Appendicitis, Cholecystitis, Diverticulitis, Intra-Abdominal Abscess, Intra-Abdominal Infection, Peritonitis
Conditions
Keywords
Intra-Abdominal Infections, Abscess
Brief summary
This is a study of the safety and efficacy of tigecycline to ceftriaxone sodium plus metronidazole in hospitalized subjects with cIAI. Subjects will be followed for efficacy through the test-of-cure assessment. Safety evaluations will occur through the treatment and post-treatment periods and continue through resolution or stability of the adverse event(s).
Interventions
every 12 hours IV (an initial dose of 100 mg followed by 50 mg every 12 hours)
Ceftriaxone sodium 2 g once daily intravenously plus metronidazole 1 g to 2 g daily given in divided doses intravenously. Test article should be administered for a minimum of 4 days and up to 14 days at the discretion of the investigator.
Sponsors
Study design
Eligibility
Inclusion criteria
* Clinical diagnosis of complicated intra-abdominal infection that requires surgery within 24 hours. * Fever plus other symptoms such as nausea, vomiting, abdominal pain.
Exclusion criteria
* Cancer * Medicines that suppress the immune system * Dialysis
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Clinically Evaluable (CE) Patients With Clinical Response of Cure at the Test-of-Cure (TOC) Visit | up to 6 weeks | CE population were those who completed TOC assessment of cure or failure (but not indeterminate) or, in case of premature discontinuation due to lack of efficacy, had completed end of treatment assessment such that assessment of clinical response could be made. Clinical response was assigned by investigator per protocol-specified guidelines and defined as: test article and initial intervention (operative and/or radiologically controlled drainage procedure) resolved the intra-abdominal infection. TOC performed 10-28 days after last dose of study drug. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Microbiologically Evaluable (ME) Patients With a Clinical Response of Cure at Test-of-Cure (TOC) Visit | up to 6 weeks | ME population were subjects who were clinically evaluable and had baseline culture with at least 1 identified isolate that was susceptible to study drug and comparator. The clinical response was assigned by the investigator according to the protocol-specified guidelines. A clinical response of cure was defined as: the test article and the initial intervention (operative and/or radiologically controlled drainage procedure) resolved the intra-abdominal infection. |
| Number of Microbiologically Evaluable (ME) Patients by Microbiological Response at Test-of-Cure (TOC) Visit | up to 6 weeks | Microbiological response was assessed at patient level was the combined responses for all baseline isolates identified in intra-abdominal and blood cultures. Eradication=baseline isolate not recovered from primary infection site/blood; Presumed Eradication=No sample for culture, clinical response was cure; Persistence=baseline isolate recovered from primary infection site/blood; Presumed Persistence=No sample available for culture, clinical response was failure; Superinfection=culture from primary infection site with new isolate not identified at baseline, clinical response was failure. |
| Number of Days of Inpatient Healthcare Resource Utilization on or Before Test-of-Cure | up to 6 weeks | Healthcare resource utilization assessment included days of overall inpatient hospitalization, days of primary inpatient hospitalization, days of Intensive Care Unit (ICU) treatment and days of non-ICU inpatient hospitalization |
Countries
Australia, China, Denmark, Finland, France, Germany, Greece, Hong Kong, India, Italy, Philippines, Portugal, Saudi Arabia, South Africa, Spain, Switzerland, Taiwan, Turkey (Türkiye), United Kingdom
Participant flow
Recruitment details
Patients were recruited worldwide from November 2005 to July 2008.
Pre-assignment details
Patients were screened according to the inclusion/exclusion criteria. Once informed consent was obtained, the patient was enrolled into the study and assigned a randomization number and a treatment regimen.
Participants by arm
| Arm | Count |
|---|---|
| Tigecycline Tigecycline administered IV every 12 hours (an initial dose of 100 mg followed by 50 mg every 12 hours). | 232 |
| Ceftriaxone Ceftriaxone sodium 2 g administered IV once daily plus metronidazole 1 to 2 g daily in divided IV doses. | 235 |
| Total | 467 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Baseline Participants | Adverse Event | 1 | 0 |
| Baseline Participants | Death | 6 | 5 |
| Baseline Participants | Failure to return | 1 | 1 |
| Baseline Participants | Lost to Follow-up | 5 | 12 |
| Baseline Participants | No bacteria observed | 1 | 0 |
| Baseline Participants | Reintervention | 1 | 0 |
| Baseline Participants | Withdrawal by Subject | 7 | 1 |
| Randomization | No study drug administered | 3 | 3 |
Baseline characteristics
| Characteristic | Tigecycline | Ceftriaxone | Total |
|---|---|---|---|
| Age Continuous | 48.55 years STANDARD_DEVIATION 18.37 | 46.81 years STANDARD_DEVIATION 18.38 | 47.67 years STANDARD_DEVIATION 18.37 |
| Sex: Female, Male Female | 80 Participants | 72 Participants | 152 Participants |
| Sex: Female, Male Male | 152 Participants | 163 Participants | 315 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 173 / 232 | 155 / 235 |
| serious Total, serious adverse events | 37 / 232 | 38 / 235 |
Outcome results
Number of Clinically Evaluable (CE) Patients With Clinical Response of Cure at the Test-of-Cure (TOC) Visit
CE population were those who completed TOC assessment of cure or failure (but not indeterminate) or, in case of premature discontinuation due to lack of efficacy, had completed end of treatment assessment such that assessment of clinical response could be made. Clinical response was assigned by investigator per protocol-specified guidelines and defined as: test article and initial intervention (operative and/or radiologically controlled drainage procedure) resolved the intra-abdominal infection. TOC performed 10-28 days after last dose of study drug.
Time frame: up to 6 weeks
Population: All patients who received at least 1 dose of study drug who had clinical evidence of a complicated intra-abdominal infection (cIAI) and completed the test-of-cure (TOC) assessment of cure or failure within 8 to 44 days after the last administration of study article. Patients with an indeterminate assessment were excluded.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Tigecycline | Number of Clinically Evaluable (CE) Patients With Clinical Response of Cure at the Test-of-Cure (TOC) Visit | 162 participants |
| Ceftriaxone | Number of Clinically Evaluable (CE) Patients With Clinical Response of Cure at the Test-of-Cure (TOC) Visit | 150 participants |
Number of Days of Inpatient Healthcare Resource Utilization on or Before Test-of-Cure
Healthcare resource utilization assessment included days of overall inpatient hospitalization, days of primary inpatient hospitalization, days of Intensive Care Unit (ICU) treatment and days of non-ICU inpatient hospitalization
Time frame: up to 6 weeks
Population: All patients who received at least 1 dose of study drug.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Tigecycline | Number of Days of Inpatient Healthcare Resource Utilization on or Before Test-of-Cure | Overall inpatient hospitalization | 13.03 days | Standard Deviation 12.45 |
| Tigecycline | Number of Days of Inpatient Healthcare Resource Utilization on or Before Test-of-Cure | Primary inpatient hospitalization | 12.62 days | Standard Deviation 12.28 |
| Tigecycline | Number of Days of Inpatient Healthcare Resource Utilization on or Before Test-of-Cure | ICU treatment | 8.24 days | Standard Deviation 9.47 |
| Tigecycline | Number of Days of Inpatient Healthcare Resource Utilization on or Before Test-of-Cure | Inpatient hospitalization, non-ICU | 11.09 days | Standard Deviation 9.21 |
| Ceftriaxone | Number of Days of Inpatient Healthcare Resource Utilization on or Before Test-of-Cure | Inpatient hospitalization, non-ICU | 10.80 days | Standard Deviation 7.93 |
| Ceftriaxone | Number of Days of Inpatient Healthcare Resource Utilization on or Before Test-of-Cure | Overall inpatient hospitalization | 12.69 days | Standard Deviation 10.25 |
| Ceftriaxone | Number of Days of Inpatient Healthcare Resource Utilization on or Before Test-of-Cure | ICU treatment | 6.14 days | Standard Deviation 8.7 |
| Ceftriaxone | Number of Days of Inpatient Healthcare Resource Utilization on or Before Test-of-Cure | Primary inpatient hospitalization | 12.16 days | Standard Deviation 9.75 |
Number of Microbiologically Evaluable (ME) Patients by Microbiological Response at Test-of-Cure (TOC) Visit
Microbiological response was assessed at patient level was the combined responses for all baseline isolates identified in intra-abdominal and blood cultures. Eradication=baseline isolate not recovered from primary infection site/blood; Presumed Eradication=No sample for culture, clinical response was cure; Persistence=baseline isolate recovered from primary infection site/blood; Presumed Persistence=No sample available for culture, clinical response was failure; Superinfection=culture from primary infection site with new isolate not identified at baseline, clinical response was failure.
Time frame: up to 6 weeks
Population: All patients who received ≥1 dose, had clinical evidence of complicated intra-abdominal infection, met all inclusion/exclusion criteria, completed TOC assessment within 8-44 days after last dose, and had a baseline culture with ≥1 identified isolate that was susceptible to both study drugs. Patients with an indeterminate assessment were excluded.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Tigecycline | Number of Microbiologically Evaluable (ME) Patients by Microbiological Response at Test-of-Cure (TOC) Visit | Persistence + Presumed Persistence | 21 participants |
| Tigecycline | Number of Microbiologically Evaluable (ME) Patients by Microbiological Response at Test-of-Cure (TOC) Visit | Eradication + Presumed Eradication | 98 participants |
| Tigecycline | Number of Microbiologically Evaluable (ME) Patients by Microbiological Response at Test-of-Cure (TOC) Visit | Superinfection | 3 participants |
| Ceftriaxone | Number of Microbiologically Evaluable (ME) Patients by Microbiological Response at Test-of-Cure (TOC) Visit | Eradication + Presumed Eradication | 86 participants |
| Ceftriaxone | Number of Microbiologically Evaluable (ME) Patients by Microbiological Response at Test-of-Cure (TOC) Visit | Persistence + Presumed Persistence | 22 participants |
| Ceftriaxone | Number of Microbiologically Evaluable (ME) Patients by Microbiological Response at Test-of-Cure (TOC) Visit | Superinfection | 0 participants |
Number of Microbiologically Evaluable (ME) Patients With a Clinical Response of Cure at Test-of-Cure (TOC) Visit
ME population were subjects who were clinically evaluable and had baseline culture with at least 1 identified isolate that was susceptible to study drug and comparator. The clinical response was assigned by the investigator according to the protocol-specified guidelines. A clinical response of cure was defined as: the test article and the initial intervention (operative and/or radiologically controlled drainage procedure) resolved the intra-abdominal infection.
Time frame: up to 6 weeks
Population: All patients who received ≥1 dose, had clinical evidence of complicated intra-abdominal infection, met all inclusion/exclusion criteria, completed TOC assessment within 8-44 days after last dose, and had a baseline culture with ≥1 identified isolate that was susceptible to both study drugs. Patients with an indeterminate assessment were excluded.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Tigecycline | Number of Microbiologically Evaluable (ME) Patients With a Clinical Response of Cure at Test-of-Cure (TOC) Visit | 97 participants |
| Ceftriaxone | Number of Microbiologically Evaluable (ME) Patients With a Clinical Response of Cure at Test-of-Cure (TOC) Visit | 86 participants |