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Rifampicin, is key in the treatment of staphylococcal PJIs. Rifabutin has a better profile of tolerance than rifampicin regarding the risk of interaction with concomitant medications and liver disorders. The hypothesis is that rifabutin may be an alternative antibiotic option as efficient as rifampicin for the treatment of staphylococcal PJIs, with a better safety profile. The investigator aim to demonstrate the non-inferiority of rifabutin as compared with rifampicin prescribed in combination treatment for PJIs.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| RIFAMPICIN | Active Comparator | Patient with staphylococcal PJI, treated with DAIR strategy, and randomized in the control group will receive rifampicin in association with another antibiotic except rifabutin, as-per recommendations for 12 weeks. |
|
| RIFABUTIN | Experimental | Patient with staphylococcal PJI treated with DAIR strategy, and randomized in the experimental group, will receive rifabutin in association with another antibiotic except rifampicin, as-per recommendations for 12 weeks. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Rifabutin | Drug | 2 tablets of 150 mg per day rifabutin tablet daily for 12 weeks in 1 administration with a companion treatment |
|
| Measure | Description | Time Frame |
|---|---|---|
| Treatment failure | Treatment failure defined as one of following events:
| At one year |
| Measure | Description | Time Frame |
|---|---|---|
| Occurrence of serious adverse events (SAEs), including death (i.e. all cause) | Proportion of patient which are free from SAEs occurrence, as defined by: -Patients who completed the entire 12 weeks duration of antibiotic treatment planned initially and; xWho did not experience grade 3-4 adverse events, including death, regardless of the link with antibiotic therapy; xWho did not experience adverse events which led to either to:
|
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Inclusion Criteria:
Hip or knee Prosthetic joint infection treated by debridement, antibiotic therapy initiation and retention of prothesis (DAIR strategy)
Infected with at least one of the following microorganisms:
Microorganisms susceptible to rifampicin and at least one other antibiotic suitable for the treatment of PJI (e.g., penicillin, fluoroquinolone, (doxy/mino)cycline, oxazolidinone, cotrimoxazole, daptomycin, glycopeptide, macrolide, fusidic acid), regardless of sensitivity to methicillin.
Age ≥ 18 years
At least 2 days of appropriate (i.e., covering pathogen(s) identified in the intraoperative samples) empirical agents are needed. Pre-randomization antimicrobial therapy could be: flucloxacillin, oxacillin, vancomycin, daptomycin. β-lactam plus β-lactamase-inhibitors (e.g. ampicillin+sulbactam, piperacillin+tazobactam), cephalosporins (except ceftazidime), carbapenems, teicoplanin, ceftaroline, ceftobiprole.
Signed Inform consent
Patient having the rights to French social insurance
For women of childbearing potential i.e. fertile, following menarche and until becoming post-menopausal unless permanently sterile and excluding oestroprogestative-based contraception, any effective contraceptive: vasectomy (for men), intrauterine device copper, feminine sterilization, condom, sexual abstinence is required. A postmenopausal state is defined as no menses for 12 months without an alternative medical cause
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Eric SENNEVILLE, MD PhD | Contact | 0320694949 | esenneville@ch-tourcoing.fr | |
| Solange TREHOUX | Contact | 0320694280 | strehoux@ch-tourcoing.fr |
| Name | Affiliation | Role |
|---|---|---|
| Eric SENNEVILLE, Md PhD | CH TOURCOING | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| CHU Amiens Picardie | Not yet recruiting | Amiens | France |
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| Rifampicin | Drug | 10 mg/kg per day (range 600 mg to 1,200 mg) rifampicin tablet in 1 daily dose for 12 weeks with a companion treatment |
|
| At the end of 12 weeks duration of antibiotic treatment planned |
| Occurrence of any adverse event that could be related to rifampicin or rifabutin | Number and rate of patients in each arm who experiences:
| At the end of 12 weeks duration of antibiotic treatment planned |
| Proportion of patients from each arm who will complete the 12-week duration of rifampicin/rifabutin treatment, early termination of the planned 12 weeks' period of antibiotics | Early termination rate will be measured in each arm, as the number of patients having stopped rifampicin or rifabutin before the planned 12 weeks period over the total number of patients enrolled in the studied arm. | At the end of 12 weeks duration of antibiotic treatment planned |
| Adherence to antibiotics regimen | Adherence rate to medication will be measured as the number of days on which all doses were missed over the number of days of planned antibiotic therapy. Patients enrolled in the study will have to fill their pill count in a daily notebook. | At the end of 12 weeks duration of antibiotic treatment planned |
| Quality of life, as evaluated by EQ 5D 3L questionnaire | Quality of life, as evaluated by the use EQ 5D 3L auto-questionnaire as used in previous randomized clinical trial on bone and joint infection | At the end of the study follow up, an average of 24 months |
| Functional prognosis using Oxford questionnaire evolution according to location of PJI | Oxford Scores as used in previous randomized clinical trial on bone and joint infection | At the end of the study follow up, an average of 24 months |
| Long term efficacy of rifampicin and rifabutin treatment | Long term efficacy: treatment failure, as defined for primary outcome, at 24 months | At the end of the study follow up, an average of 24 months |
| CHU Angers | Not yet recruiting | Angers | France |
| CHU Besançon | Recruiting | Besançon | France |
|
| CH de Béthune | Not yet recruiting | Béthune | France |
| CHU Bordeaux | Not yet recruiting | Bordeaux | France |
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| APHP Hôpital Ambroise Paré | Not yet recruiting | Boulogne-Billancourt | France |
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| CHRU Brest | Recruiting | Brest | France |
|
| CHU Caen | Recruiting | Caen | France |
| CH Alpes Leman | Not yet recruiting | Contamine-sur-Arve | France |
| CHU Dijon Bourgogne | Not yet recruiting | Dijon | France |
|
| CHU Grenoble Alpes | Not yet recruiting | Grenoble | France |
| CHRU Lille | Recruiting | Lille | France |
|
| GHICL Hôpital Saint Vincent de Paul | Not yet recruiting | Lille | France |
| CHU de Limoges | Recruiting | Limoges | France |
| GHICL Hôpital Saint Philibert | Not yet recruiting | Lomme | France |
| Clinique de la Sauvegarde | Not yet recruiting | Lyon | France |
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| Hospices Civils de Lyon | Not yet recruiting | Lyon | France |
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| APHM Hôpital Nord | Not yet recruiting | Marseille | France |
| CHU Nice | Not yet recruiting | Nice | France |
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| CH Annecy Genevois | Recruiting | Pringy | France |
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| CH Cornouaille | Not yet recruiting | Quimper | France |
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| CHU Reims | Not yet recruiting | Reims | France |
| CHU de Rennes | Recruiting | Rennes | France |
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| CHU Saint Etienne | Not yet recruiting | Saint-Priest-en-Jarez | France |
| CHRU Strasbourg | Not yet recruiting | Strasbourg | France |
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| Hôpital d'instruction des armées Sainte Anne | Recruiting | Toulon | France |
| Clinique Joseph Ducuing | Not yet recruiting | Toulouse | France |
| Clinique Médipole Garonne | Not yet recruiting | Toulouse | France |
| CH Tourcoing | Recruiting | Tourcoing | France |
|
| CHRU Tours | Recruiting | Tours | France |
|
| ID | Term |
|---|---|
| D017828 | Rifabutin |
| D012293 | Rifampin |
| ID | Term |
|---|---|
| D012294 | Rifamycins |
| D006576 | Heterocyclic Compounds, 4 or More Rings |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D006571 | Heterocyclic Compounds |
| D047029 | Lactams, Macrocyclic |
| D047028 | Macrocyclic Compounds |
| D011083 | Polycyclic Compounds |
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