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Adjunctive Clindamycin for Cellulitis: C4C Trial. (C4C)

This study is ongoing, but not recruiting participants.
University of Bristol
Public Health England
Information provided by (Responsible Party):
University Hospitals Bristol NHS Foundation Trust Identifier:
First received: June 10, 2013
Last updated: January 7, 2016
Last verified: November 2015
The aim of this study is to see whether the addition of Clindamycin, a protein inhibiting antibiotic, to the standard antibiotic treatment of limb cellulitis, with Flucloxacillin, results in less tissue damage and a more rapid resolution of both systemic and local features, in a cost-effective manner. This study is a randomised controlled trial comparing Clindamycin with placebo.

Condition Intervention Phase
Drug: Flucloxacillin and Clindamycin
Drug: Flucloxacillin and placebo
Phase 4

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double Blind (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Double Blind Randomised Control Trial to Measure the Effect of the Addition of Clindamycin to Flucloxacillin for the Treatment of Limb Cellulitis

Resource links provided by NLM:

Further study details as provided by University Hospitals Bristol NHS Foundation Trust:

Primary Outcome Measures:
  • Improvement based on a composite of systemic and local features [ Time Frame: Day 5 ]
    Temperature less than 37.5 degrees centigrade, reduction in limb swelling and reduction in skin temperature

Secondary Outcome Measures:
  • Decrease in pain [ Time Frame: Day 10 ]
    Assessed using a visual analogue score

  • Quality of life [ Time Frame: Day 30 ]
    Assessment based on a questionnaire plus return to work or normal activities and absence of increased side-effects.

  • Physiological recovery [ Time Frame: Day 10 ]
    Resolution of systemic features, composite inflammatory markers and recovery of renal function.

Estimated Enrollment: 450
Study Start Date: October 2013
Estimated Study Completion Date: January 2016
Primary Completion Date: December 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Placebo Comparator: Flucloxacillin and placebo
Intravenous or oral Flucloxacillin with an oral placebo
Drug: Flucloxacillin and placebo
Placebo is externally identical to the over-encapsulated clindamycin and is taken four times each day for 2 days
Other Names:
  • Floxapen
  • Fluclomix
  • Ladropen
Active Comparator: Flucloxacillin and Clindamycin
Intravenous or oral Flucloxacillin with oral Clindamycin
Drug: Flucloxacillin and Clindamycin
Clindamycin dose 300mg four times each day for 2 days, within 48 hours of commencing flucloxacillin. Clindamycin is over-encapsulated and externally identical to placebo.
Other Names:
  • Floxapen
  • Fluclomix
  • Ladropen
  • Dalacin C
  • Lincocin
  • Daclin

Detailed Description:

Criteria to be used to assess tissue damage and clinical response:

  1. Fever, tachycardia, neutrophil count, urea and other laboratory parameters at five and ten days post first dose of clindamycin
  2. Limb swelling (by the measurement of limb circumference), skin surface temperature and tissue damage (by the proportion of the limb affected)
  3. Document the duration between initial systemic features and the development of local signs
  4. Examine the effect of the duration between systemic and local features and first dose of flucloxacillin on the subsequent duration and severity of cellulitis
  5. Examine the effect of duration between the first dose of flucloxacillin and the first dose of clindamycin on the subsequent duration and severity of cellulitis
  6. Identify and quantify possible side effects of clindamycin

Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Male or female subjects aged 18 or over who have a diagnosis of cellulitis of a single, upper or lower, limb
  • Who are able to understand the study and give consent
  • Who are able to take oral medication

Exclusion Criteria:

  • Patients with a confirmed history of penicillin, flucloxacillin or clindamycin allergy
  • Patients known to be colonised with Methicillin-resistant Staphylococcus aureus or Methicillin-resistant Staphylococcus aureus isolated from wound within the last year
  • Patients unable to take oral medication
  • Previous history of Clostridium difficile colitis
  • Clindamycin taken within the last 30 days
  • Clinically unstable
  • Unable to understand the study or give consent
  • Any doubt over the certainty of the diagnosis of cellulitis
  • Patients taking any drug that is incompatible with either flucloxacillin or clindamycin
  • Pre-existing diarrhoea
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Please refer to this study by its identifier: NCT01876628

United Kingdom
University Hospitals Bristol NHS Foundation Trust
Bristol, United Kingdom, BS2 8HW
Sponsors and Collaborators
University Hospitals Bristol NHS Foundation Trust
University of Bristol
Public Health England
  More Information

Responsible Party: University Hospitals Bristol NHS Foundation Trust Identifier: NCT01876628     History of Changes
Other Study ID Numbers: C4C-4078
2013-001218-14 ( EudraCT Number )
Study First Received: June 10, 2013
Last Updated: January 7, 2016

Keywords provided by University Hospitals Bristol NHS Foundation Trust:
Group A streptococcus
Staphylococcus aureus

Additional relevant MeSH terms:
Skin Diseases, Infectious
Connective Tissue Diseases
Pathologic Processes
Clindamycin palmitate
Clindamycin phosphate
Anti-Bacterial Agents
Anti-Infective Agents
Protein Synthesis Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action processed this record on April 27, 2017