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Safety and Efficacy of an Antibiotic Sponge in Diabetic Patients With a Mild Infection of a Foot Ulcer

Primary Purpose

Diabetic Foot Ulcer

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
gentamicin-collagen sponge
Levofloxacin
Sponsored by
Innocoll
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Diabetic Foot Ulcer focused on measuring Diabetic Foot Ulcer

Eligibility Criteria

18 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Is a man or woman aged 18 to 80 years.
  • Has diabetes mellitus, according to the American Diabetes Association criteria.
  • Has a single infected skin ulcer below the knee, defined as "mild" by the Infectious Disease Society of America (IDSA) Guidelines, for whom, in the Investigator's judgment, topical or oral antimicrobial therapy is appropriate (Mild infection severity: The presence of ≥ 2 manifestations of inflammation (purulence or erythema, pain, tenderness, warmth or induration) but any cellulitis/erythema extends ≤ 2 cm around the ulcer, and the infection is limited to the skin or superficial subcutaneous tissue, with no other local complications or acute, systemic illness).
  • Has had an x-ray of the infected area within the 2 days immediately preceding or at Visit 1 (Baseline/Randomization) that is negative for osteomyelitis.
  • Meets the certain minimal laboratory criteria
  • Has an ankle-brachial index (ABI) ≥ 0.7 and ≤ 1.3. (Note: Patients with ABI < 0.7 or > 1.3 may be included if they have either a transcutaneous oxygen pressure or a toe pressure ≥ 40 mm Hg on the limb with the target ulcer.)
  • If female, is nonpregnant (negative pregnancy tests at the Baseline/Randomization Visit) and nonlactating.
  • If female, is either not of childbearing potential (defined as postmenopausal for ≥ 1 year or surgically sterile [bilateral tubal ligation, bilateral oophorectomy or hysterectomy]) or practicing 1 of the following medically-acceptable methods of birth control and agrees to continue with the regimen throughout the duration of the study:

    • Oral, implantable or injectable contraceptives for 3 consecutive months before the Baseline/Randomization Visit
    • Total abstinence from sexual intercourse (≥ 1 complete menstrual cycle before the Baseline/Randomization Visit)
    • Intrauterine device (IUD)
    • Double barrier method (condoms, sponge, diaphragm or vaginal ring with spermicidal jellies or cream)
  • Willing to return to the study facility for the Final Study Visit.
  • Must be able to fluently speak and understand English and be able to provide meaningful written informed consent for the study

Exclusion Criteria:

  • Has a known history of hypersensitivity to gentamicin (or other systemic aminoglycosides) or levofloxacin or drugs in the same class, or any of the test article or reference product components.
  • Has a known hypersensitivity to bovine collagen.
  • Has any uncontrolled illnesses that, in the opinion of the Investigator, would interfere with interpreting the results of the study.
  • Has an infecting pathogen known to be intermediate or resistant in vitro to levofloxacin. Patients enrolled into the study presumptively will be discontinued if their cultured organism is intermediate or resistant to levofloxacin.
  • Has a target ulcer with a wound size > 5 × 5 cm.
  • Has gangrenous tissue of the affected limb that cannot be removed with a single debridement.
  • Has a wound associated with prosthetic material or device.
  • Received any topical or systemic antimicrobial therapy within the 2 weeks prior to study entry (Visit 1 [Day 1]).
  • Has documented osteomyelitis.
  • If severely immunocompromised, may be excluded at the discretion of the Investigator.
  • Has a history of alcohol or substance abuse in the past 12 months.
  • Is undergoing dialysis (renal or peritoneal) or has history of kidney transplant.
  • Has a history of myasthenia gravis or other neurological condition where gentamicin use is contraindicated as determined by the Investigator.
  • Has a history of epilepsy
  • Has a history of tendon disorders related to fluoroquinolone administration

Sites / Locations

  • Chesapeake Research Group LLC

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

A

B

Arm Description

Daily topical gentamicin sponge and standard daily wound care

Daily oral levofloxacin 750 mg and standard daily wound care

Outcomes

Primary Outcome Measures

Number of Participants With a Clinical Outcome of "Clinical Cure"
Number of Participants with a clinical outcome of "clinical cure" at final visit. Clinical Cure is defined as positive clinical response and with pathogen eradication.

Secondary Outcome Measures

Number of Participants With a Clinical Outcome of "Clinical Cure" in Each Treatment Group
Number of participants with a clinical outcome of "clinical cure" in each treatment group at/by each time point (except the Final Study Visit). Clinical Cure is defined as positive clinical response and with pathogen eradication.
Time to Baseline Pathogen Eradication
Number of Participants With Complete Wound Closure by Each Visit
Time to Clinical Cure
Time to Clinical Cure is measured by days to the first observed cure. Clinical Cure is defined as positive clinical response and with pathogen eradication.
Time to Pathogen Eradication
Time to Baseline Pathogen Eradication summed
Time to Positive Clinical Response

Full Information

First Posted
January 4, 2008
Last Updated
May 27, 2022
Sponsor
Innocoll
Collaborators
Premier Research Group plc
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1. Study Identification

Unique Protocol Identification Number
NCT00593567
Brief Title
Safety and Efficacy of an Antibiotic Sponge in Diabetic Patients With a Mild Infection of a Foot Ulcer
Official Title
A Study to Investigate the Safety and Efficacy of a Topical Gentamicin-Collagen Sponge Compared to Levofloxacin in Diabetic Patients With a Mild Infection of a Lower Extremity Skin Ulcer
Study Type
Interventional

2. Study Status

Record Verification Date
May 2022
Overall Recruitment Status
Completed
Study Start Date
December 2007 (undefined)
Primary Completion Date
May 2009 (Actual)
Study Completion Date
May 2009 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Innocoll
Collaborators
Premier Research Group plc

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of this study is to determine whether the gentamicin-collagen sponge when combined with standard of daily wound care is safe and effective in treating mildly infected skin ulcers compared to treatment with an oral antibiotic (levofloxacin) and standard daily wound care.
Detailed Description
Infected skin ulcers in patients 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 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-collagen sponge is a thin flat sponge made out of collagen that comes from cow 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. In this study, all subjects will be given the necessary supplies and taught how to take care of their foot ulcer. Subjects who are randomly assigned to the gentamicin-collagen sponge treatment group will place a gentamicin-collagen sponge on their ulcer during daily wound care. Subjects who are randomly assigned to the oral levofloxacin treatment group will also perform daily wound care, but they will not be given the gentamicin-collagen sponge. Instead they will be given the antibiotic, levofloxacin to take by mouth during the treatment period.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diabetic Foot Ulcer
Keywords
Diabetic Foot Ulcer

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
70 (Actual)

8. Arms, Groups, and Interventions

Arm Title
A
Arm Type
Experimental
Arm Description
Daily topical gentamicin sponge and standard daily wound care
Arm Title
B
Arm Type
Active Comparator
Arm Description
Daily oral levofloxacin 750 mg and standard daily wound care
Intervention Type
Drug
Intervention Name(s)
gentamicin-collagen sponge
Intervention Description
Inserted daily into open ulcer
Intervention Type
Drug
Intervention Name(s)
Levofloxacin
Intervention Description
750mg oral levofloxacin daily
Primary Outcome Measure Information:
Title
Number of Participants With a Clinical Outcome of "Clinical Cure"
Description
Number of Participants with a clinical outcome of "clinical cure" at final visit. Clinical Cure is defined as positive clinical response and with pathogen eradication.
Time Frame
Final Study Visit (Day 21 [or 28 or 35])
Secondary Outcome Measure Information:
Title
Number of Participants With a Clinical Outcome of "Clinical Cure" in Each Treatment Group
Description
Number of participants with a clinical outcome of "clinical cure" in each treatment group at/by each time point (except the Final Study Visit). Clinical Cure is defined as positive clinical response and with pathogen eradication.
Time Frame
Each time point (Day 3, 7 [14 and 21 if necessary])
Title
Time to Baseline Pathogen Eradication
Time Frame
assessed at each time point on days 7, 14, 21, time to pathogen eradication from baseline up to day 21 reported
Title
Number of Participants With Complete Wound Closure by Each Visit
Time Frame
At each timepoint Day 3, 7, 14 & 21
Title
Time to Clinical Cure
Description
Time to Clinical Cure is measured by days to the first observed cure. Clinical Cure is defined as positive clinical response and with pathogen eradication.
Time Frame
Actual time assessed (Day 1, 3, 7 [14 and 21 if necessary] and Day 21 [or 28 or 35])
Title
Time to Pathogen Eradication
Description
Time to Baseline Pathogen Eradication summed
Time Frame
Actual time assessed (Day 1-21
Title
Time to Positive Clinical Response
Time Frame
(Day 1, 3, 7 [14 and 21 if necessary] and Day 21 [or 28 or 35])

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Is a man or woman aged 18 to 80 years. Has diabetes mellitus, according to the American Diabetes Association criteria. Has a single infected skin ulcer below the knee, defined as "mild" by the Infectious Disease Society of America (IDSA) Guidelines, for whom, in the Investigator's judgment, topical or oral antimicrobial therapy is appropriate (Mild infection severity: The presence of ≥ 2 manifestations of inflammation (purulence or erythema, pain, tenderness, warmth or induration) but any cellulitis/erythema extends ≤ 2 cm around the ulcer, and the infection is limited to the skin or superficial subcutaneous tissue, with no other local complications or acute, systemic illness). Has had an x-ray of the infected area within the 2 days immediately preceding or at Visit 1 (Baseline/Randomization) that is negative for osteomyelitis. Meets the certain minimal laboratory criteria Has an ankle-brachial index (ABI) ≥ 0.7 and ≤ 1.3. (Note: Patients with ABI < 0.7 or > 1.3 may be included if they have either a transcutaneous oxygen pressure or a toe pressure ≥ 40 mm Hg on the limb with the target ulcer.) If female, is nonpregnant (negative pregnancy tests at the Baseline/Randomization Visit) and nonlactating. If female, is either not of childbearing potential (defined as postmenopausal for ≥ 1 year or surgically sterile [bilateral tubal ligation, bilateral oophorectomy or hysterectomy]) or practicing 1 of the following medically-acceptable methods of birth control and agrees to continue with the regimen throughout the duration of the study: Oral, implantable or injectable contraceptives for 3 consecutive months before the Baseline/Randomization Visit Total abstinence from sexual intercourse (≥ 1 complete menstrual cycle before the Baseline/Randomization Visit) Intrauterine device (IUD) Double barrier method (condoms, sponge, diaphragm or vaginal ring with spermicidal jellies or cream) Willing to return to the study facility for the Final Study Visit. Must be able to fluently speak and understand English and be able to provide meaningful written informed consent for the study Exclusion Criteria: Has a known history of hypersensitivity to gentamicin (or other systemic aminoglycosides) or levofloxacin or drugs in the same class, or any of the test article or reference product components. Has a known hypersensitivity to bovine collagen. Has any uncontrolled illnesses that, in the opinion of the Investigator, would interfere with interpreting the results of the study. Has an infecting pathogen known to be intermediate or resistant in vitro to levofloxacin. Patients enrolled into the study presumptively will be discontinued if their cultured organism is intermediate or resistant to levofloxacin. Has a target ulcer with a wound size > 5 × 5 cm. Has gangrenous tissue of the affected limb that cannot be removed with a single debridement. Has a wound associated with prosthetic material or device. Received any topical or systemic antimicrobial therapy within the 2 weeks prior to study entry (Visit 1 [Day 1]). Has documented osteomyelitis. If severely immunocompromised, may be excluded at the discretion of the Investigator. Has a history of alcohol or substance abuse in the past 12 months. Is undergoing dialysis (renal or peritoneal) or has history of kidney transplant. Has a history of myasthenia gravis or other neurological condition where gentamicin use is contraindicated as determined by the Investigator. Has a history of epilepsy Has a history of tendon disorders related to fluoroquinolone administration
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
David Prior
Organizational Affiliation
Innocoll
Official's Role
Study Director
Facility Information:
Facility Name
Chesapeake Research Group LLC
City
Pasadena
State/Province
Maryland
ZIP/Postal Code
21122
Country
United States

12. IPD Sharing Statement

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Safety and Efficacy of an Antibiotic Sponge in Diabetic Patients With a Mild Infection of a Foot Ulcer

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