Imipenem and Tigecycline Versus Imipenem and Tigecycline With GM-CSF for the Management of Spontaneous Bacterial Peritonitis Presenting With Septic Shock.
试验速览
- 阶段
- 不适用
- 入组人数
- 90
- 试验地点
- 1
- 主要终点
- Resolution of Spontaneous Bacterial peritonitis in both groups
研究概览
简要总结
Study population: A total of 90 consecutive patients of decompensated cirrhosis of any etiology, presenting to the Institute of Liver and Biliary Sciences with SBP with septic shock will be included.
Study design: Randomized controlled trial Study period: August 2019 to December 2021. Sample size: Assuming that the response rate is 90% with GM-CSF and 60% without GM-CSF after day 5. With alpha 5 and power 80,we need to enroll 76 cases (38 cases with each). Further assuming 20 % drop-out due to various reasons, it was decided to enroll 90 cases randomly allocated into two groups (i.e., 45 in each) by block randomization method by taking block size as 6. So for the present study, it was decided to enroll 90 cases in all.
Group A will be given Imipenem and Tigecycline. Patients with recent hospitalisation will be given Colistin in addition.
Group B will be given: To another group we will give Imipenem and Tigecycline and GMCSF.Patients with recent hospitalisation will be given Colistin in addition.
The dose of antibiotic will be given at dosage Inj Imipenem 1gm i.v. TDS Inj Tigecycline 100mg stat f/b 50mg i.v. OD Inj GM-CSF 500mcg s.c. OD Inj Colistin 9 MIU i.v. stat f/b 4.5 MIU i.v. BD Monitoring and assessment At the baseline, all patients will undergo investigational evaluation as described
Daily monitoring of following parameters:
- Haemoglobin,
- Total peripheral leucocyte counts,
- Platelet counts,
- Renal function tests
- Liver function tests and
- Chest X rays will be undertaken
- Ascitic fluid analysis will be done on day 0, day 2 and day 5
Stopping rule:If the patient develops a TLC of more than 50,000, the dose of the GM CSF will be reduced to half and the treatment continued. If, even after the reduction, the TLC rises to more than 50,000, then the treatment will be stopped and the patient excluded.
Expected outcome of the project: Addition of GM-CSF to standard antibiotic regimen helps resolve SBP and improves outcome in decompensated liver cirrhotic patients.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Double (Participant, Investigator)
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Spontaneous Bacterial Peritonitis (SBP) with shock in a cirrhotic
- •Hospital acquired SBP with shock
- •Difficult to treat SBP
排除标准
- •Refractory Shock
- •Cardiac comorbidities (known Coronary Artery Disease)
- •Chronic Kidney Disease on Maintenance Hemodialysis
- •< 18 years.
- •Advanced Hepatocellular Carcinoma
- •Post liver transplant
- •HIV + ve, Immunosuppressive therapy
研究组 & 干预措施
Imipenem+Tigecycline+GM-CSF
干预措施: Imipenem (Drug)
Imipenem+Tigecycline+GM-CSF
干预措施: Tigecycline (Drug)
Imipenem+Tigecycline+GM-CSF
干预措施: GMCSF (Drug)
Imipenem+Tigecycline+GM-CSF
干预措施: Colistin (Drug)
Imipenem+Tigecycline
干预措施: Imipenem (Drug)
Imipenem+Tigecycline
干预措施: Tigecycline (Drug)
Imipenem+Tigecycline
干预措施: Colistin (Drug)
结局指标
主要结局
Resolution of Spontaneous Bacterial peritonitis in both groups
时间窗: Day 5
Response is defined by resolution of SBP in terms of total counts \< 500,Neutrophil\<250
次要结局
- Survival in both groups(Day 28)
- Development of Hepatic Encephalopathy in both groups.(Day 28)
- Development of organ failures in both groups.(Day 28)
- Reversal of shock in both groups(Day 2)
- Change in ascitic fluid metabolites Nitric Oxide in both groups(Day 28)
- Change in ascitic fluid macrophage population in both groups(Day 28)
- Development of Pneumonia in both groups.(Day 28)
- Development of Acute Kidney Injury in both groups(Day 28)
- Resolution of Spontaneous Bacterial peritonitis in both groups(Day 2)
- Development of coagulopathy in both groups.(Day 28)