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Sulopenem Versus Ertapenem for Complicated Intra-abdominal Infection (cIAI)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT03358576
Recruitment Status : Completed
First Posted : November 30, 2017
Results First Posted : December 1, 2020
Last Update Posted : December 1, 2020
Information provided by (Responsible Party):
Iterum Therapeutics, International Limited

Brief Summary:
This is a prospective, Phase 3, randomized, multi-center, double-blind study of the efficacy, tolerability and safety of sulopenem followed by sulopenem-etzadroxil/probenecid versus ertapenem followed by ciprofloxacin-metronidazole for treatment of complicated intra-abdominal infections in adults.

Condition or disease Intervention/treatment Phase
Intra Abdominal Infections Drug: Ertapenem Drug: Sulopenem-Etzadroxil/Probenecid Drug: Ciprofloxacin Drug: Metronidazole Drug: Amoxicillin-Clavulanate Drug: Sulopenem Phase 3

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 674 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Prospective, Phase 3, Randomized, Multi-center, Double-blind Study of Efiicacy, Tolerability & Safety of Sulopenem & Sulopenem-etzadroxil/Probenecid vs Ertapenem Followed by Cipro-metronidazole for Treatment of cIAI in Adults
Actual Study Start Date : September 18, 2018
Actual Primary Completion Date : October 2, 2019
Actual Study Completion Date : October 2, 2019

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: Sulopenem
Sulopenem 1000 mg IV once daily for at least 5 days, followed by Sulopenem-Etzadroxil/Probenecid 500 mg PO twice daily to complete 7-10 days of treatment
Drug: Sulopenem-Etzadroxil/Probenecid
Antibiotic for complicated intra-abdominal infection

Drug: Sulopenem
Antibiotic for complicated intra-abdominal infection

Active Comparator: Ertapenem
Ertapenem 1000 mg IV once daily for at least 5 days, followed by ciprofloxacin 500 mg PO twice daily along with metronidazole 500 mg PO four times daily. If patient is found to have causative pathogens that are resistant to ciprofloxacin they will receive amoxicillin-clavulanate 875 mg PO twice daily instead
Drug: Ertapenem
Antibiotic for complicated intra-abdominal infection
Other Name: Invanz

Drug: Ciprofloxacin
Antibiotic for complicated intra-abdominal infection
Other Name: Cipro

Drug: Metronidazole
Antibiotic for complicated intra-abdominal infection
Other Name: Flagyl

Drug: Amoxicillin-Clavulanate
Antibiotic for complicated intra-abdominal infection
Other Name: Augmentin

Primary Outcome Measures :
  1. Percentage of Participants With Clinical Success [ Time Frame: Day 28 +/- 1 day ]
    Clinical response is defined as resolution in signs and symptoms of the index infection and no new symptoms, without the need for additional antibiotics or interventions

Secondary Outcome Measures :
  1. Percentage of Participants With Clinical Success [ Time Frame: Day 11-14 +/- 1 day ]
    Clinical response is defined as resolution in signs and symptoms of the index infection and no new symptoms, without the need for additional antibiotics or interventions

Information from the National Library of Medicine

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, Learn About Clinical Studies.

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

Inclusion Criteria:

  1. Patient or the patient's legally acceptable representative able to provide a signed written informed consent prior to any study-specific procedures.
  2. Adult patients ≥18 years of age
  3. EITHER:

    a. Intra-operative/post-operative enrollment with visual confirmation (presence of pus within the abdominal cavity) of an intra-abdominal infection associated with peritonitis including at least 1 of the following diagnosed during the surgical intervention: i. Cholecystitis with gangrenous rupture or perforation or progression of the infection beyond the gallbladder wall ii. Diverticular disease with perforation or abscess iii. Appendiceal perforation or peri-appendiceal abscess iv. Traumatic perforation of the intestines, only if operated on >12 hours after perforation occurs v. Secondary peritonitis (but not spontaneous bacterial peritonitis associated with cirrhosis and chronic ascites) vi. Intra-abdominal abscess (including of liver or spleen provided that there was extension beyond the organ with evidence of intraperitoneal involvement).


    b. Pre-operative enrollment where one of the following surgical procedures are planned within 24 hours prior to the first dose of study drug: i. Open laparotomy, percutaneous drainage of an intra-abdominal abscess, or laparoscopic surgery.

  4. Evidence of systemic inflammatory indicators, with at least one of the following:

    i. Fever (defined as body temperature >38°C) or hypothermia with a core body temperature <35°C ii. Elevated white blood cell count (>12,000 cells/mm3) iii. Drop in blood pressure (systolic BP must be <90 mmHg without pressor support) iv. Increased heart rate (>90 bpm) and respiratory rate (>20 breaths/min) v. Hypoxia (oxygen saturation ≤90 percent on room air)

  5. Physical findings or symptoms consistent with intra-abdominal infection, with at least one of the following:

    i. Abdominal pain and/or tenderness, with or without rebound ii. Localized or diffuse abdominal wall rigidity iii. Abdominal mass iv. Nausea/vomiting v. Altered Mental Status

  6. Specimen/s from the surgical intervention were sent for culture.

Exclusion Criteria:

  1. Patient diagnosed with traumatic bowel perforation undergoing surgery within 12 hours; perforation of gastroduodenal ulcers undergoing surgery within 24 hours. Other intra-abdominal processes in which the primary etiology was not likely to be infectious.
  2. Patient has abdominal wall abscess or bowel obstruction without perforation or ischemic bowel without perforation.
  3. Patient has simple cholecystitis or gangrenous cholecystitis without rupture, or simple appendicitis, or acute suppurative cholangitis; or infected necrotizing pancreatitis or pancreatic abscess.
  4. Patient whose surgery included staged abdominal repair, or "open abdomen" technique, or marsupialization.
  5. Patient known at study entry to have a complicated intra-abdominal infection caused by pathogens resistant to the study antimicrobial agents.
  6. Patient needed effective concomitant systemic antibacterials (oral, IV, or intramuscular) or antifungals in addition to those designated in the 2 study groups, except vancomycin, linezolid, or daptomycin if started for known or suspected methicillin-resistant Staphylococcus aureus (MRSA) or Enterococcus spp. as per clinical study protocol (CSP).
  7. Patient has perinephric infections or an indwelling peritoneal dialysis catheter.
  8. Patient has suspected intra-abdominal infections due to fungus, parasites (e.g., amoebic liver abscess), virus, or tuberculosis.
  9. Patient has a known history of serious allergy, hypersensitivity or any serious reaction to carbapenem antibiotics, or to other β-lactam antibiotics
  10. Patient known to have any of the following laboratory values as defined below:

    1. Hematocrit <25% or hemoglobin <8 g/dL
    2. Absolute neutrophil count <1000/mm3
    3. Platelet count <75,000/mm3
    4. Bilirubin >3 x the upper limit of normal (ULN), unless isolated hyperbilirubinemia was directly related to the acute infection or known Gilbert's disease
    5. Alanine aminotransferase (ALT) or aspartate aminotransferase (AST) >3 x ULN values at Screening. Patients with elevations of AST and/or ALT up to 5 x ULN will be eligible if these elevations are acute and directly related to the infectious process being treated. This must be documented
    6. Alkaline phosphatase (ALP) >3 x ULN. Patients with values >3.0 x ULN and <5.0 x ULN are eligible if this value is acute and directly related to the infectious process being treated. This must be documented.
    7. Estimated creeatinine clearance <50 mL/min
  11. Patient has a body mass index >45 kg/m2.
  12. Patient has APACHE II score >30.
  13. Patient considered unlikely to survive the 4-week study period or has a rapidly progressive or terminal illness, including septic shock that was associated with a high risk of mortality.
  14. Patient unlikely to respond to 10-14 days of treatment with antibiotics.
  15. Patient received systemic antibacterial agents within the 72-hour period prior to study entry, unless either of the following pertained:

    a. Patient has a new infection (not considered a treatment failure) and both of the following were met: i. Patient received no more than 24 hours of total prior antibiotic therapy ii. Patient received ≤1 dose of a treatment regimen post-operatively and antibiotics were not received more than 6 hours post-procedure.

    b. Patient considered to have failed the previous treatment regimen i.e., pre-operative treatment of any duration with non-study systemic antimicrobial therapy for peritonitis or abscess permitted provided that all of the following are met: i. The treatment regimen had been administered for at least 72 hours and was judged to have been inadequate ii. The patient had an operative intervention that was just completed or was intended no more than 24 hours after study entry iii. Findings of infection were documented at surgery iv. Specimens for bacterial cultures and susceptibility testing were taken at operative intervention v. No further non-study antibacterials were administered after randomization.

  16. Patient has a concurrent infection that may interfere with the evaluation of response to the study antibiotic.
  17. Patient receiving hemodialysis or peritoneal dialysis.
  18. Patient has a history of acute hepatitis in the recent past (3 months prior to study entry), chronic hepatitis, cirrhosis, acute hepatic failure, or acute decompensation of chronic hepatic failure.
  19. Patient has past or current history of epilepsy or seizure disorders excluding febrile seizures of childhood.
  20. Patient immunocompromised as evidenced by any of the following:

    1. Human immunodeficiency virus infection, with either a recent (in the past 6 months) acquired immune deficiency syndrome-defining condition or a CD4 + T lymphocyte count <200/mm3
    2. Systemic or hematological malignancy requiring chemotherapeutic or radiologic/immunologic interventions within 6 weeks prior to randomization, or anticipated to begin prior to completion of study
    3. Immunosuppressive therapy, including maintenance corticosteroid therapy (>40 mg/day equivalent prednisolone) for 5 days or more.
  21. Patient participating in any other clinical study that involved the administration of an investigational medication at the time of presentation, during the course of the study, or who had received treatment with an investigational medication in the 30 days prior to study enrollment, or had previously been enrolled in this study or had been treated with sulopenem.
  22. Patient is in a situation or has a condition that, in the investigator's opinion, may interfere with optimal participation in the study.
  23. Patient unlikely to comply with protocol e.g., uncooperative attitude, inability to return for follow-up visits, and unlikely to complete the study.
  24. Patient has known inflammatory bowel disease (ulcerative colitis or Crohn's disease) or Clostridium difficile-associated diarrhea.
  25. Patients with a history of blood dyscrasias
  26. Patients with a history of uric acid kidney stones
  27. Patients with acute gouty attack
  28. Patients on chronic methotrexate therapy
  29. Females of child-bearing potential who are unable to take adequate contraceptive precautions, have a positive pregnancy test result within 24 hours of study entry, are otherwise known to be pregnant, or are currently breastfeeding an infant.
  30. Male subjects who do not agree to use an effective barrier method of contraception during the study and for 14 days post treatment.

Information from the National Library of Medicine

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 identifier (NCT number): NCT03358576

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United States, California
Medical Facility
Chula Vista, California, United States, 91911
Medical Facility
Torrance, California, United States, 90509
United States, Idaho
Medical Facility
Idaho Falls, Idaho, United States, 83404
United States, Massachusetts
Medical Facility
Boston, Massachusetts, United States, 02111
United States, Michigan
Medical Facility
Royal Oak, Michigan, United States, 48073
United States, Missouri
Medical Facility
Saint Louis, Missouri, United States, 63110
United States, Montana
Medical Facility
Butte, Montana, United States, 59701
United States, Nebraska
Medical Facility
Lincoln, Nebraska, United States, 68510
Medical Facility
Omaha, Nebraska, United States, 68114
United States, New Jersey
Medical Facility
Somers Point, New Jersey, United States, 08244
United States, Ohio
Medical Facility
Columbus, Ohio, United States, 43210
Medical Facility
Columbus, Ohio, United States, 43215
Medical Facility
Blagoevgrad, Bulgaria, 2700
Medical Facility
Lom, Bulgaria, 3600
Medical Facility
Pleven, Bulgaria, 5809
Medical Facility
Plovdiv, Bulgaria, 4003
Medical Facility
Plovdiv, Bulgaria, 4004
Medical Facility
Ruse, Bulgaria, 7002
Medical Facility
Sofia, Bulgaria, 1606
Medical Facility
Varna, Bulgaria, 9000
Medical Facility
Varna, Bulgaria, 9002
Medical Facility
Kohtla-Järve, Estonia, 31025
Medical Facility
Tallinn, Estonia, 13419
Medical Facility
Tallin, Estonia, 10138
Medical Facility
Tartu, Estonia, 51014
Medical Facility
Viljandi, Estonia, 71024
Medical Facility
Võru, Estonia, 65526
Medical Facility
Gori, Georgia, 1400
Medical Facility
Kutaisi, Georgia, 4600
Medical Facility
Tbilisi, Georgia, 0102
Medical Facility
Tbilisi, Georgia, 0114
Medical Facility
Tbilisi, Georgia, 0141
Medical Facility
Tbilisi, Georgia, 0144
Medical Facility
Tbilisi, Georgia, 0159
Medical Facility
Tbilisi, Georgia, 0160
Medical Facility
Kaposvár, Hungary, 7400
Medical Facility
Pécs, Hungary, 7624
Medical Facility
Veszprém, Hungary, 8200
Medical Facility
Daugavpils, Latvia, 5417
Medical Facility
Riga, Latvia, 1038
Medical Facility
Rēzekne, Latvia, 4600
Medical Facility
Bielsk Podlaski, Poland, 17-100
Sponsors and Collaborators
Iterum Therapeutics, International Limited
  Study Documents (Full-Text)

Documents provided by Iterum Therapeutics, International Limited:
Study Protocol  [PDF] May 29, 2018
Statistical Analysis Plan  [PDF] December 6, 2019

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Responsible Party: Iterum Therapeutics, International Limited Identifier: NCT03358576    
Other Study ID Numbers: IT001-303
First Posted: November 30, 2017    Key Record Dates
Results First Posted: December 1, 2020
Last Update Posted: December 1, 2020
Last Verified: November 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Intraabdominal Infections
Clavulanic Acid
Clavulanic Acids
Amoxicillin-Potassium Clavulanate Combination
Anti-Bacterial Agents
Anti-Infective Agents
Antiprotozoal Agents
Antiparasitic Agents
Topoisomerase II Inhibitors
Topoisomerase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Cytochrome P-450 CYP1A2 Inhibitors
Cytochrome P-450 Enzyme Inhibitors
beta-Lactamase Inhibitors
Uricosuric Agents
Gout Suppressants
Antirheumatic Agents
Renal Agents