Title

Study Comparing the Safety and Efficacy of Cethromycin to Clarithromycin for the Treatment of Community-Acquired Pneumonia (CAP)
A Double-Blinded, Randomized, Parallel Group, Multi-Center, Multi-National Comparative Study of the Safety and Efficacy of Cethromycin 300 mg QD to Clarithromycin (BIAXIN® Filmtab®) 250 mg BID for the Treatment of Community-Acquired Pneumonia in Adults
  • Phase

    Phase 3
  • Study Type

    Interventional
  • Study Participants

    584
The purpose of this study is to compare the efficacy of cethromycin to clarithromycin for the treatment of mild to moderate community-acquired pneumonia (CAP).
Lower respiratory tract infections remain one of the leading causes of death worldwide. Increasing rates of antibiotic resistance and newer, more pervasive pneumonia-causative pathogens contribute to this statistic. Currently available macrolide antibiotics for the treatment of community-acquired pneumonia are slowly losing effectiveness, resulting in the need to develop newer drugs to fight resistant infections. In this study, we compare the safety and efficacy of a common macrolide, clarithromycin, to a new ketolide, cethromycin.
Study Started
Dec 31
2005
Primary Completion
Oct 31
2007
Study Completion
Oct 31
2007
Results Posted
Feb 26
2010
Estimate
Last Update
Feb 26
2010
Estimate

Drug Cethromycin

Cethromycin 300 mg once per day (QD) for 7 days, administered orally

  • Other names: Restanza, ABT-773

Drug Clarithromycin

Clarithromycin 250 mg twice per day (BID) for 7 days, administered orally

  • Other names: Biaxin, Klacid, Klaracid

Clarithromycin Active Comparator

Cethromycin Experimental

Criteria

Inclusion Criteria:

Ambulatory male or female, 18 years of age or older
If female, non-lactating and at no risk or pregnancy (post-menopausal or must use adequate birth control)
Positive Chest X-ray consistent with diagnosis of bacterial pneumonia
Must be a suitable candidate for oral antibiotic therapy and must be able to swallow capsules intact
Recent history of respiratory illness consistent with the clinical signs and symptoms of bacterial CAP
Must be able to produce sputum

Exclusion Criteria:

Prior hospitalization within previous 4 weeks
Residence at a chronic care facility
Active tuberculosis (or other mycobacterial infection, empyema, lung abscess, pulmonary embolism, pulmonary edema, cystic fibrosis, tumor (primary or metastatic) involving the lung, bronchial obstruction, a history of post-obstructive pneumonia (chronic obstructive pulmonary disease [COPD] is not exclusionary), known or suspected Pneumocystis carinii pneumonia
Treatment with long-acting antimicrobial agents within the last 4 weeks, treatment with ceftriaxone, azithromycin or dirithromycin antibiotic within the last 7 days, or subjects who have received more than 24 hours of treatment with other antibiotics within 7 days prior to study drug administration
Any infection which requires the use of a concomitant antimicrobial agent
History of hypersensitivity or allergic reactions to macrolide, ketolide, quinolone, azalide or streptogramin antimicrobials
Treatment with another investigational drug within the last 4 weeks
Females who are pregnant or lactating
Subjects with known significant renal or hepatic impairment or disease
Subjects with a history of impaired renal function
Evidence of uncontrolled clinically significant cardiovascular, pulmonary, metabolic, gastrointestinal, neurological or endocrine disease, malignancy, or other abnormality (other than the disease being studied)
Subjects who would require parenteral antimicrobial therapy for the treatment of pneumonia
Any underlying disease or condition that would interfere with the completion of the study procedures and evaluations or absorption of the study drug
Currently receiving or are likely to require any of the following medications during the period between 2 weeks prior to Evaluation 1 and within 24 hours after the last dose of study drug: astemizol (Hismanal®) or pimozide (Orap®)
Currently receiving or are likely to require any of the following during the period from Evaluation 1 and within 24 hours after the last dose of study drug: theophylline or theophylline analogues (unless adequately monitored), carbamazepine, dexamethasone, phenobarbital, phenytoin, St. John's Wort, lamotrigine, troglitazone, warfarin and digitalis glycoside. Other barbiturates may be used with careful monitoring
Subjects who are currently receiving or who are likely to require any of the following medications during the period between Evaluation 1 and 4: other systemic antibiotic therapy, rifampin or rifabutin
Immunocompromised subjects, subjects receiving immunosuppressive agents, subjects with known human immunodeficiency virus (HIV) infections and history of acquired immune deficiency syndrome (AIDS) defining conditions or CD4+ T-lymphocyte count <200.
Subject with known or suspected central nervous system (CNS) disorder that predisposes them to seizures/lower seizure threshold (e.g., severe cerebral arteriosclerosis, epilepsy)
Previous treatment with cethromycin
Subjects with signs of septic shock (e.g., mental confusion, severe hypoxemia, severe hypotension, any other condition requiring intensive care unit [ICU] admission)

Summary

Cethromycin

Clarithromycin

All Events

Event Type Organ System Event Term Cethromycin Clarithromycin

Clinical Cures in the Intent to Treat Population

Investigators evaluated subjects for a clinical response of cure, failure, or indeterminate. Cure: Improvement or return to preinfection state or lack of progression of all pulmonary infiltrates, and resolution of all signs/symptoms present at enrollment. Failure: Persistence or worsening of signs/symptoms, the need for additional antibiotic, new pulmonary infection, progression of the chest radiograph, or death due to pneumonia. Indeterminate: Evaluation was not possible (lost to follow up, adverse event, major protocol violation). Indeterminates default to failure for analysis.

Cethromycin

Clinical Cures

217.0
Participants

Clinical Failures

14.0
Participants

Indeterminates

30.0
Participants

Clarithromycin

Clinical Cures

206.0
Participants

Clinical Failures

13.0
Participants

Indeterminates

35.0
Participants

Clinical Cures in the Per Protocol Clinically Evaluable Population

Investigators evaluated subjects for a clinical response of cure, failure, or indeterminate. Cure: Improvement or return to preinfection state or lack of progression of all pulmonary infiltrates, and resolution of all signs/symptoms present at enrollment. Failure: Persistence or worsening of signs/symptoms, the need for additional antibiotic, new pulmonary infection, progression of the chest radiograph, or death due to pneumonia. Indeterminate: Evaluation was not possible (lost to follow up, adverse event, major protocol violation). Indeterminates default to failure for analysis.

Cethromycin

Clinical Cures

205.0
Participants

Clinical Failures

13.0
Participants

Clarithromycin

Clinical Cures

195.0
Participants

Clinical Failures

13.0
Participants

Bacteriologic Cures in the Intent to Treat Population

All bacteriologically evaluable subjects (ie., the subject had at least one, protocol-defined evaluable pathogen) who demonstrated eradication of all evaluable pathogens (S. pneumoniae, S. aureus, H. influenzae, M. catarrhalis, M. pneumoniae, C. pneumoniae, L. pneumophila).

Cethromycin

Bacteriologic Cures

73.0
Participants

Clarithromycin

Bacteriologic Cures

73.0
Participants

Bacteriologic Cures in the Per Protocol Clinically Evaluable Population

All bacteriologically evaluable subjects (ie., the subject had at least one, protocol-defined evaluable pathogen) who demonstrated eradication of all evaluable pathogens (S. pneumoniae, S. aureus, H. influenzae, M. catarrhalis, M. pneumoniae, C. pneumoniae, L. pneumophila).

Cethromycin

Bacteriologic Cures

71.0
Participants

Clarithromycin

Bacteriologic Cures

67.0
Participants

Total

582
Participants

Age Continuous

49.5
years (Mean)
Standard Deviation: 15.4

Sex: Female, Male

Overall Study

Cethromycin

Clarithromycin

Drop/Withdrawal Reasons

Cethromycin

Clarithromycin