Efficacy of Loperamide in Treating Patients for C. Difficile Colitis and Diarrheal Disease of Unknown Cause Associated With Antibiotic Therapy (loperamide)

The recruitment status of this study is unknown because the information has not been verified recently.
Verified December 2007 by VA Medical Center, Houston.
Recruitment status was  Recruiting
Sponsor:
Information provided by:
VA Medical Center, Houston
ClinicalTrials.gov Identifier:
NCT00591357
First received: December 31, 2007
Last updated: January 16, 2008
Last verified: December 2007
  Purpose

To determine whether symptomatic treatment of the diarrhea in CDAD reduces morbidity and mortality of this serious nosocomial infection in patients who have antibiotic-associated diarrhea. Both C. diff positive and negative patients will be included.


Condition Intervention Phase
Antibiotic Associated Diarrhea
Clostridium Difficile
Drug: loperamide
Drug: placebo
Phase 4

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Study of the Efficacy of Loperamide in Treating Patients for Clostridium Difficile Colitis and Diarrheal Disease of Unknown Cause Associated With Prior Antibiotic Therapy.

Resource links provided by NLM:


Further study details as provided by VA Medical Center, Houston:

Primary Outcome Measures:
  • To determin symptomatic treatment of diarrhea with loperamide in antibiotic associated diarrhea [ Time Frame: 2 years ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • To measure the safety and efficacy of loperamide in the control of antibiotic associated diarrhea in hospitalized patients [ Time Frame: 2 years ] [ Designated as safety issue: Yes ]

Estimated Enrollment: 120
Study Start Date: October 2007
Estimated Primary Completion Date: December 2009 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: A
Loperamide
Drug: loperamide
4 mg PO initially and 2 mg after each water stoll not to exceed 10 mg qd
Placebo Comparator: B
Placebo
Drug: placebo
4 mg PO initially and 2 mg after each water stoll not to exceed 10 mg qd

Detailed Description:

Colitis due to Clostridium difficile has been increasingly recognized as a serious nosocomial problem. Recommended therapy is with metronidazole, 500 mg four times daily for 10 days. About 80% of patients respond to this therapy. However, the response may be be delayed, in which case debilitation due to diarrhea progresses. The 20% who do not respond tend to be sicker to start, and debilitation due to diarrhea is a severe problem. In reviewing the medical literature, we discovered that the earliest papers on C. difficile colitis emphasized symptomatic therapy with 'lomotil' (diphenoxylate with atropine).

Treatment to suppress the diarrhea fell out of favor in the late 1970's because of the theoretical consideration that it was better to expel than to retain the bacterial toxins. However, the patients who are affected by C. difficile colitis are increasingly elderly and debilitated, and suffer substantial morbidity from the diarrhea. We have shown that the 90-day associated mortality is >20%.

Loperamide is a standard treatment for diarrhea, and is available over the counter under the name, Imodium. Based on a few anecdotal reports, this drug is regarded as contraindicated in patients whose diarrheal disease is bacterial. But it is used widely, and generally without any diagnosis being established. We now propose to administer loperamide or placebo to patients with CDAD in order to determine whether the antidiarrheal drug reduces morbidity associated with the infection. We will monitor our patients closely both to observe potential benefits and/or adverse events.

In the addendum, we propose to include patients who have antibiotic-associated diarrheal disease that is not due to C. difficile. There are many patients who have antibiotic-associated diarrheal disease who test negative for C. difficile. We believe that these patient may benefit from loperamide treatment as well.

  Eligibility

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

Inclusion Criteria:

  • Patients with diarrheal stools considered to be antibiotic associated

Exclusion Criteria:

  • Inability of sign consent
  • Patient with other known gastrointestinal disease
  • Patients receiving tube feeding or fecal incontinence prior to receiving antibiotics
  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: NCT00591357

Contacts
Contact: Nancy D Logan, MA 504-988-7889 njarrar@bcm.edu
Contact: Hoonmo k Koo, MD 713-798-8918 koo@bcm.edu

Locations
United States, Texas
VAMC Recruiting
Houston, Texas, United States, 77030
Contact: Nancy D Logan, MA    504-988-7889    njarrar@bcm.edu   
Contact: Hoonmo k Koo, MD    703-798-8918    koo@bcm.edu   
Sponsors and Collaborators
VA Medical Center, Houston
Investigators
Principal Investigator: Daniel M Musher, MD VA Medical Center, Houston
  More Information

No publications provided

Responsible Party: Daniel Musher, MD Principal Investigator, Michael E. DeBakey VAMC
ClinicalTrials.gov Identifier: NCT00591357     History of Changes
Other Study ID Numbers: H-21387, Clostridium difficile, Antibiotic associated diarrhea, loperamide
Study First Received: December 31, 2007
Last Updated: January 16, 2008
Health Authority: United States: Institutional Review Board

Keywords provided by VA Medical Center, Houston:
Antibiotic associated diarrhea
Clostridium difficile
loperamide

Additional relevant MeSH terms:
Colitis
Diarrhea
Gastroenteritis
Gastrointestinal Diseases
Digestive System Diseases
Colonic Diseases
Intestinal Diseases
Signs and Symptoms, Digestive
Signs and Symptoms
Anti-Bacterial Agents
Antibiotics, Antitubercular
Loperamide
Antidiarrheals
Anti-Infective Agents
Therapeutic Uses
Pharmacologic Actions
Antitubercular Agents
Gastrointestinal Agents

ClinicalTrials.gov processed this record on July 24, 2014