Syphilis FemalePhase 1/2NCT03752112
Trial Evaluating the Clinical Efficacy of Cefixime for Treatment of Early Syphilis in Non-pregnant Women
A Phase 1/2 study testing Cefixime and Benzathine penicillin 2.4 million units in people with Syphilis Female, run by World Health Organization at 1 site in Brazil.
Trial summary
Hypotheses The antibiotic, Cefixime, for use in non-pregnant women with early syphilis will be efficacious and safe. Primary Objective The primary objective of the study is to demonstrate the efficacy, as measured by a 4 fold decrease in Rapid Plasma Reagin (RPR) titer from baseline to 6 months after treatment, with… Read more about this study
- Who is it for?
- Ages 18 years and older, women only
- Conditions the study is for
- Syphilis Female
- What is being tested?
- Cefixime and Benzathine penicillin 2.4 million units
- Type of treatment
- Pill or oral medicine
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 180 participants
- Where
- 1 siteBrazil
- Study dates
- 22 Nov 2019to 30 Sep 2021
- Phase
- Phase 1/2
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- Women only
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Female, 18 years of age or older
- Non-pregnant
- Able to provide informed consent
- Test positive for syphilis with a positive TPPA AND an RPR titer equal to or greater than 1:8
- Non-cephalosporin allergic
- Non-penicillin allergic
Show all 11Show fewer
- Agree to be called once a day by study staff to be reminded to take study drug
- Able to swallow pills
- Willing to attend follow-up visits at 3, 6, and 9 months after completion of the study treatment
- Willing to take oral contraceptive or use condom to prevent pregnancy during the study period
- HIV negative
Who cannot join
- 1) Female under 18 years of age 2) HIV positive 3) Pregnancy test positive or clinical pregnancy 4) Prior history of syphilis or syphilis treatment within 6 months of study screening 5) Allergy to penicillin or cephalosporins (including allergy to cefixime) 6) In the judgment of the interviewer, has a medical condition or other factor that might affect their ability to follow the protocol 7) Previous enrollment in the study 8) Presenting a condition that would not allow reliable informed consent (alcohol abuse or substance misuse) 9) Lacking mental capacity to give informed consent to participation
- -
Trial locations and contacts
1 site in 1 country.
Brazil1 site, 1 recruiting
- Recruiting
Fortaleza University
Fortaleza, Ceará
Alix Araujo, PhD, alix.araujo@hotmail.com
Ivo Castell Branco Coelho, MD, ivo@ufc.br
About this study
Hypotheses The antibiotic, Cefixime, for use in non-pregnant women with early syphilis will be efficacious and safe.
Primary Objective The primary objective of the study is to demonstrate the efficacy, as measured by a 4 fold decrease in Rapid Plasma Reagin (RPR) titer from baseline to 6 months after treatment, with Cefixime 400mg taken orally two times a day for 10 consecutive days.
Secondary Objective The secondary objective of the study is to determine the safety, as measured by the number of grade 3 or greater toxicities experienced, using the NIH/NCI toxicity score, during or after treatment with Cefixime 400mg taken orally two times a day for 10 consecutive days.
Read the detailed description
Hypotheses The antibiotic, Cefixime, for use in non-pregnant women with early syphilis will be efficacious and safe.
Primary Objective The primary objective of the study is to demonstrate the efficacy, as measured by a 4 fold decrease in Rapid Plasma Reagin (RPR) titer from baseline to 6 months after treatment, with Cefixime 400mg taken orally two times a day for 10 consecutive days.
Secondary Objective The secondary objective of the study is to determine the safety, as measured by the number of grade 3 or greater toxicities experienced, using the NIH/NCI toxicity score (10), during or after treatment with Cefixime 400mg taken orally two times a day for 10 consecutive days.
Methods Study design This is a randomized, non-comparative, open-label study assessing the efficacy and safety of cefixime 400mg taken orally two times a day for 10 consecutive days in non-pregnant women with early syphilis infection.
Study population and enrolment sites Numerous regions of Brazil have experienced increases in syphilis diagnoses during the previous 5 years The study sites were chosen from three cities in three separate regions (states) of Brazil based on: (1) increases in syphilis case reports, (2) access to clinics where patients are screened and treated for syphilis; (3) willingness of clinic sites and staff to participate in this research, and (4) the availability of experienced researchers with experience in studying syphilis to serve as co-investigators.
The study population will include non-pregnant women (ages 18 and over) diagnosed with early syphilis (RPR titers >1:8) recruited from 7 clinics in three cities from three states in Brazil. These include: (1) Three clinics in the city of Fortaleza (Ceara State), coordinated by the University of Fortaleza (UNIFOR): (a) Carlos Ribeiro, (a) Meireles, and (c) Federal University. Syphilis epidemiology for each site in Annex 1. (2) Two University ObGyn Clinics in the city of Pelotas (state of Rio Grande do Sul) (5-6 cases of syphilis/week) a) Ambulatorio de Ginecologia e Obstetrícia - Faculdade de Medicina - Universidade Federal de Pelotas and b) Ambulatorio de Ginecologia e Obstetrícia - Campus da Saúde - Universidade Católica de Pelotas; and (3) Two clinics in Vitoria (State of Espirito Santo): (1) Reference Center for Sexually Transmitted Diseases (http://www.vitoria.es.gov.br/cidadao/centro-de-referencia-em-infeccoes-sexualmente-transmissiveis). (2) Hospital Universitário Cassiano Antonio Moraes - UFES.
Patients identified during standard of care testing with a positive rapid syphilis test and an RPR titer of greater than or equal to 1:8 will be referred to the study and offered enrollment according to the following description.
Non-study clinic-site staff will perform the first screening rapid finger-stick test for syphilis. The rapid syphilis test currently used in these clinics detects both new (acute) infection and old treated infection but does not distinguish between the two. Patients that are positive for the syphilis rapid finger-stick test will be notified by non-study staff of this result and the need for additional testing using the RPR test according to standard of care. Blood will be collected for the confirmatory RPR test by non-study staff. These patients will be notified of RPR results in approximately 3 days to 1 week. The results a confirmed syphilis diagnosis and of the RPR test results for those patients that are eligible for enrolment in the study (RPR >1:8) will be provided by a study nurse. The study will be explained to eligible participants (RPR titer of >1:8) by this study nurse, and if women express interest in participating, informed consent will be obtained. It is expected that an enrolment visit could last approximately 1.5 hours.
Patients that are not eligible for the study (negative RPR or RPR with titer <1:8) will receive syphilis RPR results from non-study staff.
Pregnancy tests will be completed on all potential participants and those that test positive will not be enrolled in the study.
The timing of the recruitment process will depend on the number of women diagnosed with syphilis and who have an RPR titer >1:8 and who consent to participate in the study. It is anticipated that enrollment will take approximately 1 year to complete.
To benchmark the performance of benzathine penicillin in the study population being used for cefixime, The investigators will include a contemporary arm of participants that will receive standard of care treatment with benzathine penicillin according to the Brazil national sexually transmitted infection (STI) treatment guidelines. The investigators will use a ratio of 2 patients receiving cefixime to 1 patient receiving benzathine penicillin.
This non-comparator arm of benzathine penicillin will be included to account for study population differences in terms of stage of disease, history of prior infection, experience of re-infection, experience of serofast state, or other co-factors that could impact serological response. An estimate of performance of this standard of care will be calculated, but this will not be compared directly to the study intervention.
The investigators will enrol 180 eligible women into the study: 120 for the cefixime arm and 60 for the benzathine penicillin arm. It is anticipated that enrollment will take approximately 1 year to complete. Patients will be participating in the study for approximately 9 months. The study is expected to last for approximately two years. Women that are referred to the study but decline enrolment will be treated at the clinic following national STI treatment guidelines for syphilis.
- Conditions
- Syphilis Female
- Being tested
- Cefixime, Benzathine penicillin 2.4 million units
- Keywords
- Syphilis, Women, Cefixime, Brazil, Sexually Transmitted Infection, STI
- Medical subject headings
- Syphilis, Sexually Transmitted Diseases
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
CefiximeDrug
Also called Intervention
Cefixime 400mg taken orally two times a day for 10 consecutive days in non-pregnant women with early syphilis infection
Benzathine penicillin 2.4 million unitsDrug
Also called Standard treatment
Benzathine penicillin 2.4 million units: The investigators will include a contemporary arm of participants that will receive standard of care treatment with Benzathine penicillin 2.4 million units according to the Brazil national STI treatment guidelines. The investigators will use a ratio of 2 patients receiving cefixime to 1 patient receiving benzathine penicillin.This non-comparator arm of benzathine penicillin will be included to account for study population differences in terms of stage of disease, history of prior infection, experience of re-infection, experience of serofast state, or other co-factors that could impact serological response
| Study group | Role | What they receive |
|---|---|---|
| Cefixime | Experimental | cefixime 400mg taken orally two times a day for 10 consecutive days in non-pregnant women with early syphilis infection. Receives: Drug: Cefixime |
| Benzathine penicillin | Other | To benchmark the performance of benzathine penicillin in the study population being used for cefixime, the investigators will include a contemporary arm of participants that will receive standard of care treatment with benzathine penicillin according to the Brazil national STI treatment guidelines. The investigators will use a ratio of 2 patients receiving cefixime to 1 patient receiving benzathine penicillin. Receives: Drug: Benzathine penicillin 2.4 million units |
What is being measured
The primary outcome is the main question the study is designed to answer.
Quantitative RPR titer change
RPR titer response at 6 months
Measured: 6 months following last dose of Cefixime 400 mg
Secondary outcomes (2)
Number of participants with treatment-related adverse events as assessed by CTCAE with cefixime
Number of participants with treatment-related adverse events as assessed by CTCAE. Information on side effects will be collected daily for 10 days of administration of cefixime using a pre-established list of most commonly reported side effects and a grade scale will be applied using the Common Terminology Criteria for Adverse Events.
Measured: Daily after the first dose of cefixime 400mg orally through 10 days after the first dose
The number of participants reporting tolerability of cefixime
Tolerability: The number of participants reporting tolerability of cefixime as measured by quantitative reported experience of common side effects and qualitative experience of tolerance of the regimen as collected through daily questionnaires and an end treatment questionnaire at 14 days after the first dose of cefixime.
Measured: Daily after the first dose of cefixime 400mg orally through 10 days after the first dose and qualitative overall assessment of tolerability measured via questionnaire 14 days after the first dose of cefixime
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted23 Nov 2018
- Study start22 Nov 2019
- Primary completion30 Mar 2021 (estimated)
- Study completion30 Sep 2021 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (14)Papers the sponsor has linked to this study.
- Other trials for Syphilis FemaleStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 1/2
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- This is a Phase 1/2 trial to evaluate the efficacy and safety of cefixime for use in treating women with acute syphilis. This is a randomized, non-comparative, open label study assessing the efficacy and safety of cefixime 400mg taken orally two times a day for 10 consecutive days in non-pregnant women with early syphilis infection.To benchmark the performance of benzathine penicillin in the study population being used for cefixime, The investigators will include a contemporary arm of participants that will receive standard of care treatment with benzathine penicillin according to the Brazil national STI treatment guidelines. The investigators will use a ratio of 2 patients receiving cefixime to 1 patient receiving benzathine penicillin.
- Masking
- None (open label)
- Enrolment
- 180 participants (estimated)
Sponsor and investigators
- Lead sponsor
- World Health Organization
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Melanie Taylor, World Health Organization
- Investigators
- Melanie M Taylor, MD, Principal investigator, World Health OrganizationNathalie JN Broutet, MD, Study director, World Health OrganizationEdna O Kara, MD, Study chair, World Health Organization
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT03752112
- Sponsor's protocol ID
- ERC0003096
- Status last verified
- Jan 2020
- First submitted
- 20 Nov 2018
- Last updated
- 5 Feb 2020
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: Beginning 9 months and ending 24 months following article publication, the supporting information that will be shared for IPD are all data that underlie the results in the publication.
Publications
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015 Jun 5;64(RR-03):1-137.
PubMed 26042815WHO. WHO guidelines for the treatment of Treponema pallidum (syphilis). http://wwwwhoint/reproductivehealth/publications/rtis/syphilis-treatment-guidelines/en/. 2016.
Liang Z, Chen YP, Yang CS, Guo W, Jiang XX, Xu XF, Feng SX, Liu YQ, Jiang G. Meta-analysis of ceftriaxone compared with penicillin for the treatment of syphilis. Int J Antimicrob Agents. 2016 Jan;47(1):6-11. doi: 10.1016/j.ijantimicag.2015.10.020. Epub 2015 Nov 23.
PubMed 26724187Norris SJ, Cox DL, Weinstock GM. Biology of Treponema pallidum: correlation of functional activities with genome sequence data. J Mol Microbiol Biotechnol. 2001 Jan;3(1):37-62.
PubMed 11200228Faulkner RD, Fernandez P, Lawrence G, Sia LL, Falkowski AJ, Weiss AI, Yacobi A, Silber BM. Absolute bioavailability of cefixime in man. J Clin Pharmacol. 1988 Aug;28(8):700-6. doi: 10.1002/j.1552-4604.1988.tb03203.x.
PubMed 3216036Faulkner RD, Bohaychuk W, Haynes JD, Desjardins RE, Yacobi A, Silber BM. The pharmacokinetics of cefixime in the fasted and fed state. Eur J Clin Pharmacol. 1988;34(5):525-8. doi: 10.1007/BF01046715.
PubMed 3203716Barbee LA, Nayak SU, Blumer JL, O'Riordan MA, Gray W, Zenilman JM, Golden MR, Griffiss JM. A Phase 1 Pharmacokinetic and Safety Study of Extended-Duration, High-dose Cefixime for Cephalosporin-resistant Neisseria gonorrhoeae in the Pharynx. Sex Transm Dis. 2018 Oct;45(10):677-683. doi: 10.1097/OLQ.0000000000000844.
PubMed 29624558Rafal'skii VV, Dovgan' EV, Kozyrev IuV, Gustovarova TA, Khlybova SV, Novoselova AV, Filippenko NG, Likhikh DG. [The efficacy and safety of cefixime and amoxicillin/clavulanate in the treatment of asymptomatic bacteriuria in pregnant women: a randomized, prospective, multicenter study]. Urologiia. 2013 Sep-Oct;(5):24, 26-8. Russian.
PubMed 24437236Nurse-Findlay S, Taylor MM, Savage M, Mello MB, Saliyou S, Lavayen M, Seghers F, Campbell ML, Birgirimana F, Ouedraogo L, Newman Owiredu M, Kidula N, Pyne-Mercier L. Shortages of benzathine penicillin for prevention of mother-to-child transmission of syphilis: An evaluation from multi-country surveys and stakeholder interviews. PLoS Med. 2017 Dec 27;14(12):e1002473. doi: 10.1371/journal.pmed.1002473. eCollection 2017 Dec.
PubMed 29281619U.S.DEPARTMENT OF HEALTH AND HUMAN SERVICES. National Institutes of Health National Cancer Institute. Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0 . https://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03/Archive/CTCAE_4.0_2009-05-29_QuickReference_8.5x11.pdf
Hook EW 3rd, Behets F, Van Damme K, Ravelomanana N, Leone P, Sena AC, Martin D, Langley C, McNeil L, Wolff M. A phase III equivalence trial of azithromycin versus benzathine penicillin for treatment of early syphilis. J Infect Dis. 2010 Jun 1;201(11):1729-35. doi: 10.1086/652239.
PubMed 20402591Cao Y, Su X, Wang Q, Xue H, Zhu X, Zhang C, Jiang J, Qi S, Gong X, Zhu X, Pan M, Ren H, Hu W, Wei Z, Tian M, Liu W. A Multicenter Study Evaluating Ceftriaxone and Benzathine Penicillin G as Treatment Agents for Early Syphilis in Jiangsu, China. Clin Infect Dis. 2017 Oct 30;65(10):1683-1688. doi: 10.1093/cid/cix611.
PubMed 29020150Stafylis C, Keith K, Mehta S, Tellalian D, Burian P, Millner C, Klausner JD. Clinical Efficacy of Cefixime for the Treatment of Early Syphilis. Clin Infect Dis. 2021 Sep 7;73(5):907-910. doi: 10.1093/cid/ciab187.
PubMed 33640982Taylor MM, Kara EO, Araujo MAL, Silveira MF, Miranda AE, Branco Coelho IC, Bazzo ML, Mendes Pereira GF, Pereira Giozza S, Bermudez XPD, Mello MB, Habib N, Nguyen MH, Thwin SS, Broutet N. Phase II trial evaluating the clinical efficacy of cefixime for treatment of active syphilis in non-pregnant women in Brazil (CeBra). BMC Infect Dis. 2020 Jun 10;20(1):405. doi: 10.1186/s12879-020-04980-1.
PubMed 32522244
Study at a glance
From the registry record, last updated by the sponsor on 5 Feb 2020. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Trial Evaluating the Clinical Efficacy of Cefixime for Treatment of Early Syphilis in Non-pregnant Women
- ClinicalTrials.gov ID
- NCT03752112
- Acronym / sponsor ID
- ERC0003096
- Conditions
- Syphilis Female
- Keywords
- Syphilis, Women, Cefixime, Brazil, Sexually Transmitted Infection, STI
- Phase
- Phase 1/2
- Study type
- Interventional
- Recruitment status
- Unknown status
- Enrolment
- 180 participants (estimated)
- Lead sponsor
- World Health OrganizationUniversity, hospital or other
- Study start
- 22 Nov 2019 (actual)
- Primary completion
- 30 Mar 2021 (estimated)
- Study completion
- 30 Sep 2021 (estimated)
- First posted
- 23 Nov 2018 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Hypotheses The antibiotic, Cefixime, for use in non-pregnant women with early syphilis will be efficacious and safe.
Primary Objective The primary objective of the study is to demonstrate the efficacy, as measured by a 4 fold decrease in Rapid Plasma Reagin (RPR) titer from baseline to 6 months after treatment, with Cefixime 400mg taken orally two times a day for 10 consecutive days.
Secondary Objective The secondary objective of the study is to determine the safety, as measured by the number of grade 3 or greater toxicities experienced, using the NIH/NCI toxicity score, during or after treatment with Cefixime 400mg taken orally two times a day for 10 consecutive days.
Detailed description
Hypotheses The antibiotic, Cefixime, for use in non-pregnant women with early syphilis will be efficacious and safe.
Primary Objective The primary objective of the study is to demonstrate the efficacy, as measured by a 4 fold decrease in Rapid Plasma Reagin (RPR) titer from baseline to 6 months after treatment, with Cefixime 400mg taken orally two times a day for 10 consecutive days.
Secondary Objective The secondary objective of the study is to determine the safety, as measured by the number of grade 3 or greater toxicities experienced, using the NIH/NCI toxicity score (10), during or after treatment with Cefixime 400mg taken orally two times a day for 10 consecutive days.
Methods Study design This is a randomized, non-comparative, open-label study assessing the efficacy and safety of cefixime 400mg taken orally two times a day for 10 consecutive days in non-pregnant women with early syphilis infection.
Study population and enrolment sites Numerous regions of Brazil have experienced increases in syphilis diagnoses during the previous 5 years The study sites were chosen from three cities in three separate regions (states) of Brazil based on: (1) increases in syphilis case reports, (2) access to clinics where patients are screened and treated for syphilis; (3) willingness of clinic sites and staff to participate in this research, and (4) the availability of experienced researchers with experience in studying syphilis to serve as co-investigators.
The study population will include non-pregnant women (ages 18 and over) diagnosed with early syphilis (RPR titers >1:8) recruited from 7 clinics in three cities from three states in Brazil. These include: (1) Three clinics in the city of Fortaleza (Ceara State), coordinated by the University of Fortaleza (UNIFOR): (a) Carlos Ribeiro, (a) Meireles, and (c) Federal University. Syphilis epidemiology for each site in Annex 1. (2) Two University ObGyn Clinics in the city of Pelotas (state of Rio Grande do Sul) (5-6 cases of syphilis/week) a) Ambulatorio de Ginecologia e Obstetrícia - Faculdade de Medicina - Universidade Federal de Pelotas and b) Ambulatorio de Ginecologia e Obstetrícia - Campus da Saúde - Universidade Católica de Pelotas; and (3) Two clinics in Vitoria (State of Espirito Santo): (1) Reference Center for Sexually Transmitted Diseases (http://www.vitoria.es.gov.br/cidadao/centro-de-referencia-em-infeccoes-sexualmente-transmissiveis). (2) Hospital Universitário Cassiano Antonio Moraes - UFES.
Patients identified during standard of care testing with a positive rapid syphilis test and an RPR titer of greater than or equal to 1:8 will be referred to the study and offered enrollment according to the following description.
Non-study clinic-site staff will perform the first screening rapid finger-stick test for syphilis. The rapid syphilis test currently used in these clinics detects both new (acute) infection and old treated infection but does not distinguish between the two. Patients that are positive for the syphilis rapid finger-stick test will be notified by non-study staff of this result and the need for additional testing using the RPR test according to standard of care. Blood will be collected for the confirmatory RPR test by non-study staff. These patients will be notified of RPR results in approximately 3 days to 1 week. The results a confirmed syphilis diagnosis and of the RPR test results for those patients that are eligible for enrolment in the study (RPR >1:8) will be provided by a study nurse. The study will be explained to eligible participants (RPR titer of >1:8) by this study nurse, and if women express interest in participating, informed consent will be obtained. It is expected that an enrolment visit could last approximately 1.5 hours.
Patients that are not eligible for the study (negative RPR or RPR with titer <1:8) will receive syphilis RPR results from non-study staff.
Pregnancy tests will be completed on all potential participants and those that test positive will not be enrolled in the study.
The timing of the recruitment process will depend on the number of women diagnosed with syphilis and who have an RPR titer >1:8 and who consent to participate in the study. It is anticipated that enrollment will take approximately 1 year to complete.
To benchmark the performance of benzathine penicillin in the study population being used for cefixime, The investigators will include a contemporary arm of participants that will receive standard of care treatment with benzathine penicillin according to the Brazil national sexually transmitted infection (STI) treatment guidelines. The investigators will use a ratio of 2 patients receiving cefixime to 1 patient receiving benzathine penicillin.
This non-comparator arm of benzathine penicillin will be included to account for study population differences in terms of stage of disease, history of prior infection, experience of re-infection, experience of serofast state, or other co-factors that could impact serological response. An estimate of performance of this standard of care will be calculated, but this will not be compared directly to the study intervention.
The investigators will enrol 180 eligible women into the study: 120 for the cefixime arm and 60 for the benzathine penicillin arm. It is anticipated that enrollment will take approximately 1 year to complete. Patients will be participating in the study for approximately 9 months. The study is expected to last for approximately two years. Women that are referred to the study but decline enrolment will be treated at the clinic following national STI treatment guidelines for syphilis.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
- Model description
- This is a Phase 1/2 trial to evaluate the efficacy and safety of cefixime for use in treating women with acute syphilis. This is a randomized, non-comparative, open label study assessing the efficacy and safety of cefixime 400mg taken orally two times a day for 10 consecutive days in non-pregnant women with early syphilis infection.To benchmark the performance of benzathine penicillin in the study population being used for cefixime, The investigators will include a contemporary arm of participants that will receive standard of care treatment with benzathine penicillin according to the Brazil national STI treatment guidelines. The investigators will use a ratio of 2 patients receiving cefixime to 1 patient receiving benzathine penicillin.
| Arm | Type | Receives |
|---|---|---|
| Cefixime | Experimental | Drug: Cefiximecefixime 400mg taken orally two times a day for 10 consecutive days in non-pregnant women with early syphilis infection. |
| Benzathine penicillin | Other | Drug: Benzathine penicillin 2.4 million unitsTo benchmark the performance of benzathine penicillin in the study population being used for cefixime, the investigators will include a contemporary arm of participants that will receive standard of care treatment with benzathine penicillin according to the Brazil national STI treatment guidelines. The investigators will use a ratio of 2 patients receiving cefixime to 1 patient receiving benzathine penicillin. |
Who may qualify
- Ages
- 18 years and older
- Sex
- Female only
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (11 listed)
- Female, 18 years of age or older
- Non-pregnant
- Able to provide informed consent
- Test positive for syphilis with a positive TPPA AND an RPR titer equal to or greater than 1:8
- Non-cephalosporin allergic
Key exclusion criteria (2 listed)
- 1) Female under 18 years of age 2) HIV positive 3) Pregnancy test positive or clinical pregnancy 4) Prior history of syphilis or syphilis treatment within 6 months of study screening 5) Allergy to penicillin or cephalosporins (including allergy to cefixime) 6) In the judgment of the interviewer, has a medical condition or other factor that might affect their ability to follow the protocol 7) Previous enrollment in the study 8) Presenting a condition that would not allow reliable informed consent (alcohol abuse or substance misuse) 9) Lacking mental capacity to give informed consent to participation
- -
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| CefiximeAlso: InterventionCefixime 400mg taken orally two times a day for 10 consecutive days in non-pregnant women with early syphilis infection | Drug | Cefixime |
| Benzathine penicillin 2.4 million unitsAlso: Standard treatmentBenzathine penicillin 2.4 million units: The investigators will include a contemporary arm of participants that will receive standard of care treatment with Benzathine penicillin 2.4 million units according to the Brazil national STI treatment guidelines. The investigators will use a ratio of 2 patients receiving cefixime to 1 patient receiving benzathine penicillin.This non-comparator arm of benzathine penicillin will be included to account for study population differences in terms of stage of disease, history of prior infection, experience of re-infection, experience of serofast state, or other co-factors that could impact serological response | Drug | Benzathine penicillin |
Primary outcome
Quantitative RPR titer change
Time frame: 6 months following last dose of Cefixime 400 mg
RPR titer response at 6 months
2 secondary outcomes
Number of participants with treatment-related adverse events as assessed by CTCAE with cefixime
Time frame: Daily after the first dose of cefixime 400mg orally through 10 days after the first dose
The number of participants reporting tolerability of cefixime
Time frame: Daily after the first dose of cefixime 400mg orally through 10 days after the first dose and qualitative overall assessment of tolerability measured via questionnaire 14 days after the first dose of cefixime
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 5 Feb 2020.
- Background: PubMed 26042815Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015 Jun 5;64(RR-03):1-137.
- BackgroundWHO. WHO guidelines for the treatment of Treponema pallidum (syphilis). http://wwwwhoint/reproductivehealth/publications/rtis/syphilis-treatment-guidelines/en/. 2016.
- Background: PubMed 26724187Liang Z, Chen YP, Yang CS, Guo W, Jiang XX, Xu XF, Feng SX, Liu YQ, Jiang G. Meta-analysis of ceftriaxone compared with penicillin for the treatment of syphilis. Int J Antimicrob Agents. 2016 Jan;47(1):6-11. doi: 10.1016/j.ijantimicag.2015.10.020. Epub 2015 Nov 23.
- Background: PubMed 11200228Norris SJ, Cox DL, Weinstock GM. Biology of Treponema pallidum: correlation of functional activities with genome sequence data. J Mol Microbiol Biotechnol. 2001 Jan;3(1):37-62.
- Background: PubMed 3216036Faulkner RD, Fernandez P, Lawrence G, Sia LL, Falkowski AJ, Weiss AI, Yacobi A, Silber BM. Absolute bioavailability of cefixime in man. J Clin Pharmacol. 1988 Aug;28(8):700-6. doi: 10.1002/j.1552-4604.1988.tb03203.x.
- Background: PubMed 3203716Faulkner RD, Bohaychuk W, Haynes JD, Desjardins RE, Yacobi A, Silber BM. The pharmacokinetics of cefixime in the fasted and fed state. Eur J Clin Pharmacol. 1988;34(5):525-8. doi: 10.1007/BF01046715.
- Background: PubMed 29624558Barbee LA, Nayak SU, Blumer JL, O'Riordan MA, Gray W, Zenilman JM, Golden MR, Griffiss JM. A Phase 1 Pharmacokinetic and Safety Study of Extended-Duration, High-dose Cefixime for Cephalosporin-resistant Neisseria gonorrhoeae in the Pharynx. Sex Transm Dis. 2018 Oct;45(10):677-683. doi: 10.1097/OLQ.0000000000000844.
- Background: PubMed 24437236Rafal'skii VV, Dovgan' EV, Kozyrev IuV, Gustovarova TA, Khlybova SV, Novoselova AV, Filippenko NG, Likhikh DG. [The efficacy and safety of cefixime and amoxicillin/clavulanate in the treatment of asymptomatic bacteriuria in pregnant women: a randomized, prospective, multicenter study]. Urologiia. 2013 Sep-Oct;(5):24, 26-8. Russian.
- Background: PubMed 29281619Nurse-Findlay S, Taylor MM, Savage M, Mello MB, Saliyou S, Lavayen M, Seghers F, Campbell ML, Birgirimana F, Ouedraogo L, Newman Owiredu M, Kidula N, Pyne-Mercier L. Shortages of benzathine penicillin for prevention of mother-to-child transmission of syphilis: An evaluation from multi-country surveys and stakeholder interviews. PLoS Med. 2017 Dec 27;14(12):e1002473. doi: 10.1371/journal.pmed.1002473. eCollection 2017 Dec.
- BackgroundU.S.DEPARTMENT OF HEALTH AND HUMAN SERVICES. National Institutes of Health National Cancer Institute. Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0 . https://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03/Archive/CTCAE_4.0_2009-05-29_QuickReference_8.5x11.pdf
- Background: PubMed 20402591Hook EW 3rd, Behets F, Van Damme K, Ravelomanana N, Leone P, Sena AC, Martin D, Langley C, McNeil L, Wolff M. A phase III equivalence trial of azithromycin versus benzathine penicillin for treatment of early syphilis. J Infect Dis. 2010 Jun 1;201(11):1729-35. doi: 10.1086/652239.
- Background: PubMed 29020150Cao Y, Su X, Wang Q, Xue H, Zhu X, Zhang C, Jiang J, Qi S, Gong X, Zhu X, Pan M, Ren H, Hu W, Wei Z, Tian M, Liu W. A Multicenter Study Evaluating Ceftriaxone and Benzathine Penicillin G as Treatment Agents for Early Syphilis in Jiangsu, China. Clin Infect Dis. 2017 Oct 30;65(10):1683-1688. doi: 10.1093/cid/cix611.
- Individual participant dataSharing planned: Yes. Beginning 9 months and ending 24 months following article publication, the supporting information that will be shared for IPD are all data that underlie the results in the publication.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Melanie M Taylor, MD principal investigator
World Health Organization
Nathalie JN Broutet, MD study director
World Health Organization
Edna O Kara, MD study chair
World Health Organization
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 1/2 study testing Cefixime and Benzathine penicillin 2.4 million units in people with Syphilis Female, run by World Health Organization at 1 site in Brazil.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 11 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: status not confirmed, as of the sponsor's last update on 5 Feb 2020. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Brazil. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this combined phase mean?
Phase 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.
Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
Contact Melanie M Taylor, MD (+41 22 791 2172, mtaylor@who.int), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Quantitative RPR titer change (time frame: 6 months following last dose of Cefixime 400 mg). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT03752112, which also lists 14 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 5 Feb 2020.