- ICH GCP
- US Clinical Trials Registry
- Klinisk utprøving NCT07561541
Extended Oral Antibiotic Prophylaxis in Diabetic Fracture Patients
Extended Oral Antibiotic Prophylaxis in Diabetic Patients With Lower Extremity Fracture: A Multicenter Pilot Randomized Controlled Trial
The goal of this clinical trial is to learn if taking an antibiotic pill for 7 days after surgery reduces the risk of wound infection in adults with poorly controlled diabetes who have surgery to fix a broken bone in the leg, ankle, or foot. It will also learn about the safety of the extended antibiotic course. The main questions it aims to answer are:
Does a 7-day antibiotic course after surgery lower the rate of wound infection within 90 days? What medical problems do participants have when taking the extended antibiotic course?
Researchers will compare a 7-day course of an oral antibiotic (cefadroxil) to standard care (no additional antibiotics after surgery) to see if the extended course reduces infections.
Participants will:
Take an antibiotic pill or receive standard care for 7 days after surgery Receive a phone call from the study team about 1 week after surgery Visit the clinic at 3 weeks, 6 weeks, and 3 months after surgery for checkups
Studieoversikt
Status
Intervensjon / Behandling
Detaljert beskrivelse
The purpose of this research study is to investigate whether a 7-day course of an oral, prophylactic antibiotic following surgical fixation of a lower extremity fracture effectively decreases the risk of surgical site infection in patients with poorly controlled diabetes. Patients with an uncontrolled hemoglobin A1c greater than 7.0 or a random blood glucose greater than 200 mg/dL undergoing operative fixation of a closed fracture of the distal femur, patella, tibial plateau, tibial shaft, pilon, ankle, talus, calcaneus, or other operative foot fracture are considered high-risk for surgical site infection and are the target population for this study.
Study participants will be randomized to either a 7-day course of an oral prophylactic antibiotic following surgery (cefadroxil 500 mg twice daily, or an alternative regimen based on allergy status or methicillin-resistant Staphylococcus aureus colonization) or standard care with no additional antibiotics beyond the standard perioperative intravenous antibiotic dosing. All other standard perioperative fracture care will remain the same for both groups. Outcomes assessed will include superficial and deep surgical site infection occurring within 90 days of surgery, antibiotic-related adverse effects, and patient compliance with the extended antibiotic regimen.
Studietype
Registrering (Antatt)
Fase
- Fase 4
Kontakter og plasseringer
Studiekontakt
- Navn: Taylor M Yong, MD, MS
- Telefonnummer: 915-215-5480
- E-post: tayong@ttuhsc.edu
Studiesteder
-
-
California
-
Los Angeles, California, Forente stater, 90033
- Rekruttering
- University of Southern California
-
Ta kontakt med:
- Sarah Blumenthal, MD
- Telefonnummer: 800-872-2273
- E-post: Sarah.Blumenthal@med.usc.edu
-
-
Texas
-
El Paso, Texas, Forente stater, 79905
- Rekruttering
- University Medical Center of El Paso
-
Ta kontakt med:
- Taylor Yong
- Telefonnummer: 8322027406
- E-post: tayong@ttuhsc.edu
-
El Paso, Texas, Forente stater, 79912
- Rekruttering
- Texas Tech Health El Paso
-
Ta kontakt med:
- Taylor M Yong, MD, MS
- Telefonnummer: 915-215-5480
- E-post: tayong@ttuhsc.edu
-
-
Deltakelseskriterier
Kvalifikasjonskriterier
Alder som er kvalifisert for studier
- Voksen
- Eldre voksen
Tar imot friske frivillige
Beskrivelse
Inclusion Criteria:
- Low extremity fracture requiring surgical treatment
- Uncontrolled diabetes (Hemoglobin A1c > 7.0 or random glucose > 200 mg/dL)
- Age 18 years or older
- Able to provide informed consent
- English or Spanish speaker
Exclusion Criteria:
- Known allergy to prescribed antibiotic and pre-determined alternatives
- Open fractures
- Current infection requiring antibiotic treatment
- Immunocompromised status (chemotherapy, immunosuppressant medications)
- End-stage renal disease that medication dosing cannot be adjusted for
- Pregnant or breast-feeding
- Unable to comply with follow-up
Studieplan
Hvordan er studiet utformet?
Designdetaljer
- Primært formål: Forebygging
- Tildeling: Randomisert
- Intervensjonsmodell: Parallell tildeling
- Masking: Ingen (Open Label)
Våpen og intervensjoner
Deltakergruppe / Arm |
Intervensjon / Behandling |
|---|---|
|
Ingen inngripen: No extended oral antibiotic prophylaxis
No additional extended oral antibiotic prophylaxis beyond institutional perioperative protocols.
|
|
|
Eksperimentell: Extended oral antibiotic prophylaxis
Extended oral antibiotic therapy in addition to institutional protocols for perioperative antibiotic therapy
|
Cefadroxil 500 mg, twice a day for 7 days
Andre navn:
Clindamycin 300 mg, three times a day for 7 days
Bactrim DS, twice a day for 7 days
|
Hva måler studien?
Primære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
|---|---|---|
|
Surgical site infection
Tidsramme: 90 days
|
Incidence of superficial infection (a wound with erythema, warmth, or drainage that is treated with oral antibiotics or wound care) and deep infection (per fracture-related infection definition).
|
90 days
|
Sekundære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
|---|---|---|
|
Antibiotic-related adverse effects
Tidsramme: 90 days
|
Incidence of antibiotic-related adverse effects
|
90 days
|
|
Compliance with antibiotic regimen
Tidsramme: 1 week
|
Number of patients completing prescribed antibiotic regimen or not
|
1 week
|
Samarbeidspartnere og etterforskere
Samarbeidspartnere
Publikasjoner og nyttige lenker
Generelle publikasjoner
- Inabathula A, Dilley JE, Ziemba-Davis M, Warth LC, Azzam KA, Ireland PH, Meneghini RM. Extended Oral Antibiotic Prophylaxis in High-Risk Patients Substantially Reduces Primary Total Hip and Knee Arthroplasty 90-Day Infection Rate. J Bone Joint Surg Am. 2018 Dec 19;100(24):2103-2109. doi: 10.2106/JBJS.17.01485.
- Lipson S, Pagani NR, Moverman MA, Puzzitiello RN, Menendez ME, Smith EL. The Cost-Effectiveness of Extended Oral Antibiotic Prophylaxis for Infection Prevention After Total Joint Arthroplasty in High-Risk Patients. J Arthroplasty. 2022 Oct;37(10):1961-1966. doi: 10.1016/j.arth.2022.04.025. Epub 2022 Apr 25.
- Dasari SP, Kanumuri SD, Yang J, Manner PA, Fernando ND, Hernandez NM. Extended Prophylactic Antibiotics for Primary and Aseptic Revision Total Joint Arthroplasty: A Meta-Analysis. J Arthroplasty. 2024 Sep;39(9S2):S476-S487. doi: 10.1016/j.arth.2024.01.014. Epub 2024 Jan 17.
- Kheir MM, Dilley JE, Ziemba-Davis M, Meneghini RM. The AAHKS Clinical Research Award: Extended Oral Antibiotics Prevent Periprosthetic Joint Infection in High-Risk Cases: 3855 Patients With 1-Year Follow-Up. J Arthroplasty. 2021 Jul;36(7S):S18-S25. doi: 10.1016/j.arth.2021.01.051. Epub 2021 Jan 23.
Studierekorddatoer
Studer hoveddatoer
Studiestart (Faktiske)
Primær fullføring (Antatt)
Studiet fullført (Antatt)
Datoer for studieregistrering
Først innsendt
Først innsendt som oppfylte QC-kriteriene
Først lagt ut (Faktiske)
Oppdateringer av studieposter
Sist oppdatering lagt ut (Faktiske)
Siste oppdatering sendt inn som oppfylte QC-kriteriene
Sist bekreftet
Mer informasjon
Begreper knyttet til denne studien
Ytterligere relevante MeSH-vilkår
- Sykdommer i det endokrine systemet
- Metabolske sykdommer
- Glukosemetabolismeforstyrrelser
- Ernæringsmessige og metabolske sykdommer
- Sukkersyke
- Svovelforbindelser
- Organiske kjemikalier
- Heterocykliske forbindelser, 1-ring
- Heterocykliske forbindelser
- Heterocykliske forbindelser, 2-ring
- Heterocykliske forbindelser, smeltet ringen
- Farmasøytiske preparater
- Hydrokarboner
- Hydrokarboner, syklisk
- Karbohydrater
- Hydrokarboner, aromatisk
- Glykosider
- Amides
- Anilinforbindelser
- Aminer
- Pyrimidiner
- Benzenderivater
- Pyrrolidiner
- Lincomycin
- Lincosamides
- Medikamentkombinasjoner
- Beta-laktams
- Laktams
- Cephalosporins
- Tiaziner
- Sulfametoksazol
- Benzenesulfonamider
- Sulfonamider
- Sulfanilamider
- Sulfoner
- Trimethoprim
- Cefalexin
- Klindamycin
- Trimetoprim, Sulfamethoxazole medikamentkombinasjon
- Cefadroxil
Andre studie-ID-numre
- E26052
- 4983 (Annet stipend/finansieringsnummer: Orthopaedic Trauma Association)
Plan for individuelle deltakerdata (IPD)
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