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Wounds and InjuriesPhase 4ORALEV2NCT04161599

Preoperative Oral Antibiotics With vs Without Mechanical Bowel Preparation to Reduce Surgical Site Infections Following Colonic Resection: an International Randomized Controlled Trial.

A Phase 4 study testing Cefuroxime (750mg) I.V, Colonic Surgery and Cefuroxime 750mg oral in people with Wounds and Injuries and Surgery--Complications, run by Hospital Universitari Vall d'Hebron Research Institute at 10 sites in 6 countries.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

The ORALEV Study found that preoperative oral antibiotics can reduce the incidence of surgical site infections after colonic resection, compared with no preparation. The role of mechanical bowel preparation in patients needing colonic surgery is yet to be elucidated. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Wounds and Injuries, Surgery--Complications
What is being tested?
Cefuroxime (750mg) I.V, Colonic Surgery and Cefuroxime 750mg oral
Could I receive a placebo?
No, everyone receives an active treatment
How many people
968 participants
Where
10 sitesin 6 countries
Study dates
1 Mar 2022to Jul 2024
Phase
Phase 4
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
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients of both genders, aged 18 years or above, with colonic disease without contraindications to surgical treatment, diagnosed with neoplasia or diverticular disease (diverticulosis with indication to elective surgery: stricture, chronic constipation), patients for whom a segmental or total colectomy is indicated.
  • Patients who voluntarily accept to join the study and sign a dedicated written consent.
  • Capability of understanding the study and take the medications prescribed.

Who cannot join

  • Patients undergoing urgent surgery or no elective admission
  • Patients who refuse to participate
  • Patients with rectal disease or neoplasia
  • Patients with pre-existing intrabdominal sepsis (abscess, acute diverticulitis)
  • Patients who received preoperative antibiotic treatment for any other reasons during the two weeks before surgery
  • Patients with Crohn's disease or ulcerative colitis
Show all 16Show fewer
  • Patients unlikely to adhere to the treatment prescribed
  • Patients with allergy or contraindication to the medications used in the study
  • Patients who need mechanical bowel preparation
  • Patients with contraindication to bowel preparation used in the study (Citrafleet®):
  • Patients with kidney failure needing haemodialysis or with hypermagnesemia
  • Patients with severe heart failure
  • Patients with gastric or duodenal ulcer
  • Patients with mechanical obstruction
  • Patients with toxic megacolon
  • Patients with ascites or rhabdomyolysis

Trial locations and contacts

10 sites in 6 countries.

Eloy Espín-Basany, MD PhD contact

934 893 000 ext. 6587

eespin@vhebron.net

Gianluca Pellino, MD, PhD contact

934 893 000 ext. 6587

gpellino@vhebron.net

10 sites in 6 countries

Spain5 sites, 5 recruiting
  • Hospital General Universitario Vall d´Hebron

    Barcelona, Barcelona, Spain, 08035

    Eloy Espín Basany, MD PhD, 934 893 000 ext. 6587, eespin@mac.com

    María Martínez Lopez, MD, m.martinez.21@vhebron.net

    Recruiting
  • Hospital de Bellvitge

    Barcelona, Hospitalet de Llobregat, Barcelona, Spain, 08907

    Sebastiano Biondo, MD PhD, 932 607 500

    Recruiting
  • Hospital Universitario Cruces

    Cruces

    José María García González

    Recruiting
  • Hospital Universitario Lucus Augusti

    Lugo

    Manuel Muinelo

    Recruiting
  • Hospital Universitario Ramón y Cajal

    Madrid

    Juan Ocaña Jiménez, jocajim@gmail.com

    Recruiting

Other trials in Spain

China1 site, 1 recruiting
  • Jinling Hospital

    Nanjing

    Huajian Ren, rhj1288@hotmail.com

    Recruiting

Other trials in China

Greece1 site, 1 recruiting
  • General University Hospital of Patras

    Pátrai

    Francesck Mulita

    Recruiting

Other trials in Greece

Italy1 site, 1 recruiting
  • Humanitas Research Hospital

    Rozzano

    Antonino Spinelli

    Annalisa Maroli

    Recruiting

Other trials in Italy

Russia1 site, 1 recruiting
  • Tomsk Oncological Hospital

    Tomsk

    Eugeniy Drozdov

    Recruiting

Other trials in Russia

United Kingdom1 site, 1 recruiting
  • Royal Marsden Hospital, Imperial College of London

    London

    Christos Kontovounisios

    Not yet recruiting

Other trials in United Kingdom

About this study

Official title: Oral + Parenteral Antibiotic Prophylaxis Before Colonic Surgery With vs Without Mechanical Bowel Preparation: a Prospective, Multicentric, Randomised, Controlled Trial.

The ORALEV Study found that preoperative oral antibiotics can reduce the incidence of surgical site infections after colonic resection, compared with no preparation.

The role of mechanical bowel preparation in patients needing colonic surgery is yet to be elucidated.

No randomised controlled trials have assessed the impact of mechanical bowel preparation combined with oral antibiotics on the incidence of surgical site infections after colonic surgery, compared with oral antibiotics only.

Read the detailed description

International, multicentre, pragmatic, parallel-group, randomised controlled trial.

Routine antibiotics for the intravenous and oral prophylaxis of colorectal surgery will be used.

Experimental group: Patients undergoing elective colonic surgery that involves colonic resection.

The antibiotic prophylaxis in this group will be composed of:

An oral antibiotic pattern of ciprofloxacin (750mg / 12h, 2 doses) and metronidazole (250mg / 8h, 3 doses) the day before surgery, plus mechanical bowel preparation with Sodium picosulfate, light magnesium oxide, and anhydrous citric acid (10 mg - 3.5 g - 10.97 g per dose/ 2 doses the day before surgery) + An intravenous antibiotics pattern of cefuroxime 1,5 g and metronidazole 1 g at anesthetic induction.

Control group: Patients undergoing elective colonic surgery that involves colonic resection.

The antibiotic prophylaxis in this group will be composed of:

An oral antibiotic pattern of ciprofloxacin (750mg / 12h, 2 doses) and metronidazole (250mg / 8h, 3 doses)

+ An intravenous antibiotic pattern of cefuroxime 1,5 g and metronidazole 1 gr at anesthetic induction.

In both groups a second intravenous dose of cefuroxime (750mg) will be administered if the intraoperative time prolongs for more than three hours or if there is an intraoperative bleeding over 1000cc.

There will not be a placebo treatment. Subject compliance will be evaluated according to the usual practice in surgical care field

Being tested
Cefuroxime (750mg) I.V, Colonic Surgery, Cefuroxime 750mg oral, Metronidazole 250 MG Oral Tablet [Flagyl], Metronidazole 1 g Intravenous
Medical subject headings
Wounds and Injuries

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Cefuroxime (750mg) I.VDrug

    Extra dosage

  • Colonic SurgeryProcedure or surgery

    Colonic Surgery

  • Cefuroxime 750mg oralDrug

    Oral prophylaxis

  • Metronidazole 250 MG Oral Tablet [Flagyl]Drug

    Oral prophylaxis

  • Metronidazole 1 g IntravenousDrug

    IV prophylaxis

  • Cefuroxime 1,5 g IntravenousDrug

    IV prophylaxis

  • Sodium picosulfate, light magnesium oxide, anhydrous citric acid 10 mg/3.5 g/10.97 g OralDrug

    Laxative for bowel cleansing

Study groups in NCT04161599
Study groupRoleWhat they receive
Oral + Parenteral prophylaxis + Mechanical Bowel PreparationExperimentalDrug: Extra dosage - cefuroxime (750mg) I.V Procedure: Colonic Surgery Both groups undergo colonic surgery. This section does not include rectal surgery ( see Inclusion/exclusion criteria) Drug: Cefuroxime 750mg oral An oral antibiotic pattern of ciprofloxacin (750mg / 12h, 2 doses) the day before surgery. Drug: Metronidazole 250mg oral An oral antibiotic pattern of metronidazole (250mg / 8h, 3 doses) the day before surgery. Drug: Sodium picosulfate, magnesium oxide, citric acid anhydrous 15.08 g oral An oral laxative for bowel cleansing (2 doses) the day before surgery. Drug: Metronidazole 1 g Intravenous An intravenous antibiotic pattern of metronidazole 1 g during anesthetic induction. Drug: Cefuroxime 1,5 g Intravenous An intravenous antibiotic pattern of cefuroxime 1,5 g during anesthetic induction.
Receives: Drug: Cefuroxime (750mg) I.V; Procedure: Colonic Surgery; Drug: Cefuroxime 750mg oral; Drug: Metronidazole 250 MG Oral Tablet [Flagyl]; Drug: Metronidazole 1 g Intravenous; Drug: Cefuroxime 1,5 g Intravenous; Drug: Sodium picosulfate, light magnesium oxide, anhydrous citric acid 10 mg/3.5 g/10.97 g Oral
Oral + Parenteral prophylaxisActive comparatorDrug: Extra dosage - cefuroxime (750mg) I.V In both groups a second intravenous dose of cefuroxime (750mg) will be administered if the intraoperative time elongates more than three hours or there is an intraoperative bleeding over 1000cc Procedure: Colonic Surgery Both groups undergo colonic surgery. This section does not include rectal surgery ( see Inclusion/exclusion criteria) Drug: Cefuroxime 750mg oral An oral antibiotic pattern of ciprofloxacin (750mg / 12h, 2 doses) the day before surgery. Drug: Metronidazole 250mg oral An oral antibiotic pattern of metronidazole (250mg / 8h, 3 doses) the day before surgery. Drug: Metronidazole 1 gr Intravenous An intravenous antibiotic pattern of metronidazole 1 g during anesthetic induction. Drug: Cefuroxime 1,5 g Intravenous An intravenous antibiotic pattern of cefuroxime 1,5 g during anesthetic induction.
Receives: Drug: Cefuroxime (750mg) I.V; Procedure: Colonic Surgery; Drug: Cefuroxime 750mg oral; Drug: Metronidazole 250 MG Oral Tablet [Flagyl]; Drug: Metronidazole 1 g Intravenous; Drug: Cefuroxime 1,5 g Intravenous

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Rate of Wound infection

    Superficial, deep, body-cavity This is a Clinical measure supported by image if necessary All the morbidity problems are reported independently

    Measured: 30 days

Secondary outcomes (19)
  1. Local complications

    Hematoma, seroma, evisceration

    This is a Clinical measure. This morbidity problems are reported independently as a YES/NO variable

    Measured: 30 days after surgery

  2. Impaired healing

    This is a Clinical measure always supported by image tests. This morbidity problems are reported independently as a YES/NO variable

    Measured: 30 days after surgery

  3. Occlusive problems

    Intestinal occlusion, Anastomotic stenosis, Postoperative ileus

    Measured: 30 days from surgery

  4. Nephro-urinary complications

    Acute urinary retention, Acute renal failure, cystitis, pyelonephritis ...

    This is a Clinical measure supported by more specific tests if necessary. This morbidity problems are reported independently as a YES/NO variable

    Measured: 30 days after surgery

  5. Adverse events related to drugs (Harms)

    Any adverse event related with the drug

    •This morbidity problems are reported independently as a YES/NO variable

    Measured: 30 days after surgery

  6. Time to complete recovery

    Interval between hospital admission and complete recovery ("can be discharged")

    Measured: 30 days after surgery

  7. Length of Hospital stay

    Hospital stay since colorectal surgery is done

    Measured: Participants will be followed for the duration of hospital stay, an expected average of 7 days

  8. Iatrogenic problems

    Injury to structures such as ureters, bowel loops artery / veins .

    •This morbidity problems are reported independently as a YES/NO variable

    Measured: 30 days after surgery

  9. Bleeding problems

    Hemoperitoneum, abdominal hematoma,anastomotic bleeding

    •This morbidity problems are reported independently as a YES/NO variable

    Measured: 30 days after surgery

  10. Cardiac complications

    Acute myocardial infarction, angor pectoris , atrial fibrillation, acute pulmonary edema

    This is a Clinical measure supported by more specific tests if necessary. This morbidity problems are reported independently as a YES/NO variable Cardiologist report will be required for including this items

    Measured: 30 days after surgery

  11. Respiratory complications

    Pneumonia, Atelectasia, Pulmonary embolism, ARDS

    This is a Clinical measure always supported by image . This morbidity problems are reported independently as a YES/NO variable

    Measured: 30 days after surgery

  12. Neurological complications

    Disorientation, cerebral vascular accident,

    This is a Clinical measure. This morbidity problems are reported independently as a YES/NO variable. Neurologist report will be required beyond disorientation.

    Measured: 30 days after surgery

  13. Postoperative intestinal problems

    Postoperative diarrhoea, nausea and vomiting

    Measured: 30 days after surgery

  14. Readmission

    Need to be readmitted after discharge

    Measured: 30 days after surgery

  15. Reintervention

    Need to be reoperated

    Measured: 30 days after surgery

  16. Perioperative Hypovolemia

    Signs or symptoms of hypovolemia not related with bleeding, as assessed by the anesthetist at surgery

    Measured: Intraoperative assessment

  17. Patient satisfaction with preparation received

    Patient satisfaction with the preparation receivced, assessed with a Verbal Rating Scale (VRS) from 1 (minimum satisfaction) to 10 (maximum satisfaction)

    Measured: within the 30 days from surgery

  18. Death

    Patient death for any cause and patient death in relation with treatment received

    Measured: 30 days after surgery

  19. Anastomotic leak

    clinical, radiological or intraoperatively detected abdominal or pelvic leak or collection

    Measured: 30 days after surgery

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted13 Nov 2019
  2. Study start1 Mar 2022
  3. Primary completionJun 2024 (estimated)
  4. Study completionJul 2024 (estimated)

Resources

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 4
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
968 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04161599
Sponsor's protocol ID
2019-004283-21
Other IDs
2019
Acronym
ORALEV2
Status last verified
Apr 2022
First submitted
4 Nov 2019
Last updated
26 Apr 2022
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Pellino G, Solis-Pena A, Kraft M, Huguet BM, Espin-Basany E. Preoperative oral antibiotics with versus without mechanical bowel preparation to reduce surgical site infections following colonic resection: Protocol for an international randomized controlled trial (ORALEV2). Colorectal Dis. 2021 Aug;23(8):2173-2181. doi: 10.1111/codi.15681. Epub 2021 May 12.

    PubMed 33872448
  • Willis MA, Toews I, Soltau SL, Kalff JC, Meerpohl JJ, Vilz TO. Preoperative combined mechanical and oral antibiotic bowel preparation for preventing complications in elective colorectal surgery. Cochrane Database Syst Rev. 2023 Feb 7;2(2):CD014909. doi: 10.1002/14651858.CD014909.pub2.

    PubMed 36748942
  • Koskenvuo L, Sallinen V. Preoperative oral antibiotics in colon surgery. Lancet Gastroenterol Hepatol. 2020 Sep;5(9):801-802. doi: 10.1016/S2468-1253(20)30203-X. No abstract available.

    PubMed 32818460

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Cefuroxime (750mg) I.V, Colonic Surgery and Cefuroxime 750mg oral in people with Wounds and Injuries and Surgery--Complications, run by Hospital Universitari Vall d'Hebron Research Institute at 10 sites in 6 countries.

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 3 inclusion and 16 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 26 Apr 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 10 sites in Spain, China, Greece, Italy, Russia and 1 more country. 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 phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

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 Eloy Espín-Basany, MD PhD (934 893 000 ext. 6587, eespin@vhebron.net), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Rate of Wound infection (time frame: 30 days). 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 NCT04161599, which also lists 3 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 26 Apr 2022.

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