Diabetic Foot Ulcer
Conditions
Brief summary
The purpose of this study is to determine whether Garamycin Sponge (Gentamicin-Collagen sponge) in combination with antibiotics is safe and effective in treating moderate and severe diabetic foot infections.
Detailed description
Infected skin ulcers with diabetes can be very debilitating because they are difficult to heal. Diabetic ulcers are responsible for frequent health care visits, and are a major predictor of amputation. Diabetic ulcers can be caused by a patient's inability to sense pain or warmth as well as peripheral vascular disease, which causes diminished blood flow to the foot. Early aggressive treatment is necessary to treat infection and ultimately prevent the need for amputation. Gentamicin is an antibiotic that is effective in treating certain kinds of infection. Collagen is a protein that is found in all mammals. The gentamicin sponge being used in this study is commercially available in Switzerland as Garamycin® Sponge. The Garamycin Sponge is a thin flat sponge made out of collagen that comes from bovine tendons and containing gentamicin. When applied to an open ulcer, the collagen breaks down and the gentamicin is released into the ulcer, but very little is absorbed into the blood stream. The high levels of gentamicin in the open infected ulcer may help treat the infection. All subjects will be given the necessary supplies and taught how to take care their foot ulcer. All subjects will also receive oral an antibiotic. Additionally, subjects who are randomly assigned to receive the gentamicin-collagen sponge will place a gentamicin-collagen sponge on their ulcer during daily wound care.
Interventions
DRUGGaramycin Sponge (Gentamicin-Collagen sponge)
Gentamicin Collagen Sponge: 5 × 5 cm in size containing Type I bovine collagen and 50 mg of gentamicin sulfate (equivalent to 32.5 mg of gentamicin base)
DRUGSystemic Antibiotic
Antibiotics options per protocol: Levofloxacin PO 750 mg q.24h or 500 mg q.12h Levofloxacin IV 750 mg q.24h or 500 mg q.12h Amoxicillin/clavulanate PO 500/125 mg q.12h. or q.8h Amoxicillin/clavulanate IV 1000/200 mg q.12h or q.8h Clindamycin PO 300 mg or 450 mg q.6h Clindamycin IV 600 mg q.8h or q.6h Linezolid PO 600 mg q.12h Linezolid IV 600 mg q.12h Metronidazole PO 400 mg or 500 mg q.8h or 500 mg q.6h Metronidazole IV 500 mg q.8h or q.6h Aztreonam IV 1 g or 2 g q.12h or q.8h Piperacillin/tazobactam IV 3000/375 mg q.6h or 4000/500 mg q.8h
Sponsors
University Hospital, Geneva
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Is aged ≥ 18. * Has diabetes mellitus, according to the American Diabetes Association (ADA) criteria. * Has an open foot wound with visible inflammation, namely at least 1 skin ulcer located on or below the malleolus that presents with the following clinical manifestations of a moderate or severe infection based on the Infectious Disease Society of America (IDSA). * Has received appropriate surgical intervention to remove all necrotic and infected bone if diagnosed with osteomyelitis * Meets certain minimal laboratory criteria.
Exclusion criteria
* Has an ulcer infection which, based upon the patient's known history of hypersensitivity cannot be appropriately treated with at least one of the empiric systemic antibiotic regimens per protocol. * Has received \> 48 hours of potentially effective antibiotic therapy and the wounds are clinically improving. If a patient has received an antibiotic within 72 hours, but is not improving or deep-tissue culture results indicate that the infecting pathogen is not susceptible to that antibiotic, the patient may be enrolled. * Requires or is likely to require treatment with any concomitant topical product or wound therapy during the study period.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Clinical Cure | Approximately day 38 | Clinical Cure defined as the absence of any clinical, radiological or laboratory evidence of infection |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Clinical Response | up to 38 days | Clinical significant improvement is defined as significant improvement of infection but not complete cure (e.g., residual uninfected skin lesions). |
| Pathogen Eradication | up to 38 days | Microbiological eradication of former infection |
Countries
Switzerland
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Garamycin Sponge (Gentamicin-Collagen Sponge) Garamycin Sponge (Gentamicin-Collagen sponge) applied daily plus systemic antibiotic and standard ulcer care
Garamycin Sponge (Gentamicin-Collagen sponge): Gentamicin Collagen Sponge: 5 × 5 cm in size containing Type I bovine collagen and 50 mg of gentamicin sulfate (equivalent to 32.5 mg of gentamicin base) | 43 |
| Systemic Antibiotic Systemic antibiotic therapy and standard ulcer care
Systemic Antibiotic: Antibiotics options per protocol:
Levofloxacin PO 750 mg q.24h or 500 mg q.12h Levofloxacin IV 750 mg q.24h or 500 mg q.12h Amoxicillin/clavulanate PO 500/125 mg q.12h. or q.8h Amoxicillin/clavulanate IV 1000/200 mg q.12h or q.8h Clindamycin PO 300 mg or 450 mg q.6h Clindamycin IV 600 mg q.8h or q.6h Linezolid PO 600 mg q.12h Linezolid IV 600 mg q.12h Metronidazole PO 400 mg or 500 mg q.8h or 500 mg q.6h Metronidazole IV 500 mg q.8h or q.6h Aztreonam IV 1 g or 2 g q.12h or q.8h Piperacillin/tazobactam IV 3000/375 mg q.6h or 4000/500 mg q.8h | 45 |
| Total | 88 |
Baseline characteristics
| Characteristic | Systemic Antibiotic | Garamycin Sponge (Gentamicin-Collagen Sponge) | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 23 Participants | 22 Participants | 45 Participants |
| Age, Categorical Between 18 and 65 years | 22 Participants | 21 Participants | 43 Participants |
| Age, Continuous | 72 years STANDARD_DEVIATION 8 | 71 years STANDARD_DEVIATION 8 | 71 years STANDARD_DEVIATION 8 |
| Region of Enrollment Switzerland | 45 participants | 43 participants | 88 participants |
| Sex: Female, Male Female | 17 Participants | 16 Participants | 33 Participants |
| Sex: Female, Male Male | 28 Participants | 27 Participants | 55 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 43 | 0 / 45 |
| other Total, other adverse events | 0 / 43 | 0 / 45 |
| serious Total, serious adverse events | 0 / 43 | 0 / 45 |
Outcome results
Primary
Clinical Cure
Clinical Cure defined as the absence of any clinical, radiological or laboratory evidence of infection
Time frame: Approximately day 38
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Garamycin Sponge (Gentamicin-Collagen Sponge) | Clinical Cure | 38 participants |
| Systemic Antibiotic | Clinical Cure | 39 participants |
Secondary
Clinical Response
Clinical significant improvement is defined as significant improvement of infection but not complete cure (e.g., residual uninfected skin lesions).
Time frame: up to 38 days
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Garamycin Sponge (Gentamicin-Collagen Sponge) | Clinical Response | 7 participants |
| Systemic Antibiotic | Clinical Response | 13 participants |
Secondary
Pathogen Eradication
Microbiological eradication of former infection
Time frame: up to 38 days
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Garamycin Sponge (Gentamicin-Collagen Sponge) | Pathogen Eradication | 26 participants |
| Systemic Antibiotic | Pathogen Eradication | 20 participants |