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Colistin and Rifampicin for MDR-Acinetobacter (CoRAb)

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: NCT01577862
Recruitment Status : Completed
First Posted : April 16, 2012
Last Update Posted : April 16, 2012
Federico II University
Information provided by (Responsible Party):
Riccardo Utili, University of Campania "Luigi Vanvitelli"

Brief Summary:

Acinetobacter baumannii causes severe infections (pneumonia, bacteremia, organ space) with high lethality in hospitalised critically ill patients. It can acquire resistance to all classes of antibiotics (multidrug resistance, MDR) except an 'old' drug, colistin, which may be the only therapeutic option. However, colistin is not registered for this indication. The addition of rifampicin to colistin has been shown to be synergistic in vitro, and may be promising in vivo, but this combination has not been studied in comparison with colistin alone.

The purpose of this randomised, open-label, multicentre clinical trial is to assess whether the association of colistin and rifampicin reduces significantly the mortality of patients with severe MDR A. baumannii infections compared with colistin alone.

The trial will enroll 210 patients from intensive care units (ICU) of five tertiary care hospitals where MDR A. baumannii infection is endemic with epidemic phases. Patients will be randomly allocated to either colistin alone (control arm) or colistin plus rifampicin (experimental arm).

Primary end point is overall mortality, defined as death occurring within 30 days from randomisation.

Secondary end points will be disease-specific death, microbiological eradication, hospitalization length, emergence of resistance to colistin during treatment.

Condition or disease Intervention/treatment Phase
Infection Due to Resistant Bacteria Pneumonia, Ventilator-Associated Hospital Acquired Pneumonia Infection of Bloodstream Infectious Disease of Abdomen Drug: Colistin Drug: Rifampicin Phase 3

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 210 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Randomised, Open-Label Clinical Trial on The Efficacy of Colistin Plus Rifampicin Treatment Versus Colistin Alone for Severe Infections Due to Multidrug-Resistant Acinetobacter Baumannii
Study Start Date : November 2008
Actual Primary Completion Date : August 2011
Actual Study Completion Date : October 2011

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Active Comparator: Colistin
Colistin alone, 2 million units every 8 hours intravenously or according to renal function
Drug: Colistin
2 million units every 8 hours intravenously for at least 10 and up to a maximum of 21 days
Other Name: Sodium colistimethate

Experimental: Colistin plus Rifampicin
Colistin, 2 million units every 8 hours intravenously or according to renal function, plus Rifampicin, 600 mg every 12 hours intravenously
Drug: Colistin
2 million units every 8 hours intravenously for at least 10 and up to a maximum of 21 days
Other Name: Sodium colistimethate

Drug: Rifampicin
600 mg every 12 hours intravenously
Other Name: Rifampin

Primary Outcome Measures :
  1. All cause mortality [ Time Frame: 30 day ]
    The study primary outcome is patient overall mortality, defined as death occurring during hospitalisation or within 30 days from randomization.

Secondary Outcome Measures :
  1. Disease-specific death [ Time Frame: 30 days after randomization ]
    Disease-specific death or A. baumannii infection-related death is defined as death occurring in the presence of persistent signs and symptoms of A. baumannii infection (persistent pneumonia, septic shock) and/or when it occurs within the first week of antibiotic treatment without any other clear explanation.

  2. Microbiological eradication [ Time Frame: 30 day ]
    Microbiological eradication is defined as the disappearance of A. baumannii in cultures from blood, bronchial aspirate, urines and drainage fluids.

  3. Hospitalization length [ Time Frame: From admission to hospital discharge, an average of 30 days ]
    Hospitalization length is calculated as days in the hospital as well as days in the intensive care unit since diagnosis of A. baumannii infection.

  4. Emergence of resistance to colistin [ Time Frame: From day 1 to the end of study evaluation, 30 days after randomization ]
    Emergence of resistance is defined as the detection during treatment of an A. baumannii isolate showing resistance to colistin (MIC >2 mg/l).

  5. Toxicity [ Time Frame: From day 1 to the end of treatment evaluation, performed between day 10 and day 21 ]
    Renal toxicity is defined as decrease of creatinine clearance below 50 ml/min or >50% reduction in the creatinine clearance relative to the baseline. Hepatic toxicity is defined as increase of direct bilirubin above 3 mg/dl.

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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:

  • clinical and microbiological evidence of a severe infection due to multi-drug resistant A. baumannii during hospitalization
  • susceptibility of the A. baumannii isolate to colistin (MIC < or =2 mg/l).

Exclusion Criteria:

  • age below 18 years
  • treatment with one of the study drugs prior to the diagnosis of A. baumannii infection
  • severe liver dysfunction
  • history of prior hypersensitivity to the study drugs

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): NCT01577862

Sponsors and Collaborators
University of Campania "Luigi Vanvitelli"
Federico II University
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Principal Investigator: Riccardo Utili, MD University of Campania "Luigi Vanvitelli"

Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: Riccardo Utili, Professor, University of Campania "Luigi Vanvitelli" Identifier: NCT01577862    
Other Study ID Numbers: FARM7X9F8K
First Posted: April 16, 2012    Key Record Dates
Last Update Posted: April 16, 2012
Last Verified: April 2012
Keywords provided by Riccardo Utili, University of Campania "Luigi Vanvitelli":
Additional relevant MeSH terms:
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Communicable Diseases
Healthcare-Associated Pneumonia
Pneumonia, Ventilator-Associated
Intraabdominal Infections
Lung Diseases
Respiratory Tract Diseases
Respiratory Tract Infections
Cross Infection
Iatrogenic Disease
Disease Attributes
Pathologic Processes
Antibiotics, Antitubercular
Antitubercular Agents
Anti-Bacterial Agents
Anti-Infective Agents
Leprostatic Agents
Nucleic Acid Synthesis Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Cytochrome P-450 CYP2B6 Inducers
Cytochrome P-450 Enzyme Inducers
Cytochrome P-450 CYP2C8 Inducers
Cytochrome P-450 CYP2C19 Inducers
Cytochrome P-450 CYP2C9 Inducers
Cytochrome P-450 CYP3A Inducers