CAMERA - Combination Antibiotic treatment for Methicillin Resistant Staphylococcus Aureus

In adults with methicillin resistant staphylococcus aureus (MRSA) bacteraemia, does the combination of vancomycin plus flucloxacillin lead to a faster resolution of bacteraemia than does vancomycin alone?

Status

Completed

Phases

Phase 2

Study type

Interventional

Source

ANZCTR

Registry ID

ACTRN12610000940077

Acronym

CAMERA

Enrollment

Registered

2010-11-04

Start date

2011-01-12

Completion date

2014-05-06

Last updated

2021-06-14

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

None listed

Brief summary

MRSA bacteraemia has a mortality of 30-40%, exceeding that of sensitive Staphylococcus aureus primarily due to the shortcomings of vancomycin, the standard therapy for MRSA bacteraemia. Whilst several new antibiotics have become available for MRSA, none have been shown to be superior to vancomycin. Although MRSA is by definition resistant to oxacillin, multiple in-vitro and animal studies have demonstrated synergy of vancomycin with beta-lactams (including oxacillin) against MRSA and hetro-resistant vancomycin intermediate Staphylococcus aureus (hVISA). This study aims to answer the following question: In hospitalised adults with MRSA bacteraemia, does combination therapy with vancomycin and flucloxacillin lead to a shorter time to clearance of bacteraemia than vancomycin alone?

Interventions

Vancomycin 1.5 grams every 12 hours infused intravenously over 90 minutes (for standard duration of 2-6 weeks) PLUS flucloxacillin 2grams every six hours infused intravenously over 10-30 minutes (for 7 days). Both Vancomycin and Flucloxacillin will be comenced on day one. The duration of Vancomycin treatment will be decided by the treating clinician based on clinical variables and response.

Study design

Allocation

Randomised controlled trial

Intervention model

Parallel

Primary purpose

Treatment

Masking

Open (masking not used)

Eligibility

Sex/Gender

All

Age

18 Years to 100 Years

Healthy volunteers

Inclusion criteria

1. MRSA identified in a blood culture drawn within 48 hours prior to randomisation 2. Hospital inpatient with expected stay of at least 7 days

Exclusion criteria

1. Definite history of allergy to vancomycin or flucloxacillin 2. Renal impairment with estimated Glomerular Filtration Rate (eGFR) <30ml/min 3. Polymicrobial bacteraemia in the index MRSA blood culture 4. Current treatment with a beta-lactam antibiotic which the patient's clinician deems necessary to continue 5. Pregnancy 6. Previous randomisation into this study

Outcome results