Topical Gentamicin Cream Versus Alternating Gentamicin and Mupirocin Cream in Peritoneal Dialysis
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Purpose
Catheter-related infection, namely exit site infection and peritonitis, is the commonest complication of peritoneal dialysis. This complication causes significant morbidity and mortality in patients requiring peritoneal dialysis. Topical application of mupirocin 2% cream was first proven to be effective in reduction of staphylococcus-related catheter infection in 1990s. Subsequent randomized trial published in 2005 showed that gentamicin cream was superior to mupirocin 2% cream in reducing both Gram's positive and Gram's negative related catheter infection. However, a retrospective report published in 2007 puts the use of prophylactic antibiotic cream into a question. It reported an emergency of non-tuberculous mycobacterial infection in a dialysis center in Hong Kong after practising prophylactic application of gentamicin cream at the catheter exit site. The following prospective, randomized and open-label study aims to find out an optimal regimen of topical antibiotic prophylaxis in patients requiring peritoneal dialysis.
| Condition | Intervention | Phase |
|---|---|---|
|
Rate of Exit Site Infection Rate of Atypical Mycobacterial Infection Rate of Peritoneal Dialysis |
Drug: gentamicin Drug: gentamicin cream alternating with mupirocin cream |
Phase 4 |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Prevention |
| Official Title: | Prospective, Randomized, Open-Label Study of Topical Antibiotic Prophylaxis at the Catheter Exit Site: Continuous Daily Gentamicin Cream Versus Cyclical Gentamicin Cream and Mupirocin 2% Cream Alternating at Monthly Basis. |
- Rate of Exit site infection [ Time Frame: every 3 months ] [ Designated as safety issue: Yes ]
- Rate of peritonitis [ Time Frame: every 3 months ] [ Designated as safety issue: Yes ]
| Estimated Enrollment: | 500 |
| Study Start Date: | September 2008 |
| Estimated Study Completion Date: | October 2014 |
| Estimated Primary Completion Date: | October 2014 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
group A
Topical gentamicin cream
|
Drug: gentamicin
topical gentamicin cream on daily basis
Other Name: Gentamicin
|
|
Active Comparator: Group B
topical gentamicin cream alternates with mupirocin cream at monthly basis
|
Drug: gentamicin cream alternating with mupirocin cream
topical gentamicin cream alternating with mupirocin cream at monthly basis
Other Name: Gentamicin and mupirocin
|
Detailed Description:
Topical antibiotics therapy is a well-recognized prophylactic therapy towards the catheter exit site infection in peritoneal dialysis patient. Previous data has shown the superiority of gentamicin cream over the mupirocin cream in this aspect. However, the efficacy of the combination therapy using gentamicin cream alternating with mupirocin cream has not been tested. There is a potention benefit of reducing drug resistant strain in the combination group theoretically.
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Patient aged 18 years old or above
- Patient has Tenckhoff catheter inserted
- Patient is expected to continue his or her dialysis in our center in the subsequent 3 years
Exclusion Criteria:
- Patient fails to sign the written consent
- Patient known to have allergy to either gentamicin or mupirocin
- Patient has suffered from peritonitis or exit site infection 30 days before the enrollment.
- Patient, suffering from terminal illness, has life-expectancy of less than one year
- Patient expected to undergo peritoneal dialysis for less than one year, such as patients planning for elective renal transplantation or suffering from acute renal failure necessitating dialysis while waiting for the kidney to recover.
- Pregnant patient
- Patient known to be non-compliant
- Patient bound by another clinical study
Contacts and Locations| Contact: Gensy MW Tong, MBChB | 852-3517-5000 | gensytong@hotmail.com |
| Hong Kong | |
| Kwong Wah Hospital | Not yet recruiting |
| Hong Kong, Hong Kong | |
| Contact: Gensy MW Tong, MBChB 852-3517-5000 gensytong@hotmail.com | |
| Principal Investigator: | Gensy MW Tong, MBChB | Kwong Wah Hospital |
More Information
No publications provided
| Responsible Party: | Tong Mei Wa Gensy, Kwong Wah Hospital |
| ClinicalTrials.gov Identifier: | NCT00751374 History of Changes |
| Other Study ID Numbers: | KW/FR/08-007 |
| Study First Received: | September 10, 2008 |
| Last Updated: | September 10, 2008 |
| Health Authority: | Hong Kong: Ethics Committee |
Additional relevant MeSH terms:
|
Mycobacterium Infections, Atypical Mycobacterium Infections Actinomycetales Infections Gram-Positive Bacterial Infections Bacterial Infections Gentamicins Mupirocin |
Anti-Bacterial Agents Anti-Infective Agents Therapeutic Uses Pharmacologic Actions Protein Synthesis Inhibitors Enzyme Inhibitors Molecular Mechanisms of Pharmacological Action |
ClinicalTrials.gov processed this record on May 23, 2013