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This is an open-label, multicentre, randomized, parallel group study to evaluate the efficacy of treatment with oxygen-ozone therapy plus oral antibiotic therapy, in comparison with oral antibiotic therapy alone, in the proportion of patients with resolution/improvement of signs and symptoms of infection of the wound (e.g. ulcer, eschar, sore) in the target lesion after 14 days of treatment, in patients with infections secondary to implant of orthopaedic devices.
This will be an open-label, multicentre, randomized, parallel group study. The study plan will include a screening visit (Visit 1, Day -7/-3) in which patients will be screened on the basis of inclusion/exclusion criteria and clinically evaluated.
At the end of the 3-7 days of run-in (Visit 2, Baseline visit, Day 0), patient still eligible will be randomised to one of the two following treatment groups:
Patients in both groups will receive oral antibiotic therapy, which will be prescribed at discretion of the Investigator, based on the results of the colture of the swab collected in the target lesion at the screening visit (and later, if needed) and the associated antibiogram.
Follow-up visits will be performed after 7 days (Visit 3, Day 7), 14 days (Visit 4, Day 14), 28 days (Visit 5, Day 28) and 42 days (Visit 6, End of study, Day 42) from the start of treatment.
A visit window of ± 2 days for the date of Visits 3-5 and of ± 3 days for the date of Visits 6 will be allowed.
Patients prematurely discontinued from the study will perform an 'Early termination visit', in which procedures schedule for Visit 6 (End of study, Day 42) will be performed. In case of premature study discontinuation, the Investigator will duly record the reason for premature withdrawal in the appropriate section of the case report form (eCRF).
Visit 6, or the 'Early termination Visit' will represent the conclusion of patient's participation in the investigation.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Arm A | Experimental | Oxygen-ozone therapy plus antibiotic therapy |
|
| Arm B | Other | Antibiotic therapy |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Oxygen-ozone therapy | Procedure | Oxygen-ozone therapy (group a) will be performed by: i) Self-haemoinfusion of 200 cc. with concentrations of 40-50 μg/ml, to be performed two/three times a week, for a time of 6 weeks (for a maximum of 15 sessions); ii) Subcutaneous injections in the perilesional site at the dose of 5 cc. with concentrations of 4 μg,/ml, Cleanse wounds with 100 cc of 5-10 ug ozone gas |
| Measure | Description | Time Frame |
|---|---|---|
| Clinical success at Day 14 | Resolution/improvement of signs and symptoms of infection of the wound in the target lesion (i.e. a score ≤ 1 for a maximum of two signs/symptoms) from baseline to Day 14. The following symptoms will be evaluated by patients on a 0-4 point Likert scale (0 = no symptom; 1 = mild symptom; 2 = moderate symptom; 3 = severe symptom; 4 = very severe symptom): pain, burning, redness and malodour. The following signs will be evaluated by investigators on a 0-4 point Likert scale (0 = no sign; 1 = mild sign; 2 = moderate sign; 3 = severe sign; 4 = very severe sign): erythema, local warmth, swelling, purulent secretion. | 2 week |
| Measure | Description | Time Frame |
|---|---|---|
| Proportion of patients with clinical success at Day 7, Day 28, and Day 42 | Clinical success is defined as resolution/improvement of signs and symptoms of infection of the wound in the target lesion | Day 7, Day 28, and Day 42 |
| Time to resolution of all signs and symptoms of infection |
| Measure | Description | Time Frame |
|---|---|---|
| Number of subjects experiencing treatment-emergent adverse events and serious TEAEs | 7 weeks | |
| Number of subjects experiencing local TEAEs in the site of application of the IP | 7 weeks | |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Marianno Franzini | Contact | 035 19910105 | info@ossigenoozono.it |
| Name | Affiliation | Role |
|---|---|---|
| Antonio Guastafierro | PINETA GRANDE HOSPITAL | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Pineta Grande Hospital | Recruiting | Castel Volturno | Caserta | Italy |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 38176866 | Derived | Cascini F, Franzini M, Andreoli A, Manzotti A, Cadeddu C, Quaranta G, Gentili A, Ricciardi W. Use of oxygen-ozone therapy to improve the effectiveness of antibiotic treatment on infected arthroplasty: protocol for a superiority, open-label, multicentre, randomised, parallel trial. BMJ Open. 2024 Jan 4;14(1):e076739. doi: 10.1136/bmjopen-2023-076739. |
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Open-label, multicentre, randomized, parallel group study
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It is defined as the disappearance (score = 0) of all signs and symptoms of infection of the wound in the target lesion; |
| 7 weeks |
| Eradication of the pathogen isolated at the screening visit | Bacteriological success of the wound in the target lesion at Day 14 (V4) and Day 42 (V6).A bacteriological success is defined as eradication of the pathogen isolated at the screening visit, without superinfection or reinfection with the same pathogen; | 7 weeks |
| Changes from baseline to any post-baseline time-point of the size of the target lesion | 7 weeks |
| Global assessment of the target lesion at Day 14 and Day 42 | Investigators will be requested to score the outcome of the target lesion on a five-grade scale: 1= worsening, 2 = no change, 3 = minimal improvement, 4 = moderate improvement and 5 = good improvement/resolution; | 7 weeks |
| Changes from baseline to any post-baseline time-point in body temperature | 7 weeks |
| Changes in WBCs count | Changes from baseline to Day 14 (V4) and Day 42 (V6) of white blood cells count (a laboratory parameters that is indicative of infection) | 7 weeks |
| Changes in Erythrocyte sedimentation rate | Changes from baseline to Day 14 (V4) and Day 42 (V6) of ESR values (a laboratory parameters that is indicative of infection) | 7 weeks |
| Changes in High-sensitivity C-reactive protein | Changes from baseline to Day 14 (V4) and Day 42 (V6) of hs-CRP values (a laboratory parameters that is indicative of infection) | 7 weeks |
| Changes from baseline to any post-baseline time point in blood pressure |
Systolic and diastolic blood pressure will be measured at each study visit in sitting position after at least 10 minutes rest |
| 7 weeks |
| Changes from baseline to any post-baseline time point in heart rate | Heart rate will be recorded at each study visit; it will be measured for one minute just prior to the sitting blood pressure measurement. | 7 weeks |
| Changes in haemoglobin values | Haematology will be evaluated in the reference local laboratory of each investigational study site at the screening visit (Visit 1, Day -7/-3) and at Visit 4 (Day 14) and Visit 6 (Day 42). | 7 weeks |
| Changes in haematocrit values | Haematology will be evaluated in the reference local laboratory of each investigational study site at the screening visit (Visit 1, Day -7/-3) and at Visit 4 (Day 14) and Visit 6 (Day 42). | 7 weeks |
| Changes in red blood cell (RBC) count | Haematology will be evaluated in the reference local laboratory of each investigational study site at the screening visit (Visit 1, Day -7/-3) and at Visit 4 (Day 14) and Visit 6 (Day 42). | 7 weeks |
| Changes in platelet count | Haematology will be evaluated in the reference local laboratory of each investigational study site at the screening visit (Visit 1, Day -7/-3) and at Visit 4 (Day 14) and Visit 6 (Day 42). | 7 weeks |
| Changes in creatinine values | Blood chemistry will be evaluated in the reference local laboratory of each investigational study site at the screening visit (Visit 1, Day -7/-3) and at Visit 4 (Day 14) and Visit 6 (Day 42). | 7 weeks |
| Changes in blood urea nitrogen (BUN) values | Blood chemistry will be evaluated in the reference local laboratory of each investigational study site at the screening visit (Visit 1, Day -7/-3) and at Visit 4 (Day 14) and Visit 6 (Day 42). | 7 weeks |
| Changes in glucose values | Blood chemistry will be evaluated in the reference local laboratory of each investigational study site at the screening visit (Visit 1, Day -7/-3) and at Visit 4 (Day 14) and Visit 6 (Day 42). | 7 weeks |
| Changes in aspartate aminotransferase (AST) values | Blood chemistry will be evaluated in the reference local laboratory of each investigational study site at the screening visit (Visit 1, Day -7/-3) and at Visit 4 (Day 14) and Visit 6 (Day 42). | 7 weeks |
| Changes in alanine aminotransferase (ALT) values | Blood chemistry will be evaluated in the reference local laboratory of each investigational study site at the screening visit (Visit 1, Day -7/-3) and at Visit 4 (Day 14) and Visit 6 (Day 42). | 7 weeks |
| Changes in gamma-glutamyl transpeptidase (gamma-GT) values | Blood chemistry will be evaluated in the reference local laboratory of each investigational study site at the screening visit (Visit 1, Day -7/-3) and at Visit 4 (Day 14) and Visit 6 (Day 42). | 7 weeks |
| Changes in alkaline phosphatase values | Blood chemistry will be evaluated in the reference local laboratory of each investigational study site at the screening visit (Visit 1, Day -7/-3) and at Visit 4 (Day 14) and Visit 6 (Day 42). | 7 weeks |
| Changes in total bilirubin values | Blood chemistry will be evaluated in the reference local laboratory of each investigational study site at the screening visit (Visit 1, Day -7/-3) and at Visit 4 (Day 14) and Visit 6 (Day 42). | 7 weeks |
| Changes in sodium values | Electrolytes will be evaluated in blood in the reference local laboratory of each investigational study site at the screening visit (Visit 1, Day -7/-3) and at Visit 4 (Day 14) and Visit 6 (Day 42). | 7 weeks |
| Changes in potassium values | Electrolytes will be evaluated in blood in the reference local laboratory of each investigational study site at the screening visit (Visit 1, Day -7/-3) and at Visit 4 (Day 14) and Visit 6 (Day 42). | 7 weeks |
| Changes in magnesium values | Electrolytes will be evaluated in blood in the reference local laboratory of each investigational study site at the screening visit (Visit 1, Day -7/-3) and at Visit 4 (Day 14) and Visit 6 (Day 42). | 7 weeks |
| Changes in chloride values | Electrolytes will be evaluated in blood in the reference local laboratory of each investigational study site at the screening visit (Visit 1, Day -7/-3) and at Visit 4 (Day 14) and Visit 6 (Day 42). | 7 weeks |
| Changes in calcium values | Electrolytes will be evaluated in blood in the reference local laboratory of each investigational study site at the screening visit (Visit 1, Day -7/-3) and at Visit 4 (Day 14) and Visit 6 (Day 42). | 7 weeks |
| Ospedali Riuniti Torrette | Not yet recruiting | Ancona | Italy |
|
| Università Federico II | Not yet recruiting | Naples | Italy |
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| Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone di Palermo | Not yet recruiting | Palermo | Italy |
|
| Fondazione IRCCS Policlinico San Matteo | Not yet recruiting | Pavia | Italy |
|
| Casa Di Cura Citta' Di Roma | Not yet recruiting | Roma | Italy |
|
| ID | Term |
|---|---|
| D007239 | Infections |
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