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The SCOUT Study: "Short Course Therapy for Urinary Tract Infections in Children"

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ClinicalTrials.gov Identifier: NCT01595529
Recruitment Status : Completed
First Posted : May 10, 2012
Results First Posted : July 13, 2020
Last Update Posted : August 6, 2020
Sponsor:
Information provided by (Responsible Party):
National Institute of Allergy and Infectious Diseases (NIAID)

Study Description
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Brief Summary:
The SCOUT study is a multi-center, centrally randomized, double-blind, placebo-controlled non-inferiority clinical trial. 746 participants will be enrolled over a 4.5 year period. 672 will be evaluated for the study's primary outcome measure. After the first 5 days of primary care physician initiated antimicrobial therapy, patients who are afebrile and asymptomatic will then be randomized (1:1) to the standard course therapy arm of 5 more days of the same antibiotic therapy or the short course therapy arm of a placebo for 5 more days (for 10 days total). The primary objective of this study is to determine if halting antimicrobial therapy in subjects who have exhibited clinical improvement 5 days after starting antibiotic therapy (short course therapy) have the same failure rate (symptomatic UTI) through visit Day 11-14 as subjects who continue to take antibiotics for an additional 5 days (standard course therapy).

Condition or disease Intervention/treatment Phase
Urinary Tract Infection Drug: Cefixime Drug: Cephalexin Other: Placebo Drug: Trimethoprim/Sulfamethoxazole Phase 2

Detailed Description:
The SCOUT Study is a multi-center, centrally randomized, double-blind, placebo-controlled non-inferiority clinical trial of 746 children ages two months (at least 36 weeks gestation from birth for subjects < two years of age) to 10 years with a confirmed diagnosis of a urinary tract infection (UTI) to evaluate 672 for the study's primary outcome measure. UTI is one of the most common serious bacterial infections during childhood. Escherichia coli (E. coli) isolates account for 80-90 percent of all outpatient UTIs in children. Although antibiotics are the first treatment choice for urinary tract infections, antibiotic-resistant strains of E. coli, the most common cause of UTIs, are increasing worldwide. The study will enroll 746 children who have demonstrated clinical improvement five days after starting the originally prescribed antibiotic (afebrile and asymptomatic) and they will be randomized either to the standard-course arm or the short-course arm at a 1:1 ratio. Subjects will be enrolled over approximately a four and a half year period. Study duration for each individual subject will be approximately five weeks. The study product will consist of trimethoprim-sulfamethoxazole (TMP-SMX), cefixime, cefdinir, cephalexin and the corresponding placebos. The primary objective of this study is to determine if halting antimicrobial therapy in subjects who have exhibited clinical improvement 5 days after starting antibiotic therapy (short course therapy) have the same failure rate (symptomatic UTI) through visit Day 11-14 as subjects who continue to take antibiotics for an additional 5 days (standard course therapy). The secondary objectives are: 1) to determine if short-course therapy compared to standard course therapy results in similar numbers of children experiencing a recurrent urinary tract infection (relapse and reinfection; 2) to determine if short-course therapy compared to standard course therapy results in similar numbers of children with asymptomatic bacteriuria; 3) to determine if short-course therapy compared to standard course therapy results in similar numbers of children with gastrointestinal colonization of antimicrobial resistant Escherichia coli (E. coli) and Klebsiella pneumonia (K. pneumoniae); 4) to determine if short-course therapy compared to standard course therapy results in similar numbers of subjects presenting with clinical symptoms that may be related to UTI; 5) to determine if the number of subjects with positive urine culture prior to or at visit Day 11-14 is similar after short-course therapy compared to standard course therapy.
Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 717 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Primary Purpose: Treatment
Official Title: Targeted Clinical Trials to Reduce the Risk of Antimicrobial Resistance The SCOUT Study: "Short Course Therapy for Urinary Tract Infections in Children"
Actual Study Start Date : May 18, 2012
Actual Primary Completion Date : June 30, 2019
Actual Study Completion Date : August 12, 2019

Resource links provided by the National Library of Medicine


Arms and Interventions
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Arm Intervention/treatment
Experimental: Active treatment
5 days of active therapy to match the physician-initiated therapy, Trimethoprim sulfamethoxazole, Cefixime or Cefdinir or Cephalexin (subjects originally receiving Cefdinir will receive Cefixime)
 Drug: Cefixime
Cefixime 8 mg/kg/day orally, in 1 dose, with a maximum of 400 mg. Subjects originally receiving Cefdinir will receive Cefixime.

Drug: Cephalexin
Cephalexin 50mg/kg/day in 3 divided doses

Drug: Trimethoprim/Sulfamethoxazole
8 mg/kg/day of Trimethoprim-sulfamethoxazole (TMP-SMX) orally in 2 divided doses, with a maximum dose of 160 mg twice a day.
Placebo Comparator: Placebo treatment
5 days of placebo treatment to match physician-initiated therapy
 Other: Placebo
Placebo to match the other four active treatments


Outcome Measures
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Primary Outcome Measures :
  1. Comparison of Efficacy Based on Symptomatic Urinary Tract Infection (UTI) Between Short-course and Standard-course of Antibiotics. [ Time Frame: Day 11 through Day 14 ]

    A subject will be categorized as a treatment failure, if he/she has a symptomatic UTI in period between Day 6 through the Day 11 - 14 Test of Cure (TOC) Visit:

    1. Symptoms

      • Symptoms for all subjects (ages two months to 10 years): fever (a documented temperature of at least 100.4 °F OR 38°C measured anywhere on the body) ,dysuria
      • Additional symptoms for subjects > 2 years of age: suprapubic, abdominal, or flank pain or tenderness OR urinary urgency, frequency, or hesitancy (defined as an increase in these symptoms from pre-diagnosis conditions)
      • Additional symptoms for subjects = 2 months to 2 years of age: poor feeding OR vomiting AND
    2. Pyuria on urinalysis AND
    3. Culture proven infection with a single uropathogen NOTE: As per the above criteria, asymptomatic subjects (including subjects assessed as having asymptomatic bacteriuria) at the Day 11-14 TOC visit will NOT be considered a treatment failure for the primary outcome measure.

  2. Comparison of Efficacy Based on Symptomatic Urinary Tract Infection (UTI) Between Short-course and Standard-course of Antibiotics. Per-protocol Population. [ Time Frame: Day 11 through Day 14 ]

    A subject will be categorized as a treatment failure, if he/she has a symptomatic UTI in period between Day 6 through the Day 11 - 14 Test of Cure (TOC) Visit:

    1. Symptoms

      • Symptoms for all subjects (ages two months to 10 years): fever (a documented temperature of at least 100.4 °F OR 38°C measured anywhere on the body) ,dysuria
      • Additional symptoms for subjects > 2 years of age: suprapubic, abdominal, or flank pain or tenderness OR urinary urgency, frequency, or hesitancy (defined as an increase in these symptoms from pre-diagnosis conditions)
      • Additional symptoms for subjects = 2 months to 2 years of age: poor feeding OR vomiting AND
    2. Pyuria on urinalysis AND
    3. Culture proven infection with a single uropathogen NOTE: As per the above criteria, asymptomatic subjects (including subjects assessed as having asymptomatic bacteriuria) at the Day 11-14 TOC visit will NOT be considered a treatment failure for the primary outcome measure.


Secondary Outcome Measures :
  1. Comparison of Number of Subjects That Have a Recurrent Infection (Includes a Relapse UTI or a Reinfection) Following Short-course Versus Standard-course of Antibiotics. [ Time Frame: Day 11 through Day 44 ]
  2. Comparison of Number of Subjects That Have a Recurrent Infection (Includes a Relapse UTI or a Reinfection) Following Short-course Versus Standard-course of Antibiotics. Per-protocol Population. [ Time Frame: Day 11 through Day 44 ]
  3. Comparison of the Number of Subjects That Become Colonized With Antimicrobial Resistant Escherichia Coli (E. Coli) and Klebsiella Pneumoniae (K. Pneumoniae) in the Gastrointestinal Tract Following Short-course Versus Standard Course of Antibiotics. [ Time Frame: Day 11 through Day 30 ]

    A child would have emergent antibiotic resistance if they:

    1. Had no antibiotic-resistant E.coli or K.pneumoniae at enrollment but one or both are now present. OR
    2. Had either antibiotic-resistant E.coli or K.pneumoniae at enrollment but now the other antibiotic-resistant organism is present OR
    3. Had antibiotic-resistant E.coli and/or K.pneumoniae at enrollment, but have now developed resistance to new antibiotics in either organism.

  4. Comparison of the Number of Subjects That Become Colonized With Antimicrobial Resistant E. Coli and K. Pneumoniae in the Gastrointestinal Tract Following Short-course Versus Standard Course of Antibiotics. Per-protocol Population. [ Time Frame: Day 11 through Day 30 ]

    A child would have emergent antibiotic resistance if they:

    1. Had no antibiotic-resistant E.coli or K.pneumoniae at enrollment but one or both are now present. OR
    2. Had either antibiotic-resistant E.coli or K.pneumoniae at enrollment but now the other antibiotic-resistant organism is present OR
    3. Had antibiotic-resistant E.coli and/or K.pneumoniae at enrollment, but have now developed resistance to new antibiotics in either organism.

  5. Comparison of the Number of Subjects With Asymptomatic Bacteriuria Following Short-course Versus Standard-course of Antibiotics. [ Time Frame: Day 11 through Day 14 ]

    Asymptomatic Bacteriuria is defined in any SCOUT subject by:

    1. Absence of symptoms attributable to UTI including fever AND/OR the following:

      • Symptoms for all children (ages two months to 10 years):

        • fever (a documented temperature of at least 100.4 °F OR 38°C measured anywhere on the body)
        • dysuria

      • Additional symptoms for children > 2 years of age:

        • suprapubic, abdominal, or flank pain or tenderness OR
        • urinary urgency, frequency, or hesitancy (defined as an increase in these symptoms from pre-diagnosis conditions)

      • Additional symptoms for children = 2 months to 2 years of age:

        • poor feeding OR
        • vomiting AND

    2. A positive urine culture

      • 5 x 104 CFU/mL (catheterized or suprapubic aspiration urine specimen) OR
      • >105 CFU/mL (clean void specimen).

  6. Comparison of the Number of Subjects With Asymptomatic Bacteriuria Following Short-course Versus Standard-course of Antibiotics. Per-protocol Population. [ Time Frame: Day 11 through Day 14 ]

    Asymptomatic Bacteriuria is defined in any SCOUT subject by:

    1. Absence of symptoms attributable to UTI including fever AND/OR the following:

      • Symptoms for all children (ages two months to 10 years):

        • fever (a documented temperature of at least 100.4 °F OR 38°C measured anywhere on the body)
        • dysuria

      • Additional symptoms for children > 2 years of age:

        • suprapubic, abdominal, or flank pain or tenderness OR
        • urinary urgency, frequency, or hesitancy (defined as an increase in these symptoms from pre-diagnosis conditions)

      • Additional symptoms for children = 2 months to 2 years of age:

        • poor feeding OR
        • vomiting AND

    2. A positive urine culture

      • 5 x 104 CFU/mL (catheterized or suprapubic aspiration urine specimen) OR
      • >105 CFU/mL (clean void specimen).

  7. Comparison of the Number of Subjects With Clinical Symptoms That May be Related to a UTI Following Short-course Versus Standard-course of Antibiotics. [ Time Frame: Up to Day 14 ]
  8. Comparison of the Number of Subjects With Clinical Symptoms That May be Related to a UTI Following Short-course Versus Standard-course of Antibiotics. Per-protocol Population [ Time Frame: Up to Day 14 ]
  9. Comparison of the Number of Subjects With Positive Urine Cultures Following Short-course Versus Standard-course of Antibiotics. [ Time Frame: Up to Day 14 ]
  10. Comparison of the Number of Subjects With Positive Urine Cultures Following Short-course Versus Standard-course of Antibiotics. Per-protocol Population. [ Time Frame: Up to Day 14 ]

Eligibility Criteria
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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:   2 Months to 10 Years   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Age at randomization: at least two months (at least 36 weeks gestational age for subjects less than two years of age) to 10 years of age (120 months).
  2. Confirmed UTI (Urinary Tract Infection) diagnosis.

  3. Documented Clinical Improvement at Randomization.

    1. Afebrile: No documented temperature > / = 100.4 degrees Fahrenheit or 38 degrees Celsius (measured anywhere on the body) 24 hours prior to the enrollment visit

    2. Asymptomatic: report NONE of the following symptoms:

      • Symptoms for all children (ages two months to 10 years):

        • Fever (a documented temperature of at least 100.4 degrees Fahrenheit OR 38 degrees Celsius measured anywhere on the body)

          • dysuria

      • Additional symptoms for children > 2 years of age:

        • suprapubic, abdominal, or flank pain or tenderness OR
        • urinary urgency, frequency, or hesitancy (defined as an increase in these symptoms from pre-diagnosis conditions)

      • Additional symptoms for children > / = 2 months to 2 years of age:

        • poor feeding OR
        • vomiting

  4. Only children who have been prescribed one of the four antibiotics for which a placebo is available will be eligible to participate.

    • TMP-SMX; Cefixime; Cefdinir or Cephalexin. (Note a child that received a one-time dose of I.M. or I.V. medication (i.e. in ER or clinic) prior to starting on the one of the four oral medications is eligible for enrollment)
  5. Parental or guardian permission (informed consent) and if appropriate, child assent (if > / = seven years of age).

Exclusion Criteria:

  1. A urine culture proven infection with a second uropathogen > 10,000 CFU/mL collected via suprapubic aspiration or catheter or > 50,000 CFU/mL collected via clean void.
  2. A child hospitalized with a UTI that has the following: concomitant bacteremia associated with the UTI, urosepsis, or is in intensive care.
  3. A child whose urine culture reveals an organism that is resistant to the initially prescribed antibiotic.
  4. A child with a catheter-associated UTI.
  5. A child with known anaphylactic allergies to the study products.
  6. A child with phenylketonuria (PKU).
  7. A child diagnosed with congenital anomalies of the genitourinary tract.
  8. UTI in children with known anatomic abnormalities of the genitourinary tract other than VUR (Vesicoureteral reflux), duplicated collection systems, and hydronephrosis.
  9. A child that is not able to take oral medications.
  10. Previous surgery of the genitourinary tract (except circumcision in male children).
  11. Presence of an immunocompromising condition (e.g., HIV, malignancy, solid-organ transplant recipients, use of chronic corticosteroids or other immunosuppressive agents).
  12. Unlikely to complete follow-up (e.g. not available for the two follow-up study visits and the follow-up phone call).
  13. A child with a known history of type I hypersensitivity of the study antibiotics to be prescribed .
  14. Enrollment in another antibiotic study less than 30 days prior to enrollment visit.
  15. Previous enrollment of individuals in this study.
  16. Planned enrollment during this study coincides with enrollment in another therapeutic drug study (excluding vaccine).
  17. A child with a history of UTI within the past 30 days.
  18. A child with known Grade III-V VUR.
  19. A child taking antibiotic prophylaxis for any reason.
  20. A child who has started Day 6 of the originally prescribed antibiotic treatment.
Contacts and Locations
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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 ClinicalTrials.gov identifier (NCT number): NCT01595529


Locations
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United States, Pennsylvania
Children's Hospital of Pittsburgh of UPMC - General Academic Pediatric
Pittsburgh, Pennsylvania, United States, 15213-3205
Sponsors and Collaborators
National Institute of Allergy and Infectious Diseases (NIAID)
  Study Documents (Full-Text)

Documents provided by National Institute of Allergy and Infectious Diseases (NIAID):
Study Protocol  [PDF] September 20, 2018
Statistical Analysis Plan  [PDF] February 25, 2020

More Information
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Responsible Party: National Institute of Allergy and Infectious Diseases (NIAID)
ClinicalTrials.gov Identifier: NCT01595529    
Other Study ID Numbers: 09-0103
First Posted: May 10, 2012    Key Record Dates
Results First Posted: July 13, 2020
Last Update Posted: August 6, 2020
Last Verified: October 22, 2013

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No
Keywords provided by National Institute of Allergy and Infectious Diseases (NIAID):
antibiotic therapy
antimicrobial resistance
children
E.coli
K.pneumoniae
 parent study
SCOUT Study
spectrum stool bacteria
stool culture
urinary tract infections
Additional relevant MeSH terms:
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Infections
Communicable Diseases
Urinary Tract Infections
Disease Attributes
Pathologic Processes
Urologic Diseases
Trimethoprim
Sulfamethoxazole
Cephalexin
Cefixime
Anti-Infective Agents, Urinary
Anti-Infective Agents
 Renal Agents
Antimalarials
Antiprotozoal Agents
Antiparasitic Agents
Folic Acid Antagonists
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Anti-Dyskinesia Agents
Cytochrome P-450 CYP2C8 Inhibitors
Cytochrome P-450 Enzyme Inhibitors
Anti-Bacterial Agents