Clinical Pathway Based on Procalcitonin Levels for the Management of Community-acquired Pneumonia in Outpatients
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|ClinicalTrials.gov Identifier: NCT02600806|
Recruitment Status : Unknown
Verified November 2015 by Mar Masiá Canuto, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana.
Recruitment status was: Recruiting
First Posted : November 9, 2015
Last Update Posted : November 9, 2015
|Condition or disease||Intervention/treatment||Phase|
|Community-acquired Pneumonia||Drug: Azithromycin Drug: Levofloxacin||Phase 4|
A clinical protocol was developed in collaboration with the hospital's Emergency Department for the management of adult outpatients with community-acquired pneumonia (CAP). Patients are assigned to 2 treatment categories according to the plasma procalcitonin (PCT) values.
- PCT<0.5 ng/ml: azithromycin, 500 mg/day orally for 5 days
- PCT≥0.5ng/ml: levofloxacin, 500 mg/day orally for 7 days
Laboratory and microbiological studies:
In the ED, patients with signs and symptoms of pneumonia have a blood sample collected for routine biochemical and hematological determinations, and PCT concentration measurement.
Rapid testing for the determination of PCT are performed with BRAHMS PCT-Q, an immunochromatografic test for the semi-quantitative detection of PCT in serum (BRAHMS GmbH, 16761 Hennigsdorf, Germany). PCT concentration ranges are the following: <0.5 ng/ml; ≥ 0.5 ng/ml; ≥2 ng/ml; ≥10 ng/ml.
The etiological diagnostic workup includes obtaining sputum samples from patients with productive cough, and a urine sample for detection of S. pneumoniae and Legionella pneumophila serogroup 1 antigens by immunochromatographic assays (Binax NOW, Alere Healthcare SLU, Spain). Only qualified sputum samples, as defined according to standard criteria (presence of >25 WBC and <10 squamous cells per low-power magnification field [x10]) are evaluated. Serum samples (obtained during the acute stage of illness and 4 weeks later) are collected and frozen at -80ºC for ulterior serological testing. An indirect chemiluminescent immunoassay (VirClia® Monotest, Vircell, S.L., Granada, Spain) is performed to detect IgG antibodies against Mycoplasma pneumoniae, Chlamydophila pneumoniae, Legionella pneumophila and Coxiella burnetii. Calculation of cutoff values and interpretation of the results are performed in accordance with the instructions of the manufacturer. The diagnostic criteria are either a seroconversion (index value from negative to positive) or a significant increase in the index value (≥threefold) in paired samples. All assays are performed and analyzed blindly by the same person.
Follow-up and outcome measures:
After treatment has been assigned, patients are referred to the outpatients clinic, where they are seen within the following 24 hours (Visit 2). A phone visit (Visit 3) is scheduled on day 7, and the last programmed visit on day 30 at the clinic (Visit 4). Patients are instructed to visit the outpatients' clinic if their clinical status worsens or fever persists more than 48 hours after the first visit. Cure is defined as an improvement or lack of progression of baseline radiographic findings at the end of therapy (EOT) and resolution of signs, including chest X-Ray, and symptoms of pneumonia at visit 4. Failure is defined as persistence or progression of signs and symptoms or progression of radiological signs of pneumonia at EOT, persistent infiltrate on X-Ray at visit 4, and initiation within 2 calendar days of the initial antibiotic therapy of a different potentially effective antibiotic, death on or after day 3 attributable to primary infection, or relapsed infection at visit 4. Antibiotic change requirement due to toxicity, and need for hospital admission is also recorded.
In addition to the short-term outcome, the long-term (3-year) outcome of the patients is assessed through a structured telephone interview.
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||500 participants|
|Intervention Model:||Single Group Assignment|
|Masking:||None (Open Label)|
|Official Title:||Evaluation of a Clinical Pathway Based on Procalcitonin Levels for the Management of Community-acquired Pneumonia in Outpatients|
|Study Start Date :||May 2005|
|Estimated Primary Completion Date :||March 2016|
|Estimated Study Completion Date :||June 2016|
Azithromycin or levofloxacin are given according to serum procalcitonin levels
Patients are given oral azithromycin when procalcitonin levels are < 0.5 ng/ml
Other Name: Zithromax, Zmax
Patients are given oral levofloxacin when procalcitonin levels are >= 0.5 ng/ml.
Other Name: Tavanic, Levaquin
- Clinical cure [ Time Frame: 30-day ]Improvement or lack of progression of baseline radiographic findings at the end of therapy and resolution of signs, including chest X-Ray, and symptoms of pneumonia
- Number of participants with treatment-related adverse events as assessed by a specific questionnaire designed for the study [ Time Frame: 30-day ]
- Mortality [ Time Frame: Through study completion, an average of 3 years ]30-day and during the following 3 years or longer
- Recurrences [ Time Frame: Through study completion, an average of 3 years ]New episodes of community-acquired pneumonia ocurring after clinical cure of the initial episode
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02600806
|Contact: Mar Masiá, MDfirstname.lastname@example.org|
|Contact: Inmaculada Revert||+34 966 61 61 email@example.com|
|Hospital General Universitario de Elche||Recruiting|
|Elche, Alicante, Spain, 93293|
|Contact: Mar Masiá, MD +34966616754 firstname.lastname@example.org|
|Principal Investigator:||Mar Masiá, MD||Unidad Enfermedades Infecciosas, Hospital General Univeristario de Elche|