Study of New Antibiotic Regimen for the Treatment of Uncomplicated Cellulitis in Emergency Department Patients

NCT ID: NCT00676130

Last Updated: 2012-08-14

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

153 participants

Study Classification

INTERVENTIONAL

Study Start Date

2007-05-31

Study Completion Date

2012-05-31

Brief Summary

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The primary aim of this study is to quantify the effectiveness of Bactrim as additional therapy for the treatment of uncomplicated cellulitis in adults, by comparing: standard therapy plus Bactrim, versus standard therapy plus placebo.

The primary hypothesis of this study is that, in light of increasing CA-MRSA prevalence, subjects treated with standard therapy plus Bactrim will have higher cure rates than those treated with standard therapy plus placebo.

Detailed Description

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Conditions

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Cellulitis

Keywords

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Cellulitis Bactrim Trimethoprim Sulfamethoxazole MRSA Methicillin-resistant Staphylococcus aureus

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Caregivers Investigators

Study Groups

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Standard therapy

cephalexin plus placebo

Group Type ACTIVE_COMPARATOR

Cephalexin

Intervention Type DRUG

Weight-based dosing in capsule or suspension form according to the following scale:

15-19 kg (33-42 lbs): Cephalexin 300 mg four times daily

20-24 kg (42-53 lbs): Cephalexin 400 mg four times daily

25-29 kg (53-64 lbs): Cephalexin 500 mg four times daily

29-60 kg (64-132 lbs): Cephalexin 500 mg four times daily

60-80 kg (132-176 lbs): Cephalexin 1000 mg three times daily

\> 80 kg (176 lbs): Cephalexin 1000 mg four times daily

Standard plus anti-CA-MRSA

cephalexin plus trimethoprim-sulfamethoxazole

Group Type EXPERIMENTAL

trimethoprim-sulfamethoxazole

Intervention Type DRUG

Weight-based dosing in capsule or suspension form according to the following scale:

15-19 kg (33-42 lbs): trimethoprim-sulfamethoxazole 40/200 mg four times daily

20-24 kg (42-53 lbs): trimethoprim-sulfamethoxazole 60/300 mg four times daily

25-29 kg (53-64 lbs): trimethoprim-sulfamethoxazole 72/360 mg four times daily

29-60 kg (64-132 lbs): trimethoprim-sulfamethoxazole 80/400 mg four times daily

60 kg (132 lbs): trimethoprim-sulfamethoxazole 80/400 mg four times daily

60-80 kg (132-176 lbs): trimethoprim-sulfamethoxazole 160/800 mg three times daily

\> 80 kg (176 lbs): trimethoprim-sulfamethoxazole 160/800 mg four times daily

Cephalexin

Intervention Type DRUG

Weight-based dosing in capsule or suspension form according to the following scale:

15-19 kg (33-42 lbs): Cephalexin 300 mg four times daily

20-24 kg (42-53 lbs): Cephalexin 400 mg four times daily

25-29 kg (53-64 lbs): Cephalexin 500 mg four times daily

29-60 kg (64-132 lbs): Cephalexin 500 mg four times daily

60-80 kg (132-176 lbs): Cephalexin 1000 mg three times daily

\> 80 kg (176 lbs): Cephalexin 1000 mg four times daily

Interventions

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trimethoprim-sulfamethoxazole

Weight-based dosing in capsule or suspension form according to the following scale:

15-19 kg (33-42 lbs): trimethoprim-sulfamethoxazole 40/200 mg four times daily

20-24 kg (42-53 lbs): trimethoprim-sulfamethoxazole 60/300 mg four times daily

25-29 kg (53-64 lbs): trimethoprim-sulfamethoxazole 72/360 mg four times daily

29-60 kg (64-132 lbs): trimethoprim-sulfamethoxazole 80/400 mg four times daily

60 kg (132 lbs): trimethoprim-sulfamethoxazole 80/400 mg four times daily

60-80 kg (132-176 lbs): trimethoprim-sulfamethoxazole 160/800 mg three times daily

\> 80 kg (176 lbs): trimethoprim-sulfamethoxazole 160/800 mg four times daily

Intervention Type DRUG

Cephalexin

Weight-based dosing in capsule or suspension form according to the following scale:

15-19 kg (33-42 lbs): Cephalexin 300 mg four times daily

20-24 kg (42-53 lbs): Cephalexin 400 mg four times daily

25-29 kg (53-64 lbs): Cephalexin 500 mg four times daily

29-60 kg (64-132 lbs): Cephalexin 500 mg four times daily

60-80 kg (132-176 lbs): Cephalexin 1000 mg three times daily

\> 80 kg (176 lbs): Cephalexin 1000 mg four times daily

Intervention Type DRUG

Other Intervention Names

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Bactrim Co-trimoxazole Septra Keflex

Eligibility Criteria

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Inclusion Criteria

* Must have cellulitis as defined here:

1. Definition A (preferred definition):

Recent onset of soft tissue erythema, considered by the treating clinician to be bacterial in origin, and associated with signs of infection that include at least two of the following: pain, swelling, warmth, fever, lymphangitis, induration, or ulceration.
2. Definition B (ONLY for darkly-pigmented subjects who cannot use Definition A):

Recent onset of soft tissue color change, pain, or swelling, considered by the treating clinician to be bacterial in origin, and at least one of the following: warmth, fever, induration, or ulceration
* Clinical (non-research) attending physician agrees with treatment with cephalexin until 3 days after all symptoms gone, using our weight-based dosing
* Responsible clinical attending physician comfortable with adding trimethoprim-sulfamethoxazole vs. placebo to the above
* Subject understands the study and signs written informed consent.
* Subject agrees to drink at least 1 liter of fluid per day.
* Subject will commit to all follow-up appointments

Exclusion Criteria

* Age \< 12 months or weight \<15 kg
* Current skin infection has already been treated
* Allergy to sulfa drugs
* History of severe allergic reaction to penicillin (defined as anaphylactoid reaction, angioedema, bronchospasm)
* Current use of any antibiotic (other than topicals)
* Diabetes mellitus
* Cellulitis complicated by underlying peripheral vascular disease
* Renal insufficiency, defined as patient report, clinical suspicion, or creatinine\>1.3 or EGFR\<60 on the last-available set of chemistry results in our computer system
* Hospital admission required
* Presence of \> 1 cc of purulent discharge at any time
* Cellulitis involving an indwelling vascular, enteric, or urinary catheter
* Immunocompromise of any etiology
* Pregnancy
* Breast feeding
* Facial cellulitis (infection is above the clavicles)
* Cellulitis associated with marine or freshwater injury, or animal or human bite. (Insect bites not excluded.)
* History of glucose-6-phosphate dehydrogenase deficiency
* Taking coumadin (warfarin), methotrexate, cisapride, phenytoin (dilantin), digoxin, or dofetilide
* Known megaloblastic anemia due to folate deficiency.
Minimum Eligible Age

12 Months

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Brigham and Women's Hospital

OTHER

Sponsor Role lead

Responsible Party

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Daniel Jay Pallin, MD, MPH

Associate Research Director, Department of Emergency Medicine

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Daniel J. Pallin, MD, MPH

Role: PRINCIPAL_INVESTIGATOR

Brigham and Women's Hospital

Locations

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Massachusetts General Hospital

Boston, Massachusetts, United States

Site Status

Brigham and Women's Hospital

Boston, Massachusetts, United States

Site Status

Children's Hospital Boston

Boston, Massachusetts, United States

Site Status

Countries

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United States

References

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Pallin DJ, Binder WD, Allen MB, Lederman M, Parmar S, Filbin MR, Hooper DC, Camargo CA Jr. Clinical trial: comparative effectiveness of cephalexin plus trimethoprim-sulfamethoxazole versus cephalexin alone for treatment of uncomplicated cellulitis: a randomized controlled trial. Clin Infect Dis. 2013 Jun;56(12):1754-62. doi: 10.1093/cid/cit122. Epub 2013 Mar 1.

Reference Type DERIVED
PMID: 23457080 (View on PubMed)

Other Identifiers

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F8349839

Identifier Type: -

Identifier Source: secondary_id

2007P000414

Identifier Type: -

Identifier Source: org_study_id