Evaluating the Healing of Diabetic Foot Ulcers With Compounded Anti-Infective Irrigation Therapy

Overview

Diabetic foot ulcers (DFUs) are a frequent clinical problem observed in diabetic patients. Properly managed, most can be cured, but many patients needlessly undergo amputations because of improper diagnostic and therapeutic approaches. The purpose of this study is to evaluate the effectiveness of a compounded, anti-infective irrigation therapy to increase the healing rates of diabetic foot ulcers and thereby provide a new therapeutic option for health care providers treating high-risk patients with DFUs regardless if secondary fungal infections are present. Participants diagnosed with diabetes type 1 or 2 and with a documented open diabetic foot ulcer/wound with or without a secondary fungal infection will be included in this prospective, active intervention pilot study. Healing rates will be evaluated every two weeks following the initiation of study therapy up to three months. Participants with diabetic foot ulcers will be treated with a compounded, anti-infective irrigation therapy daily until closure of the ulcer or up to a maximum of 3 months. Participants will be asked to return to clinic every two – four weeks for assessment of the ulcer and compliance with treatment. A sample size of approximately 100 patients is estimated to have 90% power to detect 15% improvement in ulcer healing rates to 45% and 35% compared to historical benchmarks of approximately 30% for ulcers of <6 months duration and 20% for ulcers ≥6 months duration and/or prior treatment failure, respectively.

Full Title of Study: “Evaluating the Healing of Diabetic Foot Ulcers With Compounded Anti-Infective Irrigation”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: N/A
    • Intervention Model: Single Group Assignment
    • Primary Purpose: Treatment
    • Masking: None (Open Label)
  • Study Primary Completion Date: August 2022

Interventions

  • Drug: vancomycin-tobramycin-itraconazole
    • Participants with diabetic foot ulcers will be treated with a compounded, anti-infective irrigation therapy daily until closure of the ulcer or up to a maximum of 3 months. This is an irrigating foot bath with a compounded medication of vancomycin-tobramycin-itraconazole. This medication with combined 3/4 gallon of water. Participant will soak foot in solution for 10 minutes per day. Daily until wound is healed for a minimum of 4 weeks and a maximum of 3 months.

Arms, Groups and Cohorts

  • Experimental: Treatment of Diabetic Foot Ulcer
    • Participants with diabetic foot ulcers will be treated with a compounded, anti-infective irrigation therapy daily until closure of the ulcer or up to a maximum of 3 months. This is an irrigating foot bath with a compounded medication of vancomycin-tobramycin-itraconazole. This medication with combined 3/4 gallon of water. Participant will soak foot in solution for 10 minutes per day. Daily until wound is healed for a minimum of 4 weeks and a maximum of 3 months.

Clinical Trial Outcome Measures

Primary Measures

  • Healing Rate
    • Time Frame: 12 weeks
    • We will be looking at measurements of the wound at the start of the study and at each study visit until the wound is healed, or the study has ended. The wounds are measured with a ruler by the provider seeing the patient at the time of the visit in centimeters. The wounds are also photographed with a ruler in the photograph for size.

Secondary Measures

  • Wound Closure
    • Time Frame: Until the wound is closed up to 12 weeks
    • Assessing how many patients wounds closed during the study and the time in weeks it took for the patient to close their wound.

Participating in This Clinical Trial

Inclusion Criteria

  • Type 1 or Type 2 diabetes mellitus – An open DFU / wound of any size (including those requiring debridement in operation room or clinic setting) with or without a secondary fungal infection – ≥ 18 years of age – Treatment naïve or treatment failure with oral antibiotics to current wound infection Exclusion Criteria:

  • Patients who present with untreated or on active-treatment for osteomyelitis, exposed bone, or have a life-threatening need of immediate surgery. – Patients who are allergic to any components of the investigated product. – Patients who have ≥ 15 shoe size – Patients who have received IV antibiotics within the past 30 days – Patients with HgbA1C > 14 – Patients on active cancer treatment – Patients needing re-vascularization of the affected area but did not receive treatment. – Patients diagnosed with HIV/AIDs – Patients unable or unwilling to obtain and wear off-loading footwear

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • University of Mississippi Medical Center
  • Collaborator
    • Keystone Pharmacy
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Laura R Vick, MD, Principal Investigator, University of Mississippi Medical Center
  • Overall Contact(s)
    • Laura R Vick, MD, 601-278-6213, lvick@umc.edu

References

Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJ, Armstrong DG, Deery HG, Embil JM, Joseph WS, Karchmer AW, Pinzur MS, Senneville E; Infectious Diseases Society of America. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2012 Jun;54(12):e132-73. doi: 10.1093/cid/cis346.

Everett E, Mathioudakis N. Update on management of diabetic foot ulcers. Ann N Y Acad Sci. 2018 Jan;1411(1):153-165. doi: 10.1111/nyas.13569. Review.

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