Ketoconazole Gel Versus Terconazole Cream for Vaginal Candidiasis
Primary Purpose
Vaginal Candidiasis
Status
Unknown status
Phase
Phase 3
Locations
Study Type
Interventional
Intervention
Ketoconazole
Terconazole
Sponsored by
About this trial
This is an interventional treatment trial for Vaginal Candidiasis
Eligibility Criteria
Inclusion Criteria:
- The selected patients had - vaginal candidiasis ,diagnosed by history of pruritus in addition to the characteristic discharge of vaginal candidiasis by vaginal examination
Exclusion Criteria:
- Women on other line of treatment as antimicrobial treatment either topical or systemic drugs within one month prior to the first clinical examination
- Known hypersensitivity for ketoconazole
Sites / Locations
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Active Comparator
Arm Label
Ketoconazole gel
terconazole cream
Arm Description
use of Ketoconazole in situ gel for treatment of vaginal candidiasis
use of terconazole 0.8 cream for treatment of vaginal candidiasis
Outcomes
Primary Outcome Measures
measure effect of ketoconazole gel in treatment of vaginal candidiasis
efficacy of ketoconazole gel by taking a vaginal swab for microbiological examination before treatment and another swab one week after treatment
improvement of patient complaint
improvement of vaginal symptoms and discharge
Secondary Outcome Measures
rate of relapse
recurrence of symptoms and discharge (patient complaint )
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT03473418
Brief Title
Ketoconazole Gel Versus Terconazole Cream for Vaginal Candidiasis
Official Title
Ketoconazole In Situ Gel Versus Terconazole Cream for Treatment of Vaginal Candidiasis
Study Type
Interventional
2. Study Status
Record Verification Date
March 2018
Overall Recruitment Status
Unknown status
Study Start Date
April 1, 2018 (Anticipated)
Primary Completion Date
October 1, 2018 (Anticipated)
Study Completion Date
April 1, 2019 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Assiut University
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No
5. Study Description
Brief Summary
Vaginal Candidiasis is an infection caused by a yeast normally lives inside the body . Sometimes Candida can multiply and cause an infection if the environment inside the vagina changes in a way that encourages its growth. Candidiasis in the vagina is commonly called a "vaginal yeast infection." Risk factor use of intra uterine devices , pregnancy ,use hormonal contraceptives ,have diabetes , immune compromised taken antibiotics Diagnosis cause itching or soreness Pain during sexual intercourse Pain or discomfort when urinating and abnormal vaginal discharge Although most vaginal candidiasis is mild, some women can develop severe infections involving redness, swelling, and cracks in the wall of the vagina
Detailed Description
terconazole- Terconazole, an azole antifungal agent, inhibits fungal cytochrome P-450-mediated 14 alpha-lanosterol demethylase enzyme. This enzyme functions to convert lanosterol to ergosterol. The accumulation of 14 alpha-methyl sterols correlates with the subsequent loss of ergosterol in the fungal cell wall and may be responsible for the antifungal activity of Terconazole. Mammalian cell demethylation is less sensitive to Terconazole inhibition Terconazole exhibits antifungal activity in vitro against Candida albicans and other Candida species. The MIC (maximum insufflation capacity values of Terconazole against most Lactobacillus spp. typically found in the human vagina were ≥128 mcg/mL; therefore these beneficial bacteria are not affected by drug treatment.
Terconazole Vaginal cream, 80 mg are indicated for the local treatment of vulvovaginal candidiasis (moniliasis). As this product is effective only for vulvovaginitis caused by the genus Ketoconazole is a broad- spectrum antimycotic agent that can be used orally or topically in the treatment vulvovaginal candidiasis and other fungal infections Candida is the second most common cause of vaginal infections. Candida albicans is responsible for 80 to 92% of episodes of vulvovaginal candidiasis . The rest are due to non-albicans Candida species, the most common of which are C. glabrata and C. tropicalis. Sporadic attacks of vulvovaginal candidiasis usually occur without an identifiable precipitating factor. The risk of vulvovaginal candidiasis may be higher in women with uncontrolled diabetes, who use oral contraceptives containing high levels of estrogen or taking antibiotics.
In situ gelling systems refer to polymer solutions which can be administered as liquid, and undergo a phase transition to semisolid gel upon exposure to physiological environments. Stimuli- sensitive hydrogels are those hydrogels, which undergo reversible volume phase - transition or sol - gel phase transition in response to external physical stimuli such as (temperature) or chemical stimuli as (ions).The most commonly used thermoreversible gels are those prepared from the pluronic block copolymers . The principle advantage of in situ forming gels is the possibility of administering accurate and reproducible quantities, in contrast to already gelled formulation . Several in situ gel forming systems have been developed to prolong the residence time of a drug and improve the bioavailability and control the drug release by changing the gel structure in response to environmental stimuli . These systems provide simplicity and safety in in vivo situations . They are handled in the liquid state before their delivery, which is likely to facilitate their use and to increase the surface of contact with the mucous membrane. The flow properties of semi-solid vaginal dosage forms might be of use to predict the spreading and coating of the formulations over the vaginal epithelia . When the preparation is given as liquid, this will give better spreading and coating of vaginal surfaces than the gelled preparations, which have not the ability to cover all the surfaces and cannot reach to epithelial folds of the vagina. So, this study aimed to formulate ketoconazole in a new vaginal mucoadhesive form "In situ gel" and it is designed to achieve the following objectives:
Formulation and evaluation of in situ-forming vaginal gels of ketoconazole.
Clinical assessment of the prepared vaginal ketoconazole in situ gels on women suffering from vaginal candidiasis.
Materials and Methods:
Preparation of ketoconazole vaginal in situ gel Different concentrations of pluronic F-127 will be used in the preparation of the in situ forming gels. Medicated in situ forming gels will be prepared on a weight basis using The Modified Cold Method .Vaginal preparations will be prepared in citro-phosphate buffer pH (power of hydrogen) 4.5.
Characterization of ketoconazole vaginal in situ gel
Gelation temperature (Tgel) measurement Ten milliliters of cold pluronic solution and a magnetic bar will be put into a beaker (25 ml) that will be placed in a low temperature water bath at room temperature. A thermometer will be immersed in the sample solution. The solution will be heated at constant rate with continuous stirring at a rate of 200 rpm. The temperature at which the magnetic bar stopped to move due to gelation will be reported as the gelation temperature (Tgel) (11).
Rheological studies The viscosity of each formula will be determined using a Brookfield DV (diluted volume )-III Ultra viscometer (RV model). The spindles used will be 60 for liquids and 95 for gels. Measurements will be carried out at spindle speed of 15 rpm. Viscosity will be measured at different temperatures 4ºC (celsius degree ), 25ºC, and 37ºC.
In vitro release of Ketoconazole from in situ gelling formulations In vitro release from in situ gelling formulae will be studied using a standard semi-permeable cellophane membrane. The membrane will be soaked in the release medium (simulated vaginal fluid 'SVF') overnight prior to its use. One gram solution of formulations will be weighed over the membrane in the dialytic tube. The prepared tube will be suspended in 100 ml freshly prepared SVF (simulated vaginal fluid ). The system will be placed into a constant temperature shaker water bath previously adjusted to 37 + 0.2 ºC and 50 rpm. Aliquots (1 ml) will be withdrawn from the release medium at each sampling time for up to 2 hours and the amount of the drug released will be calculated.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Vaginal Candidiasis
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
69 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
Ketoconazole gel
Arm Type
Experimental
Arm Description
use of Ketoconazole in situ gel for treatment of vaginal candidiasis
Arm Title
terconazole cream
Arm Type
Active Comparator
Arm Description
use of terconazole 0.8 cream for treatment of vaginal candidiasis
Intervention Type
Drug
Intervention Name(s)
Ketoconazole
Intervention Description
Ketoconazole as a topical vaginal gel
Intervention Type
Drug
Intervention Name(s)
Terconazole
Intervention Description
Terconazole 80 mg as a topical vaginal cream
Primary Outcome Measure Information:
Title
measure effect of ketoconazole gel in treatment of vaginal candidiasis
Description
efficacy of ketoconazole gel by taking a vaginal swab for microbiological examination before treatment and another swab one week after treatment
Time Frame
ketoconazole used once daily for 3 days
Title
improvement of patient complaint
Description
improvement of vaginal symptoms and discharge
Time Frame
one week
Secondary Outcome Measure Information:
Title
rate of relapse
Description
recurrence of symptoms and discharge (patient complaint )
Time Frame
2 weeks
10. Eligibility
Sex
Female
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria:
The selected patients had - vaginal candidiasis ,diagnosed by history of pruritus in addition to the characteristic discharge of vaginal candidiasis by vaginal examination
Exclusion Criteria:
Women on other line of treatment as antimicrobial treatment either topical or systemic drugs within one month prior to the first clinical examination
Known hypersensitivity for ketoconazole
12. IPD Sharing Statement
Plan to Share IPD
Undecided
Citations:
PubMed Identifier
10824446
Citation
Garcia Figueroa RG, Sauceda L, Ramirez Palacios D, Cruz Talonia F, Romero Cabello R. [Effectiveness and safety of ciclopirox olamine 1% vaginal cream versus terconazole 0.8% vaginal cream in the treatment of genital candidiasis]. Ginecol Obstet Mex. 2000 Apr;68:154-9. Spanish.
Results Reference
background
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Ketoconazole Gel Versus Terconazole Cream for Vaginal Candidiasis
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