Safety of Discontinuing Patient Antibiotic Treatment (STOP-AB)
Safety of Discontinuing Patient Antibiotic Treatment When Physicians no Longer Consider it Necessary
調査の概要
詳細な説明
Introduction: General practitioners (GP) have always been told to continue an antibiotic regimen once the patient has initiated it in order to prevent the patient from acquiring resistant microorganisms. This might be true for confirmed bacterial infections; however, continuing an antibiotic regimen when this is not indicated might hasten the acquisition of resistant organisms and cause adverse events. Since 2011 the Spanish Society of Family Medicine has been recommending GPs to ask their patients to stop taking antibiotics when they suspect a viral infection. However, there is no evidence that discontinuing antibiotic therapy for these conditions is safe. The main objective of this study is to determine whether discontinuation of antibiotic therapy when a GP no longer considers it necessary makes any difference in terms of the number of days with severe symptoms.
Methods: This is a multicentre, open-label, randomised controlled clinical trial. The study will be conducted in ten primary care centres in Spain. We will include patients from 18 to 75 years of age with uncomplicated acute respiratory tract infections (RTIs) in whom: 1. Antibiotics are not necessary; or 2. Those diagnosed with clinical conditions for which antibiotics might be necessary but according to the history and clinical examination the GP considers that antibiotics are not needed or the patient feels that the antibiotic regimen has not worked as expected; or 3. Several doses of an antibiotic have been taken from leftovers found in the household or obtained at the pharmacy without any medical prescription for a clinical condition for which antibiotics are not necessary. The patients will be randomly assigned to the usual strategy of continuing antibiotic treatment (usual intervention group) or discontinuing antibiotic therapy (novel intervention group). A sample size of 215 patients per group was calculated on the basis of a reduction of one day in the duration of severe symptoms as a clinically relevant outcome. The primary outcome will be duration of severe symptoms, i.e. symptoms scored 5 or 6 by means of a symptom diary. Secondary outcomes will include: antibiotics taken, adverse events, patient satisfaction, and complications within the first 3 months. A post-trial implementation observational clinical study by means of a qualitative analysis is planned to be carried out after the clinical trial to know the percentage of the use of the strategy of discontinuing antibiotic treatment and the pros and cons of its use.
Ethics and dissemination: The study was approved by the Ethical Board of Fundació Jordi Gol i Gurina (reference number: 16/093) and informed consent will be obtained from all the patients included. The findings of this trial will be disseminated through research conferences and peer-reviewed journals.
研究の種類
入学 (実際)
段階
- 適用できない
連絡先と場所
研究場所
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Balearic Islands
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Palma de Mallorca、Balearic Islands、スペイン、07006
- Coll d'en Rabassa Primary Health Center
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Catalonia
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Barcelona、Catalonia、スペイン、08015
- Manso - Via Roma Primary Care Center
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Barcelona、Catalonia、スペイン、08038
- La Marina Primary Care Center
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Barcelona、Catalonia、スペイン、08041
- Guinardó Primary Care Center
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Tarragona、Catalonia、スペイン、43005
- Jaume I Primary Care Center
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参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
Inclusion Criteria: Patients with uncomplicated respiratory tract infections [common cold, influenza, pharyngitis, rhinosinusitis, acute bronchitis, and acute exacerbations of mild-to-moderate chronic obstructive pulmonary disease] who has previously taken any dose of antibiotic due to any of the following 3 clinical scenarios and accepts to participate in the clinical trial will be included:
- Patients diagnosed with clinical conditions for which antibiotics are not necessary;
- Patients diagnosed with a clinical condition for which antibiotics might be necessary but according to the history and clinical examination the primary health physician considers that antibiotics are not needed to be taken or the patients feel that the antibiotic regimen has not worked as expected and feel they need clinical reassessment
- Patients who have taken some doses of an antibiotic (from leftovers found in the household or obtained at the pharmacy without any medical prescription) for a clinical condition for which antibiotics are not necessary
Exclusion Criteria:
- Subjects under 18 and over 75 years of age
- Patients with confirmed bacterial infection
- Patients requiring hospital admission
- Severe impairment of signs (impairment of consciousness, respiratory rate > 30 respirations per minute, heart rate > 125 beats per minute, systolic blood pressure < 90 mm Hg, diastolic blood pressure < 60 mm Hg, temperature > 40°C, oxygen saturation < 92%)
- Problems to comply with treatment at home - sociopathy or psychiatric problems, drug or alcohol addiction, or within an inadequate family setting -
- Lack of tolerance to oral treatment, such as the presence of nausea and vomiting, gastrectomy, post-surgery and/or diarrhoea
- Significant comorbidity, including severe renal failure, hepatic cirrhosis, severe heart failure, immunosuppression - chronic HIV infection, transplantation, neutropenic, or patients receiving immunosuppressive drugs or corticosteroids -
- Terminal disease
- Admitted to a long-term residence
- Difficulty to attend the programmed visits
- Refusal to participate in the study
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:処理
- 割り当て:ランダム化
- 介入モデル:並列代入
- マスキング:なし(オープンラベル)
武器と介入
参加者グループ / アーム |
介入・治療 |
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実験的:Novel intervention group
Discontinuing antibiotic therapy.
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Patients assigned to this group will be asked to discontinue antibiotic therapy.
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実験的:Usual intervention group
Usual strategy of continuing antibiotic treatment.
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Patients assigned to this group will be asked to complete antibiotic therapy.
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この研究は何を測定していますか?
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
---|---|---|
Duration of severe symptoms
時間枠:From 14 to 28 days after the index visit
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Days with symptoms scoring 5 or 6 by means of a six-point Likert scale
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From 14 to 28 days after the index visit
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二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
---|---|---|
Adverse effects of the medication
時間枠:From index visit to 28 days after the initial visit
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Any adverse effect appearing from day 0 to 28
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From index visit to 28 days after the initial visit
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Antibiotic consumption
時間枠:From index visit to day 28
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Any antibiotic taken by the patient
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From index visit to day 28
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Satisfaction with health care by means of a questionnaire
時間枠:Day 28 after the index visit
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Satisfaction degree stated by the patient at day 28
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Day 28 after the index visit
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Belief in the effectiveness of antibiotic therapy by means of a questionnaire
時間枠:Day 28 after the index visit
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Degree of patient's belief in how effective antibiotics are for uncomplicated respiratory tract infections
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Day 28 after the index visit
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Rate of complications
時間枠:Within the first 3 months
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Any complication related to the uncomplicated respiratory tract infection within the 3 first months after the index visit
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Within the first 3 months
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協力者と研究者
捜査官
- スタディディレクター:Josep M Cots, Professor、University of Barcelona
出版物と役立つリンク
一般刊行物
- Gilbert GL. Knowing when to stop antibiotic therapy. Med J Aust. 2015 Feb 16;202(3):121-2. doi: 10.5694/mja14.01201. No abstract available.
- Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ. 2010 May 18;340:c2096. doi: 10.1136/bmj.c2096.
- Dekker AR, Verheij TJ, van der Velden AW. Inappropriate antibiotic prescription for respiratory tract indications: most prominent in adult patients. Fam Pract. 2015 Aug;32(4):401-7. doi: 10.1093/fampra/cmv019. Epub 2015 Apr 24.
- Morgan DJ, Okeke IN, Laxminarayan R, Perencevich EN, Weisenberg S. Non-prescription antimicrobial use worldwide: a systematic review. Lancet Infect Dis. 2011 Sep;11(9):692-701. doi: 10.1016/S1473-3099(11)70054-8. Epub 2011 Jun 12.
- Goossens H, Ferech M, Vander Stichele R, Elseviers M; ESAC Project Group. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet. 2005 Feb 12-18;365(9459):579-87. doi: 10.1016/S0140-6736(05)17907-0.
- Llor C, Moragas A, Bayona C, Cots JM, Hernandez S, Calvino O, Rodriguez M, Miravitlles M. Efficacy and safety of discontinuing antibiotic treatment for uncomplicated respiratory tract infections when deemed unnecessary. A multicentre, randomized clinical trial in primary care. Clin Microbiol Infect. 2022 Feb;28(2):241-247. doi: 10.1016/j.cmi.2021.07.035. Epub 2021 Aug 4.
- Llor C, Moragas A, Bayona C, Cots JM, Molero JM, Ribas J, Fothy JF, Gutierrez I, Sanchez C, Ortega J, Arranz J, Botanes J, Robles P. The STOP-AB trial protocol: efficacy and safety of discontinuing patient antibiotic treatment when physicians no longer consider it necessary. BMJ Open. 2017 Jun 6;7(5):e015814. doi: 10.1136/bmjopen-2016-015814.
研究記録日
主要日程の研究
研究開始
一次修了 (実際)
研究の完了 (実際)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (見積もり)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
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Discontinuing antibiotic therapyの臨床試験
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Universitätsklinikum Hamburg-EppendorfCytoSorbents, Inc募集
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Universitätsklinikum Hamburg-Eppendorf完了
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Advanced Cooling Therapy, Inc., d/b/a Attune MedicalDnipropetrovsk State Medical Academy完了
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Tan Tock Seng HospitalNational Healthcare Group Polyclinics; Temasek Polytechnic完了