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Comparison of Two Antibiotic Regimen (Meropenem Versus Meropenem+Moxifloxacin)in the Treatment of Severe Sepsis and Septic Shock

Information source: Kompetenznetz Sepsis
Information obtained from ClinicalTrials.gov on October 19, 2009
Link to the current ClinicalTrials.gov record.

Condition(s) targeted: Severe Sepsis; Septic Shock

Intervention: meropenem (Drug); meropenem, moxifloxacin (Drug)

Phase: Phase 3

Status: Recruiting

Sponsored by: Kompetenznetz Sepsis

Official(s) and/or principal investigator(s):
Konrad Reinhart, MD, Study Chair, Affiliation: University Hospital Jena; Dep. of Anesthesiology and Intensive Care Medicine
Markus Löffler, MD, Study Director, Affiliation: University Leipzig; Koordinierungszentrum für Klinische Studien Leipzig (KKSL)
Thomas Deufel, MD, Study Director, Affiliation: University Hopitel Jena, Institute for Medical Chemistry

Overall contact:
Frank M. Brunkhorst, M.D., Phone: +49-3641-9323383, Email: Frank.Brunkhorst@med.uni-jena.de

Summary

Severe sepsis and septic shock are diseases of infectious origin with a high risk of death. Antibiotic therapy is mandatory but it is unknown whether one antibiotic alone is sufficient for initial therapy. The purpose of this study is to compare a therapy with meropenem alone or the combination of meropenem plus moxifloxacin in the treatment of severe sepsis/ septic shock. Patients randomly receive one of the two treatments for at least 7 days but not longer than 14 days.

Clinical Details

Official title: Prospective, Randomized, Open, Multicentre Study About the Effect of an Empirical Antibiotic Monotherapy With Meropenem (Meronem®) Versus a Combination Therapy With Moxifloxacin (Avalox®) on Organ Dysfunction in Patients With Severe Sepsis and Septic Shock

Study design: Treatment, Randomized, Open Label, Active Control, Parallel Assignment, Efficacy Study

Primary outcome: Mean total SOFA score

Secondary outcome:

Mortality

ICU and hospital length of stay

Response to therapy

Clinical and microbiological cure

Frequency of adverse events (AEs, SAEs, SUSARs)

Ventilator free days

Days without renal replacement therapy

Vasopressor free days

SOFA-subscores

Antibiotics free days

Costs of antibiotic therapy

Frequency of resistances to antibiotics

Frequency of new infections

Detailed description: Early intravenous empiric broad-spectrum antimicrobial therapy is an essential part of sepsis therapy. Inadequacy of empirical antibiotic therapy is associated with an increased mortality rate. Carbapenems are designed for empirical antimicrobial monotherapy. Combination therapy has been suggested but efficiency remains to be proven. In this study, antimicrobial monotherapy with meropenem is compared with a combination therapy of meropenem and moxifloxacin. It is hypothesized that the superior antibiotic therapy is associated with a lower overall organ dysfunction in sepsis. Study therapy lasts for at least 7 days unless microbiological results suggest otherwise. Study therapy may be extended to 14 days. Follow up examinations occur at 28 and 90 days. This investigator initiated study is supported by the German government (bmbf) and unrestricted industrial grants.

Eligibility

Minimum age: 18 Years. Maximum age: N/A. Gender(s): Both.

Criteria:

Inclusion Criteria:

- Severe sepsis or septic shock according to ACCP/SCCM criteria

- Onset of severe sepsis or septic shock <24 h

- Informed consent

- Effective contraception in fertile women

Exclusion Criteria:

- Age <18 years

- Pregnancy

- Breast-feeding women

- Pretreatment with meropenem, imipenem, or ertapenem within the last 4 weeks (>1 daily

dosage)

- Pretreatment with moxifloxacin,ciprofloxacin, or levofloxacin within the last 4 weeks

(>1 daily dosage)

- Pretreatment with a pseudomonas effective cephalosporin (cefepime, ceftazidim,

cefpirom) or piperacillin within the last 48 hours (>1 daily dosage).

- Pretreatment with other chinolones within the last 4 weeks (>1 daily dosage)

- Presence of infection where guidelines recommend another antimicrobial therapy than

the study medication (i. e. endocarditis)

- Evidence or strong clinical suspicion of a microorganism where the study medication

is known to be ineffective (i. e. tuberculosis, MRSA- or VRE-infection)

- Known allergy against meropenem or moxifloxacin

- Tendon disease or injury due to past quinolone therapy

- Congenital or acquired prolongation of QT-interval

- Concomitant medication which prolongs the QT-interval

- Electrolyte imbalance, especially uncorrected hypokalemia

- Clinically relevant bradycardia

- Clinically relevant cardiac dysfunction with reduced left-ventricular ejection

fraction

- Symptomatic arrhythmias in the medical history

- Significant hepatic impairment (Child-Pugh C) or elevation of liver enzymes >5x the

upper normal range

- No commitment to full patient support (i. e. DNR order)

- Patient's death is considered imminent due to coexisting disease

- Concomitant participation in another study or study participation with in the last 30

days.

- Relationship of the patient to study team member (i. e. colleague, relative)

Locations and Contacts

Frank M. Brunkhorst, M.D., Phone: +49-3641-9323383, Email: Frank.Brunkhorst@med.uni-jena.de

University Hospital Jena, Dep. of Anesthesiology and Intensive Care Medicine, Jena 07747, Germany; Recruiting
Konrad Reinhart, MD, Phone: +49-3641-9323100, Email: Konrad.Reinhart@med.uni-jena.de
Frank. M. Brunkhorst, MD, Phone: +49-3641-9323383, Email: Frank.Brunkhorst@med.uni-jena.de
Bloos Frank, MD, Ph.D., Sub-Investigator

University Hospital Aachen - Dep. of Anesthesiology, Aachen 52074, Germany; Recruiting
Rolf Rossaint, MD, Phone: +49-241-8088 179, Email: rossaint@post.rwth-aachen.de

Klinikum Augsburg - Dep. of Anesthesiology and Intensive Care Medicine, Augsburg 86156, Germany; Recruiting
U. Jaschinski, MD, Phone: +49-821-400 2379, Email: jaschinski@anaesthesie-klinikum-augsburg.de

Charité Berlin - Campus Virchow-Klinikum - Dep. of Nephrology, Berlin 13353, Germany; Recruiting
Michael Oppert, MD, Phone: +49 30 450 553132, Email: michael.oppert@charite.de

Charité Berlin - Dep. of Anesthesiology and Intensive Care Medicine, Berlin 10117, Germany; Recruiting
Claudia Spies, MD, Phone: +49-30-450 531 012, Email: claudia.spies@charite.de

Charité Campus Benjamin Franklin - Dep. of Medicine IV, Berlin 12203, Germany; Recruiting
Martin Tepel, MD, Phone: +49-30-8445 2305, Email: martin.tepel@charite.de

Charité Campus Mitte -Dep.of Infectiology and Pneumonology, Berlin 10117, Germany; Recruiting
Simone Rosseau, MD, Phone: +49-450-553474, Email: simone.rosseau@charite.de

Vivantes Klinikum Neukölln - Dep. of Anesthesiology, Intensive Care Medicine and Pain Therapy, Berlin 12313, Germany; Recruiting
Herwig Gerlach, MD, Phone: +49-30-130 14 2361, Email: herwig.gerlach@vivantes.de

Vivantes Klinikum Neukölln - Cardiology, Berlin 12313, Germany; Recruiting
Lorenz Reill, MD, Phone: +49-30-6004 3438, Email: lorenz.reill@vivantes.de

Ev. Krankenhaus Gilead I - Dep. of Anesthesiology and Intensive Care Medicine, Bielefeld 33617, Germany; Recruiting
Fritz Mertzlufft, MD, Phone: +49-521-772 791 02, Email: fritz.mertzlufft@evkb.de

University Hospital Bonn - Dep. of Anesthesiology and Intensive Care Medicine, Bonn 53105, Germany; Recruiting
Christian Putensen, MD, Phone: +49-228-287 4118, Email: putensen@uni-bonn.de

Städtisches Klinikum Brandenburg - Intensive Care Unit, Brandenburg 14770, Germany; Recruiting
Martin Schäfer, MD, Phone: +49-3381-41 1311, Email: martin.schaefer@klinikum-brandenburg.de

Klinikum Darmstadt - Dep. of Anesthesiology, Intensive Care Medicine and Pain Therapy, Darmstadt 64283, Germany; Recruiting
Martin Welte, MD, Phone: +49-1651-1076251, Email: martin.welte@klinikum-darmstadt.de

Klinikum Dessau - Dep. of Medicine, Dessau 06847, Germany; Not yet recruiting
Mathias Plauth, MD, Phone: +49-340 501 1275, Email: mathias.plauth@klinikum-dessau.de

Krankenhaus Dresden-Friedrichstadt, Dresden 01067, Germany; Recruiting
K. F. Rothe, MD, Phone: +49-351 480-1170, Email: rothe-ka@khdf.de

Krankenhaus Dresden-Neustadt, Dresden 01129, Germany; Withdrawn

University Hospital Dresden - Dep. of Anesthesiology and Intensive Care Med., Dresden 01307, Germany; Recruiting
Max Ragaller, MD, Phone: +49-351-458 2416, Email: ragaller@rcs.urz.tu-dresden.de

HELIOS Klinikum Erfurt - Dep. of Anesthesiology and Intensive Care Medicine, Erfurt 99089, Germany; Recruiting
Andreas Meier-Hellmann, MD, Phone: +49-361-781 6076, Email: andreas.meier-hellmann@helios-kliniken.de

University Erlangen-Nürnberg - Dep. of Medicine IV, Erlangen 91054, Germany; Recruiting
Stefan John, MD, Phone: +49-911-398 2702, Email: stefan.john@med4.med.uni-erlangen.de

University Hospital Freiburg - Dep. of Medicine III, Freiburg 79106, Germany; Recruiting
Tillmann Schwab, MD, Phone: +49-761 270 3401, Email: Tilmann.Schwab@uniklinik-freiburg.de

Klinik am Eichert - Dep. of Anesthesiology, Intensive Care Medicine, and Pain Therapy, Göppingen 73035, Germany; Not yet recruiting
Jörg Martin, MD, Phone: +49-7161-64 3453, Email: JM@kae.de

Georg August Universität Göttingen - Dep. of Anesthesiology and Intensive Care Medicine, Göttingen 37075, Germany; Recruiting
Michael Quintel, MD, Phone: +49-551-39-88 26, Email: mquintel@zari.de

Ernst-Moritz-Arndt-Universität Greifswald - Dep. of Anesthesiology and Intensive Care Medicine, Greifswald 17475, Germany; Recruiting
Matthias Gründling, MD, Phone: +49-03834-86 58 01, Email: gruendli@uni-greifswald.de

Ernst-Moritz-Arndt-Universität Greifswald, Dep. of Internal Medicine B, Greifswald 17475, Germany; Recruiting
Sigrun Friesecke, MD, Phone: +49 (3834) 866 709, Email: frieseck@uni-greifswald.de

Martin-Luther-Universität Halle-Wittenberg - Dep. of Anesthesiology and Intensive Care Medicine, Halle 06097, Germany; Recruiting
Harry Bromber, MD, Phone: +49 (345)5572403, Email: harry.bromber@medizin.uni-halle.de

Hospital Martha-Maria Halle-Dölau gGmbH - Dep. of Anesthesiology and Intensive Care Medicine, Halle 06120, Germany; Recruiting
Harald Fritz, MD, Phone: +49 (345) 559 1416, Email: H.Fritz@marthamaria-halle.de

Universitätsklinikum Hamburg-Eppendorf - Dep. of Intensive Care Medicine, Hamburg 20246, Germany; Recruiting
Axel Nierhaus, MD, Phone: +49 (40) 42803 5325, Email: nierhaus@uke.uni-hamburg.de

Medizinische Hochschule Hannover, Dep. of Internal Medicine/ Pneumology, Hannover 30625, Germany; Recruiting
Tobias Welte, MD, Phone: +49 (511) 5323530, Email: Welte.Tobias@mh-hannover.de

Klinikum Hannover Nordstadt - Dep. of Anesthesiology and Intensive Care Medicine, Hannover 30167, Germany; Recruiting
Jan-Peter Jansen, MD, Phone: +49 (511) 970 1580, Email: jan-peter.jantzen.nordstadt@klinikum-hannover.de

Westküstenklinikum Heide - Dep. of Anesthesiology and Intensive Care Medicine, Heide 25746, Germany; Recruiting
Stefan Schröder, MD, Phone: +49 (481) 785, Ext: 2101, Email: SSchroeder@WKK-Hei.de

University Hospital Heidelberg - Dep. of Visceral and Transplantation Surgery, Heidelberg 69120, Germany; Recruiting
Markus Büchler, MD, Phone: +49 (6221) 56 6202, Email: Markus.Buechler@med.uni-heidelberg.de

University Hospital Saarland - Deop. of Anesthesiology, Intensive Care Medicine, and Pain Therapy, Homburg/Saar 66421, Germany; Recruiting
Hauke Rensing, MD, Phone: +49 (6841) 16233100, Email: aihren@uniklinikum-saarland.de

University Hospital Kiel - Dep. of. Anesthesiology and Intensive Care Medicine, Kiel 24105, Germany; Recruiting
Norbert Weiler, MD, Phone: +49 (0431) 597-2970, Email: weiler@anaesthesie.uni-kiel.de

Hospital Merheim - Dep. of Anesthesiology and Intensive Care Medicine, Köln 51109, Germany; Recruiting
Frank Wappler, MD, Phone: +49 (0221) 8907-3863, Email: wapplerf@kliniken-koeln.de

University Hospital Köln - Dep. of Internal Medicine I, Köln 50924, Germany; Recruiting
Matthias Kochanek, MD, Phone: +49 (221) 478 5044, Email: matthias.kochanek@uni-koeln.de

University Hospital Leipzig - Dep. of Anesthesiology and Intensive Care Medicine, Leipzig 04103, Germany; Recruiting
Thorsten Albert, MD, Phone: +49 (341) 9717063, Email: albt@medizin.uni-leipzig.de

Hospital Ludwigshafen am Rhein - Dep. of Cardiac Surgery, Ludwigshafen 67063, Germany; Recruiting
Frank Isgro, MD, Phone: +49 (621) 503 4050, Email: isgrof@klilu.de

University Hospital Mannheim - Dep. of Medicine I, Mannheim 68167, Germany; Recruiting
Ursula Hoffmann, MD, Phone: +49 (621) 3832505, Email: ursula.hoffmann@med.ma.uni-heidelberg.de

Hospital Munich Harlaching - Dep. of Internal Acute Medicine and Prevention, Munich 81545, Germany; Recruiting
Claus Peckelsen, MD, Phone: +49-(89) 6210 2412, Email: claus.peckelsen@extern.lrz-muenchen.de

University Hospital Munich - Dep. of Internal Medicine, Munich 80336, Germany; Recruiting
Roland Gärtner, MD, Phone: +49 89 5160 2332, Email: roland.gaertner@med.uni-muenchen.de

Klinikum rechts der Isar - Dep. of Anesthesiology, Munich 81675, Germany; Recruiting
Manfred Blobner, MD, Phone: +49 89 4140 4291, Email: manfred.blobner@lrz.tum.de

University Hospital Münster - Dep. of Anesthesiology and Intensive Care Medicine, Münster 48149, Germany; Recruiting
Martin Westphal, MD, Phone: +49 (251) 83 47261, Email: martin.westphal@gmx.net

Klinikum Oldenburg - Dep. of Anesthesiology, Intensive Care Medicine, Emergency Medicine, Pain Therapy, Oldenburg 26133, Germany; Recruiting
Andreas Weyland, MD, Phone: +49 (441) 4032571, Email: weyland.andreas@klinikum-oldenburg.de

Klinikum Ernst von Bergmann - Dep. of Anesthesiology and Intensive Care Medicine, Potsdam 14467, Germany; Recruiting
Dirk Pappert, MD, Phone: +49 (331) 241-5001, Email: dpappert@klinikumevb.de

University Hospital Rostock - Dep. of Anesthesiology and Intensive Care Medicine, Rostock 18057, Germany; Recruiting
Dierk Vagts, MD, Phone: +49 (381) 4946410, Email: dierk.vagts@uni-rostock.de

Ev. Jung-Stilling-Krankenhaus - Dep. of Anesthesiology, Intensive Care Medicine, Emergency Medicine, Siegen 57074, Germany; Recruiting
Reiner Giebler, MD, Phone: +49 (271) 333 45 39, Email: anaesthesie.jsk@diakonie-siegen.de

University Hospital Tübingen - Dep. of Medicine, Tübingen 72076, Germany; Recruiting
Reimer Riessen, MD, Phone: +49 (7071) 29 83 469, Email: reimer.riessen@med.uni-tuebingen.de

University Hospital Ulm - Dep. of Internal Medicine II, Ulm 89081, Germany; Recruiting
Christian Schumann, MD, Phone: +49 (731) 500 491 14, Email: Christian.Schumann@medizin.uni-ulm.de

Stiftung Juliusspital Würzburg - Dep. of Medicine (Cardiology), Würzburg 97070, Germany; Recruiting
Malte Meesmann, MD, Phone: +49 931 393 1751, Email: m.meesmann@juliusspital.de

Charité Berlin - Dep. of Medicine (Cardiology, Angiology, Pneumology), Berlin 10117, Germany; Not yet recruiting
Marko Böhm, MD, Email: marko.boehm@charite.de

University Hospital Heidelberg - Dep. of Medicine IV, Heidelberg 69120, Germany; Not yet recruiting
Christoph Eisenbach, MD, Phone: +49 (6221) 56 8705, Email: christoph.eisenbach@med.uni-heidelberg.de

Klinikum Lüdenscheid - Dep. of Anesthesiology, Luedenscheid 58515, Germany; Not yet recruiting
Thomas Uhlig, M.D., Phone: +49 (2374) 54 170, Email: anaesthesie@klinikum-luedenscheid.de

Hospital Lippe-Detmold - Dep. of Anesthesiology and Intensive Care Medicine, Detmold 32756, Germany; Not yet recruiting
Stefan Grond, MD, Phone: +49 (5231) 72 2321, Email: stefan.grond@klinikum-lippe.de

Additional Information

Competence Networks in Medicine

Competence Network Sepsis (SepNet)

German Sepsis Society

Related publications:

[No authors listed] American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med. 1992 Jun;20(6):864-74. Review.

Reinhart K, Brunkhorst F, Bone H, Gerlach H, Grundling M, Kreymann G, Kujath P, Marggraf G, Mayer K, Meier-Hellmann A, Peckelsen C, Putensen C, Quintel M, Ragaller M, Rossaint R, Stuber F, Weiler N, Welte T, Werdan K; Deutsche Sepsis-Gesellschaft e.V. [Diagnosis and therapy of sepsis: guidelines of the German Sepsis Society Inc. and the German Interdisciplinary Society for Intensive and Emergency Medicine] Anaesthesist. 2006 Jun;55 Suppl 1:43-56. Review. German.

Bochud PY, Bonten M, Marchetti O, Calandra T. Antimicrobial therapy for patients with severe sepsis and septic shock: an evidence-based review. Crit Care Med. 2004 Nov;32(11 Suppl):S495-512. Review.

Harbarth S, Garbino J, Pugin J, Romand JA, Lew D, Pittet D. Inappropriate initial antimicrobial therapy and its effect on survival in a clinical trial of immunomodulating therapy for severe sepsis. Am J Med. 2003 Nov;115(7):529-35.

Safdar N, Handelsman J, Maki DG. Does combination antimicrobial therapy reduce mortality in Gram-negative bacteraemia? A meta-analysis. Lancet Infect Dis. 2004 Aug;4(8):519-27.

Engel C, Brunkhorst FM, Bone HG, Brunkhorst R, Gerlach H, Grond S, Gruendling M, Huhle G, Jaschinski U, John S, Mayer K, Oppert M, Olthoff D, Quintel M, Ragaller M, Rossaint R, Stuber F, Weiler N, Welte T, Bogatsch H, Hartog C, Loeffler M, Reinhart K. Epidemiology of sepsis in Germany: results from a national prospective multicenter study. Intensive Care Med. 2007 Apr;33(4):606-18. Epub 2007 Feb 24.

Starting date: October 2007
Ending date: December 2009
Last updated: January 28, 2009

Page last updated: October 19, 2009

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