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Cystic Fibrosis Microbiome-determined Antibiotic Therapy Trial in Exacerbations: Results Stratified

Information source: University College Cork
ClinicalTrials.gov processed this data on August 23, 2015
Link to the current ClinicalTrials.gov record.

Condition(s) targeted: Cystic Fibrosis

Intervention: Ceftazidime (Drug); Tobramycin (Drug)

Phase: N/A

Status: Recruiting

Sponsored by: University College Cork

Overall contact:
Barry J Plant, MD, Email: b.plant@ucc.ie

Summary

Antimicrobial resistance is a significant challenge facing global healthcare. The unnecessary use of antibiotics is a key driver in the development of antibiotic resistance. Cystic Fibrosis (CF) represents a unique disease model to study bacterial resistance and to explore therapeutic strategies for same, as chronic lung infection overlaps with acute lung exacerbation's caused by a multitude of organisms. With time, chronic polymicrobial infection develops, with the most dominant infecting organism being Pseudomonas aeruginosa. In acute CF infections, empiric intravenous antibiotics are usually given for two weeks. Recurrent infections and treatments result in increasing antimicrobial resistance, and alterations in pathogen host interactions in the lung and gut flora. Next-generation DNA sequencing technology now offers DNA-based personalised diagnostics and treatment strategies. Enhancing our knowledge of the microbiome allows the use of stratified targeted antibacterial therapy that can be compared with standard empirical antibacterial therapy currently used. Cystic Fibrosis Microbiome-determined Antimicrobial Therapy Trial in Exacerbations: Results Stratified (CFMATTERS) will provide a randomized multi-centre controlled trial of microbiome-derived antimicrobial treatments versus current empirical therapy.

Clinical Details

Official title: Cystic Fibrosis Microbiome-determined Antibiotic Therapy Trial in Exacerbations: Results Stratified

Study design: Allocation: Randomized, Intervention Model: Parallel Assignment, Primary Purpose: Treatment

Primary outcome: The percentage change in recovery (post-exacerbation) FEV1 relative to the previous pre-exacerbation FEV1.

Secondary outcome:

The time to next pulmonary exacerbation

The improvement in symptom burden by day 7 as determined by Cystic Fibrosis Respiratory Symptom Diary (CFRSD)

The improvement in health related quality of life at day 28 post treatment and at 3 months as determined by the Cystic Fibrosis Questionnaire Revised (CFQR)

Total number of i.v. antibiotic days (home or in hospital) from time of randomisation in the trial

Change in FEV1

Total number of exacerbations post trial treatment

Eligibility

Minimum age: 16 Years. Maximum age: 80 Years. Gender(s): Both.

Criteria:

Inclusion Criteria:

- Written and informed consent, and assent where required.

- Age 16 years or older at enrolment

- Diagnosis of CF by standard sweat test and/or genetic analysis

- Persistent pulmonary Pseudomonas aeruginosa colonization confirmed on at least 2

occasions in the preceding 12 months

- Screening FEV1 predicted of >25%

- Able to perform spirometry reproducibly prior to enrolment

- Able to expectorate and provide a sputum sample at least once daily

- ≥1 non-elective course of intravenous antibiotics in the preceding year

- Able to understand and comply with protocol requirements, restrictions and

instructions and likely to complete the study as planned, as judged by the investigator Exclusion Criteria:

- Life expectancy less than 6 months

- They are a solid organ transplant recipient

- Have a requirement for immunosuppression ≥10mg corticosteroids per day

- Previous positive culture of non-tuberculosis mycobacteria species M. avium,

M. abscessus or M. intracellulare within the last 12 months or undergoing active therapy

- Positive culture of any Burkholderia cepacia species within the last 12 months or

undergoing active therapy

- Allergic bronchopulmonary aspergillosis on treatment

- Known allergies to more than 3 different classes of antibiotics, and intolerance or

allergy to tobramycin.

- Liver portal hypertension, determined by identification of oesophageal varices

- Advanced kidney disease requiring a dose reduction of ceftazidime or contraindicating

aminoglycosides

- History of any illness that in the opinion of the investigator, might confound the

results of the study or pose an additional risk in administering study drug to the subject

- If patient undergoes a pulmonary exacerbation before the Microbiome analysis is

reviewed by the Consensus Treatment Panel and i. v. antibiotics are administered. In this case, a repeat sputum will be sent for analysis 4 weeks after end of antibiotic treatment.

- Pregnant or breast-feeding at time of eligible pulmonary exacerbation

Locations and Contacts

Barry J Plant, MD, Email: b.plant@ucc.ie

University College Cork, Cork, Ireland; Recruiting
Barry P Plant, MD
Marcus Mall, MD, Principal Investigator
Isabelle Fajac, MD, Principal Investigator
Stuart Elborn, MD, Principal Investigator
Charles Haworth, MD, Principal Investigator
Christopher Goss, MD, Principal Investigator
Lieven Dupont, MD, Principal Investigator
Additional Information

Starting date: January 2015
Last updated: August 17, 2015

Page last updated: August 23, 2015

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