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Antibiotic Treatment Trial for the PANDAS/PANS Phenotype (AZT)

This study has been completed.
Massachusetts General Hospital
Information provided by (Responsible Party):
University of South Florida Identifier:
First received: May 23, 2012
Last updated: February 3, 2015
Last verified: December 2014

The purpose of this research study is to know if the antibiotic azithromycin, an antibiotic approved by the U.S. Food and Drug Administration (FDA) for treating infections, improves symptom severity in children with sudden and severe onset obsessive compulsive symptoms known as PANS, Pediatric Acute Onset Neuropsychiatric Syndrome, and PANDAS, Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus. This study seeks to compare the effects of placebo vs. azithromycin on Obsessive Compulsive Disorder (OCD) symptom severity as well as to assess immune risk factors in children with PANDAS/PANS. Obsessions are repetitive, unwanted thoughts or worries that may be unpleasant, silly, or embarrassing. Compulsions are repetitive or ritualistic actions that are performed to ease anxiety or worries. Doctors think these symptoms may be caused or exacerbated by certain infections such as Streptococcus pyogenes, Mycoplasma pneumonia, Borrelia burgordfi, etc. These infections commonly cause strep throat, walking pneumonia, and Lyme Disease, among others.

This study will involve a 4 week double-blind, placebo-controlled randomized trial of azithromycin (Double Blind Phase). At the end of this 4 week trial, the child will be assigned to azithromycin for 8 weeks (Open Label Phase). At the end of these 12 weeks, a Naturalistic Observation phase will assess the child's symptom characteristics for up to 40 weeks.

The study hypothesizes that children receiving antibiotic will show significantly greater overall improvement in severity compared with placebo, and that children with sudden onset of OCD and whose subsequent course shows dramatic fluctuations will have evidence of immune risk factors that predisposes to this presentation.

Condition Intervention Phase
Obsessive Compulsive Disorder (OCD)
Drug: Azithromycin
Drug: Placebo
Phase 2

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: Antibiotic Treatment Trial for the PANDAS/PANS Phenotype

Resource links provided by NLM:

Further study details as provided by University of South Florida:

Primary Outcome Measures:
  • Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) [ Time Frame: Every 2 weeks for 12 weeks ]

Secondary Outcome Measures:
  • Clinical Global Impressions [ Time Frame: Every 2 weeks for 12 weeks ]
  • Screen for Child Anxiety Related Disorders [ Time Frame: Every week for 12 weeks ]

Enrollment: 47
Study Start Date: May 2012
Study Completion Date: December 2014
Primary Completion Date: December 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Azithromycin
Antibiotic used to treat infections.
Drug: Azithromycin
Antibiotic used to treat infections
Other Names:
  • Zithromax
  • Zmax
Placebo Comparator: Placebo
Compound thickening agent with sugar and flavor additives.
Drug: Placebo
Thickening compound with sugar and flavoring

  Show Detailed Description


Ages Eligible for Study:   4 Years to 14 Years   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Ages 4 -14 years.
  • Presence of OCD and at least two of the following:

    1. Anxieties e.g. new onset separation anxiety
    2. Sensory abnormalities (tactile/auditory/visual defensiveness or visual misperceptions)
    3. Behavioral Regression (e.g. new onset impulsivity, hyperactivity, meltdowns)
    4. Deterioration in school performance or in handwriting
    5. Emotional lability and/or depression
    6. Urinary symptoms (frequent urination or enuresis)
    7. Sleep disturbances Anorexia
  • Current episode OCD of recent onset (less or equal to 6 months) associated with infection
  • Symptom onset appears temporally related to infection or exposure
  • Symptoms are of moderate severity with significant impairment (CGI of moderate or worse) and CY-BOCS of more or equal to 16.
  • Parental willingness to accompany their child for multiple study visits and be responsible for medication compliance.

Exclusion Criteria:

  • History of Rheumatic Fever including Sydenham's Chorea (heart murmur, frank chorea, EKG PR or QTc prolongation, abnormal reflexes (Gordon-Hey reflex)).
  • Diagnosis of autism (moderate - severe), schizophrenia, mental retardation or chronic degenerative neurological disease.
  • Any illness for which antibiotic treatment may be contraindicated (e.g. Liver disease).
  • Personal history of adverse reaction or allergy to azithromycin.
  • Recent or planned psychopharmacologic (4 weeks for most medications or 8 weeks for SSRIs) treatment changes.
  • Antibiotic prophylaxis therapy or history of neuropsychiatric non-response to prior antibiotic trial.
  • Currently participating in cognitive behavioral therapy or habit reversal therapy for OCD and/or tics.
  • Weight less than 15 kilograms
  • Concurrent therapy with medications that may increase adverse effects (eg. pimozide, citalopram, tricyclic antidepressants, etc).
  Contacts and Locations
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, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT01617083

United States, Florida
Rothman Center for Neuropsychiatry
Saint Petersburg, Florida, United States, 33701
Sponsors and Collaborators
University of South Florida
Massachusetts General Hospital
Principal Investigator: Tanya Murphy, MD University of South Florida
  More Information

Constantino, J., & CP, G. The Social Responsiveness Scale (SRS) Manual. Los Angeles: Western Psychological Services, 2005.
Diggle, P. Analysis of longitudinal data. Oxford University Press, 2002.
Guy, W. Assessment Manual for Psychopharmacology, rev. edn. Rockville, MD: National Institute of Mental Health, 1976.
Landgraf, J. M., Abetz, L., & Ware, J. E. The CHQ user's manual. Boston: The Health Institute, New England Medical Center, 1996.
Meyers, J., & Meyers, K. Rey Complex Figure Test and recognition trial: Professional manual. Psychological Assessment Resources, 1995.
Murphy, T. K., Storch, E. A., & Strawser, M. S. Case Report: Selective Serotonin Reuptake Inhibitor-Induced Behavioral Activation in the PANDAS Subtype. [case report]. Primary Psychiatry, 13(8), 87-89, 2006.
Piacentini, J. C., & Jaffer, M. P., J. C., & Jaffer, M. Measuring functional impairment in youngsters with OCD: Manual for the Child OCD Impact Scale (COIS). Los Angeles, UCLA Department of Psychiatry, 1999.
Seber, G. A. F. Multivariate Observations. New York: Wiley, 1984.
Swanson, J. M. School-based assessments and interventions for ADD students. Irvine, CA: K C Publishing, 1992.
Wood, H. F., Feinstein, A. R., Taranta, A., & Simpson, R. Rheumatic fever in children and adolescents III. Comparative effectiveness of three prophylaxis regimens in preventing streptococcal infections and rheumatic fever. Annuals of Internal Medicine, 60(supplement 5), 31-46, 1964.

Responsible Party: University of South Florida Identifier: NCT01617083     History of Changes
Other Study ID Numbers: 6119-128500
270332 ( Other Grant/Funding Number: Massachusetts General Hospital (MGH) )
Study First Received: May 23, 2012
Last Updated: February 3, 2015

Keywords provided by University of South Florida:
Antibiotic Treatment

Additional relevant MeSH terms:
Compulsive Personality Disorder
Obsessive-Compulsive Disorder
Compulsive Behavior
Personality Disorders
Mental Disorders
Anxiety Disorders
Impulsive Behavior
Anti-Bacterial Agents
Antibiotics, Antitubercular
Anti-Infective Agents
Antitubercular Agents processed this record on April 21, 2017