases, offering the use if an antibiotic with significantly fewer side effects than those currently recommended.
The main objective of the trial is to demonstrate that FT is not inferior to fluoroquinolones (FQ) or cotrimoxazole (TMP-SMX) as oral step-down therapy in prostatitisfebrile male urinary tract infections caused by Escherichia coli.
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Undersøgelsestype
Undersøgelsestype
Tilmelding (Anslået)
Tilmelding
Fase
Fase
- Fase 3
Kontakter og lokationer
Studiekontakt
Studiekontakt
- Navn: Jérôme Lambert
- Telefonnummer: +33 +33 1 42 49 97 42
- E-mail: jerome.lambert@u-paris.fr
Undersøgelse Kontakt Backup
- Navn: Antoine Hamon
- Telefonnummer: +33 +33 1 40 87 54 83
- E-mail: antoine.hamon@aphp.fr
Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
Inclusion Criteria:
- Male
- Age ≥ 18
- Body temperature ≥ 38°C within the 72 hours preceding the diagnosis of UTI
- At least one of the following symptoms : dysuria, higher urinary frequency, urgency, hematuria, suprapubic pain, prostatic pain, or perineal pain
- Positive urine microbiological examination (urine culture) : Sample collected before initiation of the empiric antibiotic therapy, ≥ 10 leukocytes/µL, and monomicrobial culture positive for E. coli with bacteriuria ≥ 103 CFU/mL
- The strain must be suceptible to fosfomycin and to either FQ or TMP-SMX according to EUCAST
- The strain must be suceptible to the empiric antibiotic therapy received
- Ability to take oral treatment
- Favorable clinical evolution after receiving effective empiric antibiotic therapy for 72 ± 24 hours ; Favorable evolution is defined as body temperature < 38°C with clinical improvement or resolution of the clinical signs and symptoms of urinary tract infection present at diagnosis, including the absence or improvement of dysuria, pollakiuria, urinary urgency, hematuria, suprapubic, prostatic, or perineal pain, urethral pain during urination, and/or a burning sensation during urination.
Exclusion Criteria:
- Presence of another condition that could explain the fever
- Septic shock of urinary origin
- Need for a urological procedure
- Anatomical abnormalities of the urinary tract (e.g., urinary prostheses and implants [except JJ], Bricker, neobladder, total prostatectomy, uretrestomy, nephrostomy, urinary fistula)
- Presence of an indwelling urinary catheter, except of placed during the current UTI episode
- Neurogenic bladder
- Immunosupression
- Contraindication to the use of FQ , TMP-SMX or FT
- Severe chronic kidney disease with an estimated flomerular filtration rate < 20 mL/min
- UTI treated within the past 3 months
- High probability of death within 3 months
- Major cognitive disorders
- Patients deprived of their liberty by judicial or administrative decision, under guardianship or curatorship
- Lack of social security coverage
- Absence of written informed consent
- Participation in another interventional research protocol
- Absence of written informed consent
- Participation in another interventional research protocol
- Patients deprived of their liberty by a judicial or administrative decision
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Enkelt
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
|---|---|
|
Eksperimentel: Fosfomycin-trometamol (FT)
|
Oral dose : 3g Fosfomycin-trometamol once daily |
|
Aktiv komparator: Reference treatments as per the French SPLIF guidlines
|
Reference treatments will bet hose recommended by the French SPLIF guidlines :
|
Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Clinical cure
Tidsramme: At day 26
|
Defined as body temperature < 38°C and absence of urinary tract infection symptoms, without the need for additional antibiotic therapy up to the primary evaluation on Day 26, which corresponds to 14 days after completion of a 12-day antibiotic treatment assigned by randomization. |
At day 26
|
Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Cumulative incidence of infectious and urological complications
Tidsramme: Up to day 40
|
Up to day 40
|
|
|
Adherence to treatment
Tidsramme: Up to day 40
|
Up to day 40
|
|
|
Occurence of adverse events related to anticiotics
Tidsramme: Up to day 40
|
Occurrence, nature, and severity of adverse events |
Up to day 40
|
|
Rectal carriage of phenotypically antibiotic-resistant Enterobacterales
Tidsramme: At day 26
|
Carriage of Enterobacterales resistant to FQ, TMP-SMX, fosfomycin, and third-generation cephalosporins on Day 26, i.e., 14 days after completion of the randomized antibiotic treatment Binary outcome |
At day 26
|
|
Rates of recurrence of febrile or non-febrile UTIs (relapse or reinfection)
Tidsramme: At day 40
|
Assessed on Day40, i.e., 28 days after completion of the randomized antibiotic treatment
|
At day 40
|
|
Number of patients who experienced treatment failure
Tidsramme: Up to day 40
|
Clinical and biological characteristics of patients who experienced treatment failure compared to those who were cured during the initial episode |
Up to day 40
|
Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Datoer for undersøgelser
Studer store datoer
Studiestart (Anslået)
Studiestart
Primær færdiggørelse (Anslået)
Primær færdiggørelse
Studieafslutning (Anslået)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Yderligere relevante MeSH-vilkår
- Urogenitale sygdomme
- Genitale sygdomme
- Kønssygdomme, mandlige
- Prostatasygdomme
- Mandlige urogenitale sygdomme
- Infektioner
- Bakterielle infektioner
- Bakterielle infektioner og mykoser
- Gram-negative bakterielle infektioner
- Enterobacteriaceae infektioner
- Escherichia coli infektioner
- Prostatitis
- Organiske kemikalier
- Organophosphorforbindelser
- Organophosphonater
- Fosfomycin
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- APHP240801
Plan for individuelle deltagerdata (IPD)
Planlægger du at dele individuelle deltagerdata (IPD)?
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