Not provided
Not provided
Not provided
Not provided
Not provided
Low recruitment
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
| Name | Class |
|---|---|
| Hospital Universitari de Bellvitge | OTHER |
| Hospital Vall d'Hebron | OTHER |
| Germans Trias i Pujol Hospital | OTHER |
| Hospital Clinic of Barcelona |
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
To evaluate the efficacy of the prophylaxis with phenytoin in the prevention of seizures in patients with pneumococcal meningitis. Hypothesis: Administration of prophylactic phenytoin will reduce the incidence of seizures in patients with pneumococcal meningitis older than 50 yrs.
Background: Bacterial meningitis has still a high morbi-mortality despite the global improvement in therapy.
Among complications, the presence of seizures may contribute to increase the morbi-mortality. Prophylactic phenytoin is used in clinical practice in high risk patients but this use is variable because there are not controlled clinical trials demonstrating efficacy along with antibiotics and corticosteorids. Pneumococcal episodes are associated to a higher number of seizures and a higher mortality especially in elderly patients.
Objectives: To evaluate the efficacy of the prophylaxis with phenytoin in the prevention of seizures in patients with pneumococcal meningitis. Hypothesis: Administration of prophylactic phenytoin will reduce the incidence of seizures in patients with pneumococcal meningitis older than 50 yrs.
Methodology: Multicentre, randomized, double blind placebo controlled clinical trial. Patients will be included mostly from hospitals from REIPI and CAIBER and randomly assigned to receive phenytoin or placebo.
Sample size has been estimated in 61 patients per group. Antibiotic therapy and ICP prophylaxis will be standardized in all centres. Phenytoin administration will be maintained during antibiotic therapy. End point will be incidence of seizures during hospital stay and overall mortality will be a secondary end-point. Followup visits at 1 and 3 month will be performed.
Not provided
Not provided
Not provided
Not provided
| Label | Type | Description | Intervention Names |
|---|---|---|---|
| phenytoin prophylaxis | Experimental | Patients with suspected or proven pneumococcal meningitis are allocated to receive phenytoin prophylaxis or placebo to avoid seizures during the 10 days of antibiotic therapy starting after the antibiotic therapy |
|
| placebo | Placebo Comparator | placebo vials and pills labeled as phenytoin prophylaxis vials and pills |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Phenytoin | Drug | Phenytoin 18 mg /Kg/day iv as loading dose. 24 hours later phenytoin 6 mg/Kg/d in 3 divided doses iv shifting to oral route at the same dose when the patient is able to use oral route. |
| Measure | Description | Time Frame |
|---|---|---|
| Presence of seizures (clinical) after initiation of phenytoin /placebo prophylaxis during the 10 days of antibiotic therapy | Presence of seizures (clinical) after initiation of phenytoin /placebo prophylaxis during the 10 days of antibiotic therapy | 10 days |
| Measure | Description | Time Frame |
|---|---|---|
| Need for anticonvulsivant therapy at 3 months | Need for anticonvulsivant therapy at 3 months | 3 months |
Not provided
Inclusion Criteria:
Adult patients > or = 50 years old.
Diagnosed of pneumococcal meningitis due to clinical characteristics plus a positive CSF Gram stain and/or a detection of pneumococcal antigen or PCR
or
Suspected pneumococcal meningitis since it is an episode related to otitis, pneumonia, sinusitis or pericranial fistula or in patients with known risk factors such as myeloma or splenectomy.
Exclusion Criteria:
To have seizures prior to arrive to the hospital or the inclusion in the study.
Pregnancy or breastfeeding.
To have conduction abnormalities in ECG.
History of allergy or intolerance to phenytoin.
Patients with meningitis as a complication of neurosurgical procedures.
Epileptic patients taking usually anticonvulsivants.
Refusal by the patient or family to participate and/or to sign the informed consent.
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
| Name | Affiliation | Role |
|---|---|---|
| M. Carmen Cabellos, MD | Hospital Universitari de Bellvitge | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hospital Universitari de Bellvitge | L'Hospitalet de Llobregat | Barcelona | 08907 | Spain | ||
| Hospital Juan Canalejo |
Not provided
| ID | Term |
|---|---|
| D012640 | Seizures |
| D008586 | Meningitis, Pneumococcal |
| ID | Term |
|---|---|
| D009461 | Neurologic Manifestations |
| D009422 | Nervous System Diseases |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
Not provided
Not provided
| ID | Term |
|---|---|
| D010672 | Phenytoin |
| ID | Term |
|---|---|
| D006827 | Hydantoins |
| D048289 | Imidazolidines |
| D007093 | Imidazoles |
| D001393 | Azoles |
| D006573 |
Not provided
Not provided
| OTHER |
| Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau | OTHER |
| Hospitales Universitarios Virgen del Rocío | OTHER |
| Hospital Universitario La Paz | OTHER |
| Hospital Universitario Ramon y Cajal | OTHER |
| Hospital Juan Canalejo | OTHER |
| Hospital Mutua de Terrassa | OTHER |
| Hospital Universitario Virgen Macarena | OTHER |
Not provided
Not provided
Not provided
Not provided
| placebo | Drug | Placebo 18 mg /Kg/day iv as loading dose. 24 hours later placebo 6 mg/Kg/d in 3 divided doses iv shifting to oral route at the same dose when the patient is able to use oral route. |
|
| A Coruña |
| 15006 |
| Spain |
| Fundacio Institut per la Recerca de l'hospital de la Santa Creu i Sant Pau | Barcelona | 08025 | Spain |
| Hospital Virgen del Rocio | Seville | 41013 | Spain |
| D016920 | Meningitis, Bacterial |
| D020806 | Central Nervous System Bacterial Infections |
| D001424 | Bacterial Infections |
| D001423 | Bacterial Infections and Mycoses |
| D007239 | Infections |
| D011008 | Pneumococcal Infections |
| D013290 | Streptococcal Infections |
| D016908 | Gram-Positive Bacterial Infections |
| D002494 | Central Nervous System Infections |
| D002493 | Central Nervous System Diseases |
| D008581 | Meningitis |
| D000090862 | Neuroinflammatory Diseases |
| Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |