Extended Treatment With Vancomycin for Clostridium Difficile Colitis

NCT ID: NCT00861887

Last Updated: 2016-12-14

Basic Information

• Recruitment Status: WITHDRAWN
• Clinical Phase: NA
• Study Classification: INTERVENTIONAL
• Study Start Date: 2009-02-28
• Study Completion Date: 2010-01-31

Brief Summary

BACKGROUND: Clostridium difficile-associated colitis is an infection of the large bowel, usually associated with previous use of antibiotics. The disease course may be complicated by fulminant disease requiring removal of the colon or by multiple recurrences requiring re-hospitalization. The incidence and severity of Clostridium difficile infection is rising, and it poses an increasing burden on the health system. For example, in one of our previous studies we found that 804 in-patients and 568 out-patients had a positive test for Clostridium difficile toxin at Beaumont Laboratories in 2003. The standard treatment is a 2 week course of Vancomycin or Metronidazole. The clinical response to Metronidazole appears to be declining, and many practicing clinicians prefer Vancomycin as a first-line treatment. The recurrence rate after the treatment is similar for Vancomycin and Metronidazole and is usually in the range of 15-25%, although recent reports noted a recurrence rate up to 50% during outbreaks with a virulent strain. Recently, it has been suggested that a 2 week duration of treatment might not be adequate in clearing the infection.

Our HYPOTHESIS is that a prolongation of Vancomycin treatment from 2 weeks to 4 weeks will lead to a decrease rate of recurrent Clostridium Difficile colitis.

Detailed Description

METHODOLOGY: Patients with a first episode of Clostridium difficile colitis will be offered a prolonged course of Vancomycin. It will be disclosed that this is not the standard of care, but that a prolonged course might decrease the relapse rate. After the initial treatment with Vancomycin 125 mg four times daily, the patients will be randomly assigned to receive either 2 weeks of Vancomycin 125 mg four times daily or 2 weeks of placebo. The placebo solution will be prepared by our pharmacy to match the color and taste of the Vancomycin solution. The initial 2 weeks of therapy for both groups will be dispensed at patients' pharmacy. Patients will be called back at the end of 2 weeks and the blinded-phase drugs will be dispensed by our pharmacy staff.

We will ask permission for a follow-up phone call at the end of treatment (1 month) and at a 3-month interval. The patients will be followed longitudinally for a 3-month period. At the end of the follow-up interval, a review of any new medical records of the patient will be made and the patient will be contacted by phone for further details.

Conditions

Clostridium Difficile Colitis

Keywords

Clostridium difficile; colitis; recurrence; relapse; Vancomycin

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: QUADRUPLE

Study Groups

Vancomycin

Vancomycin 125 mg every 6 hours x 4 weeks

Group Type: ACTIVE_COMPARATOR

Standard Vancomycin

Intervention Type: DRUG

Vancomycin treatment 125 mg po every 6 hours x 2 weeks

Extended Vancomycin

Intervention Type: DRUG

Vancomycin 125 mg every 6 hours x 2 weeks

Placebo

Vancomycin 125 mg every 6 hours x 2 weeks, followed by placebo every 6 hours x 2 weeks

Group Type: PLACEBO_COMPARATOR

Standard Vancomycin

Intervention Type: DRUG

Vancomycin treatment 125 mg po every 6 hours x 2 weeks

Interventions

Standard Vancomycin

Vancomycin treatment 125 mg po every 6 hours x 2 weeks

Intervention Type: DRUG

Extended Vancomycin

Vancomycin 125 mg every 6 hours x 2 weeks

Intervention Type: DRUG

Eligibility Criteria

Inclusion Criteria

• First episode of Clostridium difficile colitis, defined by a positive toxin assay plus at least one of the following: diarrhea, toxic megacolon or leukocytosis.

Exclusion Criteria

• previous diagnosis of Clostridium difficile colitis
• concomitant use of oral Metronidazole, Rifampin, Rifaximin, Nitazoxanide, Sacharromyce boulardii or Lactobacillus spp.
• age less than 18 years-old
• pregnancy.

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Beaumont Hospital

OTHER

Sponsor Role: collaborator

William Beaumont Hospitals

OTHER

Sponsor Role: lead

Responsible Party

Mihaela Batke

Physician

Responsibility Role: PRINCIPAL_INVESTIGATOR

Locations

William Beaumont Hospital

Royal Oak, Michigan, United States

Countries

United States

References

Zar FA, Bakkanagari SR, Moorthi KM, Davis MB. A comparison of vancomycin and metronidazole for the treatment of Clostridium difficile-associated diarrhea, stratified by disease severity. Clin Infect Dis. 2007 Aug 1;45(3):302-7. doi: 10.1086/519265. Epub 2007 Jun 19.

Reference Type: BACKGROUND

PMID: 17599306 (View on PubMed)

Pepin J, Alary ME, Valiquette L, Raiche E, Ruel J, Fulop K, Godin D, Bourassa C. Increasing risk of relapse after treatment of Clostridium difficile colitis in Quebec, Canada. Clin Infect Dis. 2005 Jun 1;40(11):1591-7. doi: 10.1086/430315. Epub 2005 Apr 25.

Reference Type: BACKGROUND

PMID: 15889355 (View on PubMed)

Other Identifiers

RC 98690

Identifier Type: -

Identifier Source: secondary_id

HIC 2008-173

Identifier Type: -

Identifier Source: org_study_id