Comparison of Two Antibiotic Regimens for the Treatment of Early Airways Infection With PA in Adults With Bronchiectasis

Launched by CENTRE HOSPITALIER INTERCOMMUNAL CRETEIL · Apr 11, 2024

Keywords

ClinConnect Summary

This clinical trial is studying the effectiveness of two different antibiotic treatments for adults with bronchiectasis who have recently developed a lung infection caused by a bacteria called Pseudomonas aeruginosa (PA). This infection can make patients feel worse, lead to more frequent health issues, and impact their overall quality of life. The trial aims to find out which antibiotic regimen works better in helping to clear this infection, as current treatment practices vary and more solid evidence is needed.

To participate in the trial, individuals must be at least 18 years old, have a confirmed diagnosis of bronchiectasis, and have had a recent positive test for PA. They should either have never had PA before or have been free of PA for at least a year. Participants will be closely monitored and will need to provide informed consent. Importantly, those with certain health conditions, such as cystic fibrosis, or who are pregnant or breastfeeding, are not eligible. This trial is currently recruiting, and it's a chance for eligible patients to contribute to important research that could improve treatment for bronchiectasis in the future.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • ≥18 years of age
• • Diagnosis of bronchiectasis on thoracic CT-scan
• • Recent isolation of P. aeruginosa (PA) in a respiratory sample (spontaneous or induced sputum or other lower respiratory tract sample obtained by bronchoscopy) within the last 3 months, with a PA positive respiratory sample obtained ≤ 3 weeks before randomization
• • Patient either Pseudomonas naive (i.e., never previously isolated PA) or Pseudomonas free (i.e., infection-free for ≥1 year, proven by at least two PA negative respiratory sample during the last year)
• • Patient affiliated with the French health care system
• • Able to understand and sign a written informed consent form
• Exclusion Criteria:
• • Confirmed diagnosis of cystic fibrosis
• • Pregnancy or breastfeeding
• • Women of childbearing potential (after the first menstrual period and until menopause or permanent sterility (hysterectomy, bilateral salpingectomy and bilateral oophorectomy)) who refuse to use effective contraception (hormonal or mechanical) for 3 months and/or to undergo pregnancy tests at baseline, 1 month and 3 months after baseline.
• • Isolation of PA in a respiratory specimen (spontaneous or induced sputum or other lower respiratory tract specimen obtained by bronchoscopy) more than 3 months to 12 months prior to randomization.
• • PA resistant to ciprofloxacin or ceftazidime
• • Severe exacerbation requiring admission to an intensive care unit (e.g. for non-invasive ventilatory support, invasive mechanical ventilation, catecholamine or any other organ supportive therapy)
• • Prior severe reaction, hypersensitivity reaction or other contraindication to any of the treatments in study (ciprofloxacin, beta-lactam, colistimethate sodium)
• • Prior severe bronchospasm attributed to a nebulization
• • Patients already receiving PA suppressive therapy with an inhaled antibiotic (long-term azithromycin therapy accepted)
• • Prior PA-eradication antibiotic treatment (systemic antibiotic(s) active against PA for ≥ 14 days or nebulized anti-PA antibiotic) within the last year
• • Antibiotic treatment active against PA (anti-PA beta-lactam antibiotic and/or FQ and/or aminoglycoside) for more than 3 days before randomisation
• • Active cancer or haematological malignancy under active therapy
• • Systemic corticosteroid therapy ≥ 20 mg/d. prednisone equivalent for a predictable duration \> 4 weeks
• • Non-tuberculous mycobacterial infection or positive non-tuberculous mycobacterial respiratory specimen within 1 year prior to inclusion
• • Severe chronic renal failure defined by a creatinine clearance (Cockcroft or MDRD) ≤ 30 mL/min/1.73m2 or chronic haemodialysis
• • Severe hepatic impairment
• • Long-term oxygen therapy and/or noninvasive mechanical ventilation for chronic respiratory insufficiency (except continuous positive airway pressure for OSA) and/or forced expiratory volume at one second (FEV1) \<25% of predicted value.
• • Patient participating to another interventional clinical trial