Comparison of 3 Days and 7 Days Intravenous Ceftriaxone Prophylaxis for Variceal Bleeding

The recruitment status of this study is unknown because the information has not been verified recently.
Verified January 2009 by Far Eastern Memorial Hospital.
Recruitment status was  Recruiting
Sponsor:
Information provided by:
Far Eastern Memorial Hospital
ClinicalTrials.gov Identifier:
NCT00838864
First received: February 6, 2009
Last updated: August 8, 2010
Last verified: January 2009
  Purpose

Prophylactic antibiotics have been routinely recommended for cirrhotic patients with upper gastrointestinal bleeding recently. However, the regimen and duration of its use remain an inconclusive issue. Quinolones and 3rd generation cephalosporins have been more often used for prophyalxis recently. The duration for antibiotic usage were variable in the literatures, ranged from 4-10 days. The latest guideline from AASLD in 2007 was 7 days. In the survey of infections in cirrhotic patients with UGI bleeding performed by Bernard et al, most infections occurred in the first 5 days and half within the first 48 hours. Therefore, considering the cost-effectiveness and drug resistance issues, the necessity for such prophylaxis for 7 days may need to be re-evaluated.

The purpose of our study is to investigate the antibiotic prophylaxis duration for cirrhotic patients with acute gastro-esophageal variceal bleeding. We will enroll those patients suffering from variceal bleeding documented by endoscopic examination and without apparent evidence of infection. Those who have received antibiotics within 2 weeks, are less than 18 years old, get pregnant, have malignancy other than HCC, have allergy to ceftrioxone are excluded. After receiving well explanation and giving consent, these patients are randomly allocated to 2 groups and receive prophylactic antibiotic just after endoscopic examination; Group I: receiving ceftriaxone 500 mg iv bolus stat and then q12h for 3 days, Group II: receiving ceftriaxone 500 mg iv bolus stat and then q12h for 7 days. They will receive appropriate endoscopic treatment for gastro-esophgeal varices and glypressin 1mg q6h for 3 days. They will start to feed on the 2nd day if not contraindicated. The 2nd endoscopic treatment for varices will be performed 2 weeks later. We record the demographic data, vital signs, transfusion amount; check hemogram, U/A, CXR, ascites routine (with apparent ascites), classification of variceal size and Child-Pugh classification. We monitor the events of rebleeding & infection, transfusion amount and hospitalization days We use rebleeding rate within 14 days as the primary end point. It is defined as the following events after initial stabilization of vital signs for 24 hours; (1): recurrence of hematemesis or bloody stool (2); need of transfusion more than 2 unit of blood and systolic pressure < 100 mmHg or pulse rate > 100/mn. We use infection rate during admission and mortality rate within 28 days as secondary end points.


Condition Intervention Phase
Esophageal and Gastric Varices
Gastrointestinal Hemorrhage
Drug: ceftrioxone
Phase 4

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Prevention
Official Title: Comparison of 3 Days and 7 Days Intravenous Ceftriaxone Prophylaxis in Patients With Acute Variceal Bleeding

Resource links provided by NLM:


Further study details as provided by Far Eastern Memorial Hospital:

Primary Outcome Measures:
  • rebleeding rate within 14 days [ Time Frame: 14 days ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • motarlity rate within 28 days [ Time Frame: 28 days ] [ Designated as safety issue: No ]

Estimated Enrollment: 100
Study Start Date: March 2009
Estimated Study Completion Date: September 2011
Estimated Primary Completion Date: June 2011 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: 1
ceftrioxone 500mg q12h for 3 days
Drug: ceftrioxone
500 mg iv q12h for 3 days
Other Name: Rocephin
Active Comparator: 2
ceftrioxone 500 mg q12h for 7 days
Drug: ceftrioxone
500 mg q12h for 7 days
Other Name: Rocephin

Detailed Description:
  1. Patient including & excluding Criteria Including: Those were diagnosed to have gastro-esophageal variceal bleeding after endoscopic examination. No evidence suggestive of infection was found including: 1)fever more than 37.5。C, 2)leucocytosis with WBC > 15000 mm3 or immature neutrophils > 500 mm3, 3)PMN of ascites more than 250/mm3,4)urinalysis, WBC > 15 WBC/HPF, 5)suspected pneuminia in CXR.

    Excluding:1)no consent 2)already has infection 3) antibiotic usage within 14 days 4) less than 18 years old 5) pregnancy 6) has malignancy other than HCC 7) allergy to ceftriaxone

  2. Management, Allocation and Prophylaxis Those with esophageal variceal bleeding receive edoscopic variceal ligation; those with gastric variceal bleeding receive Histoacryl injection therapy. They all recieve glypressin 1mg q6h injection for 3 days and start to feed on the second day if not contraindicated. We will perform 2nd session of endoscopic treatment 14 days later. These patients will randomly alloacted to 2 groups and recieve prophylactic antibiotic after 1st endoscopic treatment; Group I: ceftriaxone 500 mg iv bolus stat and then q12h for 3 days, Group II: ceftriaxone 500 mg iv bolus stat and then q12h for 7 days. If rebleeding occurs after allocation, further treatment was decided by attending physician. If active infection occurs during prophylaxis period and no improvement was observed for 24 hours, ceftriaxone use will be stopped and further treatment was decided by attending physician.
  3. Data record and Surveillance Data Record: We will record the basic data of the patietns: including: age, sex, co-morbidity (CAD, heart failure, COPD, chronic liver and renal diseases, malignancy, etc);hemogram before allocation,U/A, transfusion amount,ascites routine if significant ascites noted,CXR, endoscopic finding of varices; lowest blood pressure before allocation, Child-Pugh classification of the patient Surveillance: rebleeding and infection during admission, Transfusion amount and hospitalization day after allocation, rebleeding rate within 14 days & mortality rate within 28 days.
  4. End points Primary end points: Rebleeding rate within 14 days after initial endoscopic treatment. Definition of rebleeding: the following manifestation after stabilization of vital sign for 24 hours,(1) appearance of hematemesis and bloody stool(2) need of transfusion more than 2 units of blood and vital sign change (systolic pressure < 100 mmHg or heart rate >100 beats/min).

Secondary end points: infection during admission, mortality rate within 28 days. Definition of infection: 1) bacteremia:positive blood culture, but no definite focus indentified, 2) spontaneous bacterial peritonitis : ascites routine: PMN> 250/mm3, 3)urinary tract infection: U/A WBC > 15/HPF and positive urine culture, 4)other infections: suspected by clinical, radiological or other bacterialogical examination, 5)respiratory tract infection:CXR changes with clinical evidence, 6)possible infection: fever (>37.5。C more than 6 hours) and leucocytosis,WBC > 15000 mm3 ,but with negative blood culture

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • those patients suffering from variceal bleeding documented by endoscopic examination and without apparent evidence of infection.

Exclusion Criteria:

  • received antibiotics within 2 weeks, less than 18 years old, get pregnant, have malignancy other than HCC, have allergy to ceftrioxone
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00838864

Contacts
Contact: Tzong-Hsi Lee, M.D. 886-2-89667000 ext 1702 thleekimo@yahoo.com.tw

Locations
Taiwan
Far Eastern Memorial Hospital Recruiting
Taipei, Taiwan, 22050
Contact: Tzong-Hsi Lee, M.D.    886-2-89667000 ext 1702    thleekimo@yahoo.com.tw   
Principal Investigator: Tzong-Hsi Lee, M.D.         
Sponsors and Collaborators
Far Eastern Memorial Hospital
Investigators
Principal Investigator: Tzong-Hsi Lee, M.D. Far Eastern Memorial Hospital
  More Information

Publications:

Responsible Party: Tzong-Hsi Lee, Far Eastern Memorial Hospital
ClinicalTrials.gov Identifier: NCT00838864     History of Changes
Other Study ID Numbers: FEMH-97-C-010
Study First Received: February 6, 2009
Last Updated: August 8, 2010
Health Authority: Taiwan: Department of Health

Keywords provided by Far Eastern Memorial Hospital:
variceal bleeding
antibiotic prophylaxis
ceftrioxone

Additional relevant MeSH terms:
Hemorrhage
Gastrointestinal Hemorrhage
Esophageal and Gastric Varices
Pathologic Processes
Gastrointestinal Diseases
Digestive System Diseases
Esophageal Diseases
Hypertension, Portal
Liver Diseases

ClinicalTrials.gov processed this record on October 19, 2014