Outpatient Treatment of Gram Positive Wound Infections in the Diabetic Foot: A Pharmaco-economic Comparison of Daptomycin vs. Vancomycin Based Regimens

This study has been terminated.
(Lack of patient enrollment)
Sponsor:
Collaborator:
Cubist Pharmaceuticals
Information provided by (Responsible Party):
Donald Poretz, Clinical Alliance for Research & Education - Infectious Diseases, LLC.
ClinicalTrials.gov Identifier:
NCT01133600
First received: May 28, 2010
Last updated: September 9, 2013
Last verified: September 2013
  Purpose

The purpose of the study is to evaluate the overall burden to the participant (economic, quality of life, patients satisfaction and freedom from side effects) when treating Gram positive infections of the foot in diabetic adults with daptomycin versus vancomycin.


Condition Intervention Phase
Diabetic Foot
Drug: Cubicin
Drug: Vancomycin
Phase 4

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Phase IV Study of the Outpatient Treatment of Gram Positive Wound Infections in the Diabetic Foot: A Pharmaco-Economic Comparison of Daptomycin vs Vancomycin Based Regimens

Resource links provided by NLM:


Further study details as provided by Clinical Alliance for Research & Education - Infectious Diseases, LLC.:

Primary Outcome Measures:
  • Pharmaco-economic [ Time Frame: 28 days ] [ Designated as safety issue: No ]
    Based upon 2 economic parameters associated with the treatment of the infection (provider charges and out-of-pocket costs) from screening until Day 28. Provider charges, as documented in invoices submitted to the pt's. insurance company, will be collected for all activities and services provided by the physician's office,home infusion company, laboratory, etc. during the study period. Out of pocket costs will be captured in a pt. diary and will include any health related costs that are borne by the pt. during the study period. Costs and charges will be analyzed and reported separately.


Secondary Outcome Measures:
  • Quality of Life/patient satisfaction [ Time Frame: 28 days ] [ Designated as safety issue: No ]
    QOL and pt. satisfaction with the medication, the clinical care, and the overall experience of the infection and its therapy are captured using three study intstruments, which are described in more detail in the Data Collection Instruments section. These include two validated, standardized QOL instruments administred at Baseline, at two weeks and again at 4 weeks, and a pt. satisfaction survey administered at Baseline, 2 and 4 weeks.


Enrollment: 6
Study Start Date: August 2010
Study Completion Date: August 2012
Primary Completion Date: August 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: daptomycin
Dosed at 6mg/kg body weight intravenously every 24 hours with a reduction to 6mg/kg every other day if creatinine clearance (CrCl)is <30ml/min.
Drug: Cubicin
dosed at 6 mg/kg body weight intravenously every 24 hours with a reduction to 6mg/kg every other day if CrCl is <30ml/min.
Active Comparator: vancomycin
Dosed at 15mg/kg intravenously every 12 hours with adjustments for renal function.
Drug: Vancomycin
dosed at 15mg/kg intravenously every 12 hours with adjustments for renal function.

Detailed Description:
  1. to compare the overall economic burden of therapy of a daptomycin vs. a vancomycin based antibiotic regimen for diabetic foot infections in the outpatient setting
  2. to compare Quality of Life and patient satisfaction among recipients of a daptomycin vs. a vancomycin based regimen
  3. to compare the safety and tolerance (adverse experiences) of daptomycin vs. vancomycin based regimens
  4. to compare the efficacy (complete resolution of infection) of daptomycin vs. vancomycin based regimens
  Eligibility

Ages Eligible for Study:   18 Years to 80 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • Age 18-80 who are able to give informed consent and, who are likely to be able to participate through the full 28 day of the study.
  • Previously diagnosed diabetes mellitus, requiring the use of insulin and/or oral hypoglycemic agents for glycemic control.
  • The presence of an infection of one or both feet (defined as being distal to the superior-most point of the lateral malleolus), with some drainage, abscess or fluid collection that can be cultured, yet which as not been treated for greater than 24 hours with prior oral antibiotic therapy within the last 48 hours, wand which does not include either a quinolone or linezolid. The foot lesion, in the opinion of the initial treating physician, is severe enough (either because of the lesion or because of the subject's diabetic control, vasculopathy, etc) to require intravenous antibiotics.
  • A culture of the wound, either at the time of screening or within the 72 hours prior to screening, that yields a Gram positive organism that is shown to be sensitive (or is likely to be sensitive) to both vancomycin and daptomycin. This will include Staphylococcus aureus, (including MSSA and MRSA, but excluding VRSA), Enterococcus faecalis and enterococcus faecium (excluding VRE), streptococci, including Groups A and B, as well as other beta-hemolytic streptococci, viridans streptococci, and Group D. A culture of coagulase negative staphylococci as the only Gram positive isolate will not be considered for participation. Cultures may be obtained as swab or fluid submitted for culture.
  • Able to read and write in English with a proficiency suitable for completing the pharmaco-economic and quality of life questionnaires and diaries.

Exclusion Criteria:

  • No Gram positive bacteria identified in the infected foot, infection with a Gram positive organism that is resistant to one of the two study drugs, or infection with coagulase negative staphylococci as the only Gram positive organism isolated.
  • Known hypersensitivity to either of the two proposed study agents, or to ciprofloxacin, if a second anti-microbial agent is necessary.
  • Renal dysfunction, such that the study subject requires dialysis.
  • The presence of active osteomyelitis in the foot.
  • The presence of concomitant infections that would require antibiotic therapy in addition to that being prescribed for the foot infection.
  • The presence of pneumonitis requiring antimicrobial therapy, regardless of the suspected etiologic organism.
  • A history of drug induced ototoxicity (either auditory or vestibular).
  • A history of previous or current vascular catheter-associated phlebitis.
  • Pregnancy or breastfeeding.
  • Alcohol or drug use which, in the opinion of the investigator, is likely to interfere with the conduct of the study.
  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: NCT01133600

Locations
United States, Virginia
Clinical Alliance for Research & Education, Infectious Diseases, LlC
Annandale, Virginia, United States, 22003
Infuscience
Annandale, Virginia, United States, 22003
Sponsors and Collaborators
Clinical Alliance for Research & Education - Infectious Diseases, LLC.
Cubist Pharmaceuticals
Investigators
Principal Investigator: Donald Poretz, MD Clinical Alliance for Research & Education - Infectious Diseases, LLC.
  More Information

No publications provided

Responsible Party: Donald Poretz, Research Director, Clinical Alliance for Research & Education - Infectious Diseases, LLC.
ClinicalTrials.gov Identifier: NCT01133600     History of Changes
Other Study ID Numbers: 2008-0020-15
Study First Received: May 28, 2010
Last Updated: September 9, 2013
Health Authority: United States: Food and Drug Administration

Additional relevant MeSH terms:
Diabetic Foot
Wound Infection
Cardiovascular Diseases
Diabetes Complications
Diabetes Mellitus
Diabetic Angiopathies
Diabetic Neuropathies
Endocrine System Diseases
Foot Ulcer
Infection
Leg Ulcer
Skin Diseases
Skin Ulcer
Vascular Diseases
Wounds and Injuries
Daptomycin
Vancomycin
Anti-Bacterial Agents
Anti-Infective Agents
Pharmacologic Actions
Therapeutic Uses

ClinicalTrials.gov processed this record on October 22, 2014