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Published in: Trials 1/2019

Open Access 01-12-2019 | Escherichia Coli | Study protocol

Uro-Vaxom® versus placebo for the prevention of recurrent symptomatic urinary tract infections in participants with chronic neurogenic bladder dysfunction: a randomised controlled feasibility study

Authors: Derick Wade, James Cooper, Fadel Derry, Julian Taylor

Published in: Trials | Issue 1/2019

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Abstract

Background

Patients with lower neurogenic bladder dysfunction are at an increased risk of suffering from recurrent urinary tract infections. Recurrent symptomatic urinary tract infection is occasionally treated with antibiotics as a prophylactic prevention strategy. This risks increasing the frequency of antibiotic resistance. National healthcare policymakers have requested further research into alternative preventive measures for pathologies that require antibiotic treatment.

Methods

This study protocol describes a two-centre, randomised, double-blinded, placebo-controlled study to evaluate the prevention of recurrent urinary tract infections with the commercial immunotherapy agent Uro-Vaxom®, based on Escherichia coli pathogen-associated molecular patterns. Eligible participants are recruited by the direct healthcare team and randomised to receive Uro-Vaxom® in the form of an oral capsule, or a matching placebo. Participants will receive the study treatment daily for 3 months and followed up for an additional 3 months so that the number of symptomatic urinary tract infection episodes and individual signs and symptoms per episode can be recorded using participant study diaries. Primary outcome measures are: number of symptomatic urinary tract infections experienced over 3 months, number of symptomatic urinary tract infections experienced over 6 months, time from the start of treatment to the first urinary tract infection, and the presence of asymptomatic bacteriuria at 3 and 6 months. Secondary outcome measures are: individually recorded symptoms normally associated with recurrent urinary tract infection and consistency of reported symptoms during the symptomatic urinary tract infection experienced during the study, compliance with study protocol and study medication, and adverse events.

Discussion

Healthcare policymakers recommend that alternative preventative strategies are identified for symptomatic urinary tract infections that require antibiotic treatment. If Uro-Vaxom® is shown to be effective, this feasibility study would warrant a larger, statistically powered, multicentre study to investigate whether this immunotherapy strategy is an effective preventative measure for recurrent symptomatic urinary tract infection for people with spinal cord injuries and neurological pathologies.

Trial registration

ISRTCN. Registered on 30 October 2015.
ClinicalTrials.gov, ID: NCT0251901. Registered on 30 October 2015.
URL of trial registry record: Ethics Ref: 15-LO-2069. IRAS Number: 185760. Sponsor Number: RXQ/648.
NIHR Funding Reference: PB-PG-1013-32017.
Appendix
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Literature
1.
go back to reference Salomon J, Denys P, Merle C, Chartier-Kastler E, Perronne C, Gaillard JL, Bernard L. Prevention of urinary tract infection in spinal cord-injured patients: safety and efficacy of a weekly oral cyclic antibiotic (WOCA) programme with a 2-year follow-up—an observational prospective study. J Antimicrob Chemother. 2006;57:784–8.CrossRef Salomon J, Denys P, Merle C, Chartier-Kastler E, Perronne C, Gaillard JL, Bernard L. Prevention of urinary tract infection in spinal cord-injured patients: safety and efficacy of a weekly oral cyclic antibiotic (WOCA) programme with a 2-year follow-up—an observational prospective study. J Antimicrob Chemother. 2006;57:784–8.CrossRef
2.
go back to reference Manack A, Motsko SP, Haag-Molkenteller C, Dmochowski RR, Goehring EL Jr, Nguyen-Khoa BA, Jones JK. Epidemiology and healthcare utilization of neurogenic bladder patients in a US claims database. Neurourol Urodyn. 2011;30:395–401.CrossRef Manack A, Motsko SP, Haag-Molkenteller C, Dmochowski RR, Goehring EL Jr, Nguyen-Khoa BA, Jones JK. Epidemiology and healthcare utilization of neurogenic bladder patients in a US claims database. Neurourol Urodyn. 2011;30:395–401.CrossRef
3.
go back to reference Esclarin De Ruz A, Garcia Leoni E, Herruzo Cabrera R. Epidemiology and risk factors for urinary tract infection in patients with spinal cord injury. J Urol. 2000;164:1285–9.CrossRef Esclarin De Ruz A, Garcia Leoni E, Herruzo Cabrera R. Epidemiology and risk factors for urinary tract infection in patients with spinal cord injury. J Urol. 2000;164:1285–9.CrossRef
4.
go back to reference Khatri B, Basnyat S, Karki A, Poudel A, Shrestha B. Etiology and antimicrobial susceptibility pattern of bacterial pathogens from urinary tract infection. Nepal Med Coll J. 2012;14:129–32.PubMed Khatri B, Basnyat S, Karki A, Poudel A, Shrestha B. Etiology and antimicrobial susceptibility pattern of bacterial pathogens from urinary tract infection. Nepal Med Coll J. 2012;14:129–32.PubMed
5.
go back to reference Ginsberg D. The epidemiology and pathophysiology of neurogenic bladder. Am J Manag Care. 2013;19:s191–6.PubMed Ginsberg D. The epidemiology and pathophysiology of neurogenic bladder. Am J Manag Care. 2013;19:s191–6.PubMed
6.
go back to reference D'Hondt F, Everaert K. Urinary tract infections in patients with spinal cord injuries. Curr Infect Dis Rep. 2011;13:544–51.CrossRef D'Hondt F, Everaert K. Urinary tract infections in patients with spinal cord injuries. Curr Infect Dis Rep. 2011;13:544–51.CrossRef
10.
go back to reference Salameh A, Al Mohajer M, Daroucihe RO. Prevention of urinary tract infections in patients with spinal cord injury. CMAJ. 2015;187:807–11.CrossRef Salameh A, Al Mohajer M, Daroucihe RO. Prevention of urinary tract infections in patients with spinal cord injury. CMAJ. 2015;187:807–11.CrossRef
11.
go back to reference Hess MJ, Hess PE, Sullivan MR, Nee M, Yalla SV. Evaluation of cranberry tablets for the prevention of urinary tract infections in spinal cord injured patients with neurogenic bladder. Spinal Cord. 2008;46:622–6.CrossRef Hess MJ, Hess PE, Sullivan MR, Nee M, Yalla SV. Evaluation of cranberry tablets for the prevention of urinary tract infections in spinal cord injured patients with neurogenic bladder. Spinal Cord. 2008;46:622–6.CrossRef
12.
go back to reference Barclay J, Veeratterapillay R, Harding C. Non-antibiotic options for recurrent urinary tract infections in women. BMJ. 2017;359:j5193.CrossRef Barclay J, Veeratterapillay R, Harding C. Non-antibiotic options for recurrent urinary tract infections in women. BMJ. 2017;359:j5193.CrossRef
13.
go back to reference Huber M, Ayoub M, Pfannes SD, Mittenbuhler K, Weis K, Bessler WG, Baier W. Immunostimulatory activity of the bacterial extract OM-8. Eur J Med Res. 2000;5:101–9.PubMed Huber M, Ayoub M, Pfannes SD, Mittenbuhler K, Weis K, Bessler WG, Baier W. Immunostimulatory activity of the bacterial extract OM-8. Eur J Med Res. 2000;5:101–9.PubMed
14.
go back to reference Bauer HW, Alloussi S, Egger G, Blumlein HM, Cozma G, Schulman CC. Multicenter UTISG.:A long-term, multicenter, double-blind study of an Escherichia coli extract (OM-89) in female patients with recurrent urinary tract infections. Eur Urol. 2005;47:542–8 discussion 548.CrossRef Bauer HW, Alloussi S, Egger G, Blumlein HM, Cozma G, Schulman CC. Multicenter UTISG.:A long-term, multicenter, double-blind study of an Escherichia coli extract (OM-89) in female patients with recurrent urinary tract infections. Eur Urol. 2005;47:542–8 discussion 548.CrossRef
15.
go back to reference Schulman CC, Corbusier A, Michiels H, Taenzer HJ. Oral immunotherapy of recurrent urinary tract infections: a double-blind placebo-controlled multicenter study. J Urol. 1993;150:917–21.CrossRef Schulman CC, Corbusier A, Michiels H, Taenzer HJ. Oral immunotherapy of recurrent urinary tract infections: a double-blind placebo-controlled multicenter study. J Urol. 1993;150:917–21.CrossRef
16.
go back to reference Magasi P, Panovics J, Illes A, Nagy M. Uro-Vaxom and the management of recurrent urinary tract infection in adults: a randomized multicenter double-blind trial. Eur Urol. 1994;26:137–40.CrossRef Magasi P, Panovics J, Illes A, Nagy M. Uro-Vaxom and the management of recurrent urinary tract infection in adults: a randomized multicenter double-blind trial. Eur Urol. 1994;26:137–40.CrossRef
17.
go back to reference Tammen H. Immunobiotherapy with Uro-Vaxom in recurrent urinary tract infection. The German Urinary Tract Infection Study Group. Br J Urol. 1990;65:6–9.CrossRef Tammen H. Immunobiotherapy with Uro-Vaxom in recurrent urinary tract infection. The German Urinary Tract Infection Study Group. Br J Urol. 1990;65:6–9.CrossRef
18.
go back to reference Hachen HJ. Oral immunotherapy in paraplegic patients with chronic urinary tract infections: a double-blind, placebo-controlled trial. J Urol. 1990;143:759–62 discussion 762-753.CrossRef Hachen HJ. Oral immunotherapy in paraplegic patients with chronic urinary tract infections: a double-blind, placebo-controlled trial. J Urol. 1990;143:759–62 discussion 762-753.CrossRef
19.
go back to reference Krebs J, Fleischli S, Stoyanov J, Pannek J. Effects of oral immunomodulation therapy on urinary tract infections in individuals with chronic spinal cord injury—A retrospective cohort study. Neurourol Urodyn. 2019;38:346–52.CrossRef Krebs J, Fleischli S, Stoyanov J, Pannek J. Effects of oral immunomodulation therapy on urinary tract infections in individuals with chronic spinal cord injury—A retrospective cohort study. Neurourol Urodyn. 2019;38:346–52.CrossRef
21.
go back to reference Eldridge SM, Chan CL, Campbell MJ, Bond CM, Hopewell S, Thabane L, Lancaster GA, PAFS Consensus Group. CONSORT 2010 Statement: extension to randomised pilot and feasibility trials. BMJ. 2016;355:i5239.CrossRef Eldridge SM, Chan CL, Campbell MJ, Bond CM, Hopewell S, Thabane L, Lancaster GA, PAFS Consensus Group. CONSORT 2010 Statement: extension to randomised pilot and feasibility trials. BMJ. 2016;355:i5239.CrossRef
22.
go back to reference Sunden F, Hakansson L, Ljunggren E, Wullt B. Escherichia coli 83972 bacteriuria protects against recurrent lower urinary tract infections in patients with incomplete bladder emptying. J. Urol. 2010;184:179–85.CrossRef Sunden F, Hakansson L, Ljunggren E, Wullt B. Escherichia coli 83972 bacteriuria protects against recurrent lower urinary tract infections in patients with incomplete bladder emptying. J. Urol. 2010;184:179–85.CrossRef
Metadata
Title
Uro-Vaxom® versus placebo for the prevention of recurrent symptomatic urinary tract infections in participants with chronic neurogenic bladder dysfunction: a randomised controlled feasibility study
Authors
Derick Wade
James Cooper
Fadel Derry
Julian Taylor
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Trials / Issue 1/2019
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-019-3275-x

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