Efficacy of 30-day Duration of Fidaxomicin for Recurrent C. Difficile Infection

  • STATUS
    Recruiting
  • End date
    Jun 23, 2022
  • participants needed
    50
  • sponsor
    McMaster University
Updated on 23 January 2021
antibiotic therapy
antibiotics
diarrhea
vancomycin
a 10
clostridium difficile
oral vancomycin
stool test
fidaxomicin

Summary

This is a medical research study designed to look at the safety and efficacy of 30-day course of fidaxomicin for treatment of recurrent CDI (Clostridium difficile Infection). CDI is an infection that results when the normal flora (resident bacteria) of the colon is substantially altered by antibiotic treatment. The decrease in this normal flora allows for the growth of the C. difficile bacteria. Fidaxomicin is an antibiotic which is approved by Health Canada for treatment of CDI. Only patients with a primary case of CDI or 1st episode of recurrent CDI have been studied using a 10-day course of fidaxomicin.

Description

Clostridium difficile (C. difficile) infection (CDI) is one of the most frequent causes of healthcare associated infections and its rates are also growing in the community. The efficacy of standard antibiotics especially for recurrent CDI is limited as oral vancomycin and metronidazole also suppress the growth of anaerobic bacteria such as Bacteroides fragilis group which protect against proliferation of C. difficile. In contrast, in vitro study has shown that fidaxomicin has negligible activity against B. fragilis. The persistent disruption of healthy colonic flora may be the reason for recurrences following a course of treatment with metronidazole or vancomycin. Fidaxomicin has shown to reduce recurrences by approximately 50% when compared to oral vancomycin for primary or 1st episode of recurrent CDI.

Determining the efficacy and safety of 30-day duration of fidaxomicin for recurrent CDI through an open label clinical trial has important implications for policy making related to the drug reimbursement programs. In addition, the results of this study will be instrumental in demonstrating to the scientific and healthcare communities there may be a role for the 30-day course of fidaxomicin as a treatment modality for recurrent CDI. Curing CDI will restore the health and quality of life not just at the individual patient level but to the healthcare communities as well. Patients with refractory CDI require prolonged hospital admission, which increases the organism burden within the healthcare facilities. This in turn leads to the spread of the infection to other vulnerable patients. If a 30-day course of fidaxomicin proves to be safe and effective in curing patients with recurrent CDI, it will reduce the risk of severe complications in each patient and reduce transmission of CDI to other susceptible patients.

Details
Condition Clostridium Difficile Infection
Treatment Fidaxomicin
Clinical Study IdentifierNCT02395848
SponsorMcMaster University
Last Modified on23 January 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

Age 18 years or older
Able to provide informed consent
Willing and able to comply with all the required study procedures
A positive stool test for C. difficile toxin/gene using either PCR or enzyme immunoassay within 3 months of recruitment
History of at least 2 recurrent CDI within 6 months where recurrence is dened as return of diarrhea consistent with CDI within 8 weeks following CDI symptom resolution for at least 24 hours after a minimum of 10-day course of standard antibiotic therapy and positive stool test for C. difficile toxin or toxin gene and/or ongoing symptoms consistent with CDI despite at least 5 days of treatment using oral vancomycin
Has more than three unformed bowel movements or 200 mL of stool for individuals with a stool collection device such as rectal tube or colostomy during a 24-hour period at the time of initiation of fidaxomicin. Participants will be enrolled when they meet inclusion criteria 1 - 5; will be initiated at fidaxomicin when they have CDI symptoms and stool will be tested for C. difficile toxin/gene. Only those with positive stool for C. difficile toxin/gene with current episode of CDI will continue with the study
Females of child bearing potential must be willing to use acceptable birth control as per the Health Canada Guidance Document: Considerations for Inclusion of Women in Clinical Trials and Analysis of Sex Differences

Exclusion Criteria

Planned or actively taking an investigational product for another study
Prior fidaxomicin use
Hypersensitivity to fidaxomicin or to any ingredient in the formulation or component of the container
Evidence of toxic megacolon or gastrointestinal perforation on abdominal x-ray or life expectancy of less than 72 hours
Active gastroenteritis due to Salmonella, Shigella, E. coli 0157H7, Yersinia or Campylobacter
Anticipated requirement for systemic antibiotic therapy for more than 7 days during the study period
Actively taking Saccharomyces boulardii or other probiotics other than yogurt
Any condition that, in the opinion of the investigator, that the treatment may pose a health risk to the subject
Pregnant or lactating
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