Ciprofloxacin Versus Azithromycin for Children Hospitalised With Dysentery

Diarrhea Clinical Trial

— CIPAZ  

Official title:

An Open Label Randomised Controlled Trial of Azithromycin Versus Ciprofloxacin for the Treatment of Children Hospitalised With Dysentery in Ho Chi Minh City, Vietnam

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03854929
• Other study ID #: 26EN
• Status: Completed
• Phase: Phase 4
• Start date: December 11, 2019
• Est. completion date: July 12, 2022

Study information

• Verified date: June 2023
• Source: Oxford University Clinical Research Unit, Vietnam
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The purpose of this study is to assess the efficacy of 3 days of azithromycin (AZI) compared to 3 days of ciprofloxacin (CIP) (standard-of-care) for the treatment of children hospitalised with dysentery in Ho Chi Minh City.

Description:

Antimicrobial resistance is a well-established international healthcare crisis and children with diarrhoeal infections represent a significant proportion of the global infectious disease burden. With the increasing rates of antimicrobial resistance observed in the organisms associated with children presenting with dysentery in Vietnam and the investigator's capacity to demonstrate international transmission events, new data regarding alternative treatment options such as azithromycin, in particular for the new highly-antimicrobial resistant S. sonnei, are urgently needed. The study team will perform a phase IV open label randomised controlled trial to compare the efficacy of AZI to CIP (standard-of-care) for the treatment of children hospitalised with dysentery in Ho Chi Minh City, Vietnam. Children aged 6 to 60 months presenting to the participating hospital with symptoms/signs of dysentery (diarrhoea with blood and/or mucus accompanied by 1 or more of: fever ≥37.8°C, abdominal pain and /or tenesmus) within the previous 72 hours will be enrolled to the study. After enrolment, participants will be managed according to WHO and local algorithms for children with bloody diarrhoea. In addition, after providing a stool sample, children will be randomly allocated to receive CIP 15mg/kg body weight/ twice daily or AZI 10mg/kg body weight/ daily for 3 days. After enrolment, children will be reviewed for clinical and microbiological response to treatment.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 364
• Est. completion date: July 12, 2022
• Est. primary completion date: February 6, 2021
• Accepts healthy volunteers: No
• Gender: All
• Age group: 6 Months to 60 Months

Eligibility

Inclusion Criteria:

1. Male or female aged 6 months to 60 months at time of hospital presentation.

2. Have symptoms and/or signs of dysentery, specifically passing stools containing mucus and/or blood with/without abdominal pain, tenesmus or fever (=37.8°C).

3. Be eligible for treatment with oral medication in the opinion of the admitting physician (i.e. no clinical requirement for parenteral treatment on admission).

4. Be within 72 hours of the onset of signs/symptoms.

5. Have a parent/guardian present at admission who can provide written informed consent.

Exclusion Criteria:

1. Those known to have specific medical (patients with known prolongation of the QT interval, congenital long QT syndrome)/surgical conditions which may affect disease severity/presentation or response to treatment (e.g. affecting antimicrobial

absorption), including:

1. gastrointestinal abnormalities, including short bowel syndrome, chronic (inflammatory or irritable) bowel disease.

2. inherited or acquired immune system deficiency rendering the patient immunocompromised, including chronic/long-term steroid treatment or other immunosuppressive treatment

2. Presentation with severe infection requiring parenteral antimicrobial treatment, including shock jaundice, extensive gastrointestinal bleeding, convulsion , drowsiness or coma, reduced or less movement when stimulated, tachypnea > 60 times per minute, grunting, chest retraction, refuse to suck.

3. Known hypersensitivity to any of the trial drugs (CIP or AZI).

4. Coexisting infection requiring other or additional antimicrobials to be prescribed/ administered.

Related Conditions & MeSH terms

• Diarrhea
• Dysentery
• Dysentery, Bacillary
• Dysentery, Shigella
• Shigellosis

Intervention

Drug:
• Ciprofloxacin
Fluoroquinolone, ATC code: J01MA02 DNA-gyrase and topoisomerase IV inhibitor
• Azithromycin
Macrolide, ATC code: J01FA10 Binds to ribosomal 50S sub-unit inhibiting translocation of peptides thereby suppressing bacterial protein synthesis.

Locations

Country	Name	City	State
Vietnam	Children's Hospital 2	Ho Chi Minh City

Sponsors (3)

Lead Sponsor	Collaborator
Oxford University Clinical Research Unit, Vietnam	Number 2 Children's Hospital, Ho Chi Minh City, University of Liverpool

Country where clinical trial is conducted

Vietnam, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Assess the Clinical treatment failure between treatment groups.	Clinical treatment failure including: fever =38.0°C or the persistence of signs or symptoms of the infection (vomiting, abdominal pain, passing loose stools more than 3 times per 24 hours ( with blood and mucus, blood or mucus, without both))	after 120 hours of start of either treatment.
Primary	Assess the microbiological treatment failure between treatment groups.	The microbiological treatment failure is assessed by positive PCR stool with original pathogen after day 3 of treatment.	after 72 hours of start of either treatment.
Secondary	Measure differences in symptom duration between treatment groups by stratifying stool PCR.	Compare the duration of symptom ( from the onset to disappear) between the two groups.; The duration of symptom will be stratified by stool PCR.	120 hours of start of either treatment.
Secondary	Measure differences in symptom duration between treatment groups by stratifying stool culture.	Compare the duration of symptom ( from the onset to disappear) between the two groups.; The duration of symptom will be stratified by stool culture.	120 hours of start of either treatment.
Secondary	Assess the time to resolution of objective markers of infection and inflammation, including cessation of culture- and PCR-confirmed Shigella shedding, normalization of blood total white cell count, C-reactive protein and stool lipocalin	Time to cessation of Shigella shedding in stool (PCR).	at enrolment, day 7th (+3 days) and day 28th (+3 days)
Secondary	Assess the rates of adverse events associated with exposure to the antimicrobial agents used.	Adverse effects of antimicrobial treatment, including (i) life-threatening events, (ii) events requiring drug discontinuation, (iii) mild adverse events that require additional medication to be used but not resulting in drug discontinuation.	at enrolment, during 31 days after enrolment
Secondary	Assess the effects of antimicrobial exposure on the host microbiome, including diversity and abundance of specific bacterial species in stool.	The extend of intestinal microbial colonisation will be assessed by analyses of stool sample collected at enrolment, day 7th (+3 days) and day 28th (+3 days)	at enrolment, day 7th (+3 days) and day 28th (+3 days).