The Use of Inhaled Aztreonam in Children With a Tracheostomy Tube and Pseudomonas (A-PACT)
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|ClinicalTrials.gov Identifier: NCT03158116|
Recruitment Status : Terminated (IRB application expired.)
First Posted : May 17, 2017
Last Update Posted : December 24, 2020
|Condition or disease||Intervention/treatment||Phase|
|Tracheostomy Infection||Drug: Inhaled Aztreonam||Phase 4|
Inhalation aztreonam (AZLI) is an aerosolized formulation of the monobactam antibiotic aztreonam with lysine as a synthetic substance in place of arginine. This substitution was made as arginine, which is in the intravenous (IV) formulation of aztreonam, can cause airway inflammation as seen in patients with cystic fibrosis when aerosolized. There have been several published studies on the efficacy and adverse effects of aerosolized aztreonam in CF patients. Two placebo-controlled studies of AZLI revealed a benefit in patients with CF and colonization with PsA. AIR-CF1 revealed that a 28-day course of AZLI given three times daily (TID) resulted in improved respiratory symptoms. They measured this improvement by using a cystic fibrosis questionnaire (CFQ-R), measuring forced expiratory volume in 1 second (FEV 1), and measuring bacterial density in sputum. AIR-CF2 demonstrated that a 28-day course of AZLI followed by a 28-day course of Tobramycin Inhaled Solution (TIS) delayed the time to the need for additional inhaled or systemic anti-pseudomonal antibiotics. They also used the CFQ-R and measured FEV1 and found improvement in both when compared to placebo. In AIR-CF3, an open-label 18-month study was conducted to evaluate the efficacy of AZLI using a month on/month off cycle, and to observe long-term effects of the drug. This protocol found that AZLI did have a long-term suppressive effect on PsA as there was a persistent reduction in Pseudomonas CFUs from baseline each month of the study. As expected, the decreases in bacterial density were consistently occurring during on months; and during off months, the density increased toward baseline. Thrice-daily dosing appeared more efficacious than twice-daily dosing. This was attributed to the mode of action of aztreonam, as bacterial killing is dependent on time above the MIC (minimal inhibitory concentration). Adverse events include: cough, respiratory tract congestion, pharyngolaryngeal pain, nasal congestion, dyspnea, hemoptysis, rhinorrhea, wheezing, chest discomfort, crackles lung, pulmonary function testing decreased, non-cardiac chest pain, sinus congestion, sinus headache, dyspnea exacerbated, exertional dyspnea.
Antibiotics currently on the market as inhaled antibiotics include tobramycin (TOBI), polymyxin E (Colistin), and aztreonam (Cayston). Studies of all of these have shown clinical benefits in those with Cystic Fibrosis. Given these findings, there is a growing interest in the use of inhaled antibiotics in other disease processes in which subjects become colonized with bacteria in the lower respiratory tract.
The investigators propose a two-center, prospective, case control clinical trial on the use of inhaled aztreonam (AZLI) in pediatric patients ages 7-21 years with a tracheostomy who have had one of their previous 3 tracheostomy aspirate cultures positive for PsA. Their past history in the previous year of requirement for systemic antibiotics will be used for each subject as the historical control. A tracheostomy aspirate culture will be collected upon initiation of the study. The investigators will subsequently start the participants on AZLI on a one month on/one month off schedule. Tracheal aspirate cultures will continue to be collected quarterly (every 3 months), and the bacterial density will be used for analysis. Goal is to see if there is a decrease need for systemic antibiotics for PsA infection.
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||6 participants|
|Intervention Model:||Single Group Assignment|
|Intervention Model Description:||two-center, prospective, case control clinical trial|
|Masking:||None (Open Label)|
|Official Title:||A-PACT: The Use of Inhaled Aztreonam to Eliminate or Decrease the Bacterial Burden of Pseudomonas Aeruginosa in Children With a Tracheostomy Tube.|
|Actual Study Start Date :||July 1, 2017|
|Actual Primary Completion Date :||February 20, 2020|
|Actual Study Completion Date :||February 20, 2020|
All participants will be receiving the study drug
Drug: Inhaled Aztreonam
Inhaled antibiotic with anti-pseudomonal properties
- Need for Systemic Antibiotics [ Time Frame: 1 year ]See if the number of days of systemic antibiotics needed decreases after participant starts using the study drug. (compare 1 year prior to starting study drug to the 1 year while patient is on the study drug)
- Bacterial Density [ Time Frame: 1 year ]See if bacterial density of Pseudomonas is decreased or eliminated with the study drug (will compare all cultures from the year prior to starting the trial to the year during the trial)
- Tracheostomy tube type [ Time Frame: 1 year ]to see if there is a difference in how effective the study drug is depending on what type of trach tube the subject has. Will assess this by looking at the Pseudomonas bacterial density from the tracheostomy tube cultures from the year prior to starting the study drug and compare to the year while on the study drug.
- Hospital admissions [ Time Frame: 1 year ]Can study drug decrease number of hospital admissions form the year prior to starting the study drug compared to the year while taking the study drug
- Hospital duration [ Time Frame: 1 year ]Can the study drug decrease the duration of hospitalizations from the year prior to starting the study drug compared to the year while taking the study drug
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): NCT03158116
|United States, California|
|Benioff Children's Hospital Oakland|
|Oakland, California, United States, 94609|
|Principal Investigator:||Rachna Wadia, MD||UCSF Benioff Children's Hospital Oakland|