E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Complex appendicitis. |
Complexe appendicitis |
|
E.1.1.1 | Medical condition in easily understood language |
Complicated inflammation of the appendix. |
Gecompliceerde blindedarmontsteking. |
|
E.1.1.2 | Therapeutic area | Diseases [C] - Digestive System Diseases [C06] |
MedDRA Classification |
E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
The goal of this study is to evaluate efficacy and safety of stopping postoperative antibiotic treatment after 48 hours of intravenous therapy versus continuing for three more days (to complete a total of five days which is common practice), following appendectomy in patients suffering from complex appendicitis. |
Het doel van de studie is om de effectiviteit en veiligheid te evalueren van een kortdurend postoperatief antibioticaschema (48u) ten opzichte van het huidige standaard schema (5 dagen) na appendectomie voor complexe appendicitis |
|
E.2.2 | Secondary objectives of the trial |
Secondary objectives are to compare between both trial arms : - intra-abdominal abscess rate - superficial and/or deep surgical site infections rate - overall postoperative complication rate & severity - duration of postoperative antibiotic treatment - re-start of antibiotics - adverse events on antibiotics - hospital stay in hours from the operation - time to reach discharge criteria in hours from the operation - postoperative imaging for suspected complication - emergency room visits and readmission rate - cost-effectiveness All within 90 days after appendectomy. |
Secundaire eindpunten zijn om te vergelijken tussen beide studie-armen: - intra-abdominale abcessen - oppervlakkige en diepe wondinfectie - postoperatieve complicaties en ernst - duur van postoperatieve antibioticabehandeling - herstart van antibiotica - bijwerkingen van antibiotica - opnameduur (in uren vanaf operatie) - tijd tot bereiken ontslagcriteria (in uren vanaf operatie) - postoperatieve beeldvorming voor verdenking op complicaties - bezoeken aan de eerste hulp en heropnames - kosten-effectiviteit Allen binnen 90 dagen na appendectomie. |
|
E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
- age minimum 8 years old (no upper limit) - patients with suspected acute appendicitis, awaiting appendectomy - written informed consent - intraoperative diagnosis of a complex appendicitis |
- leeftijd ouder dan 8 jaar - patienten met verdenking op acute appendicitis, in afwachting van appendectomie - geschreven informed consent - intraoperatieve diagnose complexe appendicitis |
|
E.4 | Principal exclusion criteria |
- appendectomy à froid - not able to give informed consent - severe sepsis, defined as sepsis-induced tissue hypoperfusion or organ dysfunction - conservative treatment of acute appendicitis - ASA score IV or not able to undergo surgery - known allergy or any other contraindication for the use of the study medication - immunocompromised patients - pregnancy - use of other antibiotics for other reason than mentioned in above. - simple acute appendicitis - intraoperative appendicular infiltration not amendable for appendectomy - inadequate source control during operation. |
- appendectomie a froid - niet in staat informed consent te geven - ernstige sepsis - conservatieve behandeling appendicitis - ASA score IV of niet in staat operatie te ondergaan - bekende allergie of enige andere contraindicatie voor de studiemedicatie - immuungecompromiteerde patienten - gebruik van andere antibiotica - intraoperatieve diagnose simpele appendicitis - intraoperatief een appendiculair infiltraat niet geschikt voor appendectomie - inadequate source control tijdens operatie |
|
E.5 End points |
E.5.1 | Primary end point(s) |
Primary endpoint is a composite endpoint of mortality and postoperative infectious complications related to complex appendicitis, including intra-abdominal abscess and both deep and superficial surgical site infections within 90 days. A detailed definition of intra-abdominal abscess (IAA) and surgical site infection (SSI) according to the Center for Disease Control (CDC) criteria is given in chapter 8 of the studyprotocol. |
De primaire uitkomstmaat is een samengesteld eindpunt van mortaliteit, intra-abdominale abcessen en diepe- en oppervlakkige wondinfecties binnen 90 dagen. Een gedetailleerde definitie van het primaire eindpunt vindt u in het studieprotocol in hoofdstuk 8 Methods, op pagina 29. |
|
E.5.1.1 | Timepoint(s) of evaluation of this end point |
Follow-up until 90 days after appendectomy. |
Follow-up t/m 90 dagen na appendectomie. |
|
E.5.2 | Secondary end point(s) |
Secundary outcomes are amongst others: intra-abdominal abscess, superficial and/or deep surgical site infections, restart of antibiotics, hospital stay in hours, readmission rate and cost-effectiveness.
Study variables are: age at time of diagnosis, location of operation, medical history (including diabetes mellitus, corticosteroid use), ASA score, gender, BMI, body temperature and laboratory results at time of presentation (CRP, WBC, eGFR), diagnostic radiological imaging, duration and severity of abdominal pain (VAS scale), antibiotic use prior to clinical diagnosis of acute appendicitis (type and dosage), prophylactic antibiotic use (type and dosage), laparoscopic or open appendectomy, duration of operation (skin-to-skin time), type of appendicitis (phlegmonous, gangrenous or perforated, with or without abscess), degree of peritonitis, level of expertise of surgeon, peritoneal irrigation and/or suction, wound management, use of (endo)loops or (endo)stapler, intraperitoneal drain placement, cultures of intra-abdominal fluid collections, histological type of appendicitis, (time to reach) discharge criteria, postoperative imaging for suspected complications, intra-abdominal abscess (IAA), deep and/or superficial surgical site infection (SSI), treatment of IAAs and SSIs, any other postoperative complication including severity, duration and doses of antibiotics received, restart of antibiotics and type, adverse events on antibiotics, type and resistance profile of cultured micro-organisms postoperatively, length of hospital stay, post-operative outpatient visit, readmission, re-interventions for complications (all within 90 days after appendectomy). |
Secundaire uitkomstmaten zijn o.a.: intra-abdominale abccessen (IAA), wondinfecties (SSI), duur van opname, herstart van antibiotica, heropname en kosteneffectiviteit.
Studievariabelen zijn: leeftijd ten tijde van diagnose, locatie van operatie, voorgeschiedenis patient (incl. diabetes mellitus, corticosteroidengebruik), ASA score, geslacht, body mass index (BMI), lichaamstemperatuur en bloedwaarden ten tijde van presentatie presentation (C-reactive protein (CRP), leukocyten), preoperatieve echografie of andere beeldvormende technieken, duur en ernst van buikpijn (VAS score of analgetische behoefte), gebruik van profylactische antibiotica peroperatief (type and dosering), laparoscopische or open appendectomie, operatieduur (snijtijd), perioperatieve ernst/type van appendicitis, level van expertise chirurg (arts-assistent in opleiding, specialist, type specialisatie), gebruik van (endo)loops of (endo)stapler, kweken, histologisch type appendicitis, ontslagcriteria, postoperatieve beeldvorming voor verdenking op complicaties, alle complicaties (volgens Clavien-Dindo classificatie), intra-abdominale abcessen (IAA), diepe en/of oppervlakkige wondinfecties (SSI), behandeling van IAA en/of SSI, totale opnameduur, postoperatieve poliklinische bezoek(en), heropnames, reinterventies (allen binnen 90 dagen na appendectomie). |
|
E.5.2.1 | Timepoint(s) of evaluation of this end point |
Also follow-up until 90 days after appendectomy. |
Tevens follow-up t/m 90 dagen na appendectomie. |
|
E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | Yes |
E.6.13.1 | Other scope of the trial description |
Duration of therapy. |
Duur van therapie. |
|
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | Yes |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | Yes |
E.8.2.3.1 | Comparator description |
Interventie: staken antibiotica na 48 uur, comparator: antibiotica 3 dagen voortzetten (5dgn totaal) |
Intervention: discontinuing antibiotics after 48hrs. Comparator: continuing 3 more days (5dys total) |
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E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 14 |
E.8.5 | The trial involves multiple Member States | No |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
|
The end of the trial is a) when the targeted number of 1066 patients has been reached; or b) if one of the stopping rules is reached as defined in the studyprotocol and DSMB Charter. |
Het einde van de studie is wanneer: a) het beoogde aantal van 1066 patienten inclusies is bereikt; of b) wanneer een van de stopregels bereikt is, zoals beschreven in het studieprotocol en het DSMB Charter. |
|
E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 3 |
E.8.9.1 | In the Member State concerned months | 9 |
E.8.9.1 | In the Member State concerned days | |