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TerminatedNCT01618591TrEAT TDUpdated Nov 28, 2016

Trial Evaluating Ambulatory Treatment of Travelers' Diarrhea

An interventional study of Single dose rifaximin 1650 mg and Single dose azithromycin 500 mg in Acute Watery Diarrhea and Dysentery/Febrile Diarrhea, sponsored by Uniformed Services University of the Health Sciences. Terminated at 5 sites in 5 countries. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2016-11-28.

Sponsored by Uniformed Services University of the Health Sciences · Not applicable, Interventional, and Treatment

Why this study was terminated
AWD arm was completed. ADF diarrhea arm was unable to fill completely and there are no funds remaining to continue recruiting/enrolling.
Phase
Not applicable
Study type
Interventional
Enrollment
384
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

The purpose of the trial is to develop the evidence on relative efficacy of 3 available single-dose loperamide adjuncted regimens for watery diarrhea and a single-dose regimen, with and without loperamide, for dysentery/febrile diarrhea required for informing decisions among these regimens. Information from this study will be used to develop management guidelines for the diagnosis and management of travelers' diarrhea (TD) among deployed United States and United Kingdom military personnel.

Read the detailed description

The study will be a multi-site, randomized, double-blind, controlled clinical trial among ambulatory deployed personnel. Patients presenting for care will be clinically assessed and a determination made as to whether they have acute watery diarrhea (AWD) or acute dysentery/febrile diarrhea (ADF). For the AWD arm, patients will be randomized to receive 1 of 3 regimens: (1) rifaximin 1650 mg as a single dose plus loperamide 4 mg initially followed by 2 mg after each unformed stool, not to exceed 16 mg/day for 2 days (120 subjects); (2) azithromycin 500 mg as a single dose plus loperamide 4 mg initially followed by 2 mg after each unformed stool, not to exceed 16 mg/day for 2 days (120 subjects); or (3) levofloxacin 500 mg as a single dose plus loperamide 4 mg initially followed by 2 mg after each unformed stool, not to exceed 16 mg/day for 2 days (120 subjects).

For the ADF arm, patients will be randomized to receive 1 of 2 regimens: (1) azithromycin 1000 mg as a single dose plus loperamide 4 mg initially followed by 2 mg after each unformed stool, not to exceed 16 mg/day for 2 days (75 subjects); or (2) azithromycin 1000 mg as a single dose without loperamide (75 subjects).

Study Procedures (Brief): Baseline exam as well as blood and stool samples will be collected at initial clinic visit. Clinical assessments will be performed at 24 hours, 72 hours, and 7 days. In addition, microbiological cure will be evaluated at 7-d post initiation of treatment. Subjects will have blood drawn to assess for serological conversion to common enteric pathogens, and stool collected at 7- and 21-d . Subjects may also opt in for long-term follow-up at time of enrollment, which will assess for development of post-infectious functional bowel disorders. All subjects will complete a baseline assessment at 7-d visit, and those who opt for the additional follow-up will complete a series of web-based surveys at 3-, 6-, 9-, and 12-m post enrollment.

02

Conditions studied

  • Acute Watery Diarrhea
  • Dysentery/Febrile Diarrhea

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Keywords

  • diarrhea
  • travelers' diarrhea
  • watery diarrhea
  • enteric illness
  • dysentery
  • gastrointestinal
03

In context

Dysentery

44 studies on the registry are indexed under Dysentery; 6 are open to participants now.

This study's enrollment of 384 is above the median of 163 across 38 interventional studies indexed under Dysentery.

Browse Dysentery studies →

Lead sponsor

Uniformed Services University of the Health Sciences is the lead sponsor of 45 studies on the registry; 12 are open to participants now.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  1. Active duty military or military beneficiary, 18 years-old or older.
  2. Presence of acute diarrhea (3 or more stools in 24 hours or 2 or more stools in 24 hours and associated symptoms such as nausea, vomiting, abdominal cramps or tenesmus) and \<96 hours duration.
  3. Eligible for ambulatory management.
  4. Able to comply with follow-up procedures.
  5. Will remain in country for at least 7 days

Exclusion criteria

Exclusion Criteria:

  1. Allergy to rifamycins, quinolones, macrolides, or loperamide (not including mild gastrointestinal upset).
  2. Antibiotic therapy in the 72 hours prior to presentation (excluding malaria prophylaxis with mefloquine, malarone, chloroquine/proguanil, or doxycycline).
  3. Concomitant medications with known drug-drug interactions with any of the study drugs (includes theophylline, digoxin, and warfarin).
  4. History of seizures (relative to quinolones)
  5. Positive pregnancy test at presentation (contraindicated with fluoroquinolone therapy). All female subjects will be administered a urine pregnancy test prior to enrollment.
  6. Presence of symptoms >96 hours prior to initiating treatment.
  7. Use of >4 mg loperamide or use of any amount of loperamide for greater than 24 hours prior to enrollment.
Terms in these criteria, in plain language(1)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Contraindication

A reason a treatment, test or procedure should not be given to a particular person, such as an allergy, another illness or a medicine they take.

05

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Triple (Participant, Investigator, Outcomes assessor)
Enrollment
384 participants (actual)

Study arms

  • Experimental
    Acute Watery Diarrhea

    Drug: Single dose rifaximin 1650 mg · Drug: Single dose azithromycin 500 mg · Drug: Single dose levofloxacin 500 mg

  • Experimental
    Acute Dysentery/Febrile

    Drug: Single dose azithromycin 1000 mg plus loperamide · Drug: Single dose azithromycin 1000 mg plus placebo

Interventions

  • DrugSingle dose rifaximin 1650 mg

    Rifaximin 1650 mg as a single dose plus loperamide 4 mg initially followed by 2 mg after each unformed stool, not to exceed 16 mg/day for 2 days

  • DrugSingle dose azithromycin 500 mg

    Azithromycin 500 mg as a single dose plus loperamide 4 mg initially followed by 2 mg after each unformed stool, not to exceed 16 mg/day for 2 days

  • DrugSingle dose levofloxacin 500 mg

    Levofloxacin 500 mg as a single dose plus loperamide 4 mg initially followed by 2 mg after each unformed stool, not to exceed 16 mg/day for 2 days

  • DrugSingle dose azithromycin 1000 mg plus loperamide

    Azithromycin 1000 mg as a single dose plus loperamide 4 mg initially followed by 2 mg after each unformed stool, not to exceed 16 mg/day for 2 days

  • DrugSingle dose azithromycin 1000 mg plus placebo

    Azithromycin 1000 mg as a single dose and placebo in lieu of loperamide

06

What researchers measure

Primary outcomes

  1. Clinical Cure - Acute Watery Diarrhea group

    * No grade 3-5 stools beyond 24 hours after initiation of therapy meeting diarrhea definition (≥3 loose or liquid stools in 24 hour period). All diarrhea associated symptoms present must be no greater than mild in severity and have no impact on activity. * AND, no treatment failure events to include the following: * Recurrence of diarrheal illness meeting case definition of TD occurring within 72 hours after clinical cure * Worsening of, or failure to improve, clinical symptoms after 24 hours of therapy * Illness continuing after 72 hours

    Time frame: 24 hours

  2. Clinical Cure - Acute Dysentery/Febrile Diarrhea group

    * No grade 3-5 stools beyond 48 hours after initiation of therapy meeting diarrhea definition (≥3 loose or liquid stools in 24 hour period) and resolution of acute dysentery/febrile diarrhea-associated signs/symptoms to include fever and gross blood in stool, as well as report of no impact on activity * AND, no treatment failure events to include the following: * Recurrence of diarrheal illness meeting case definition of TD occurring within 72 hours after clinical cure * Worsening of, or failure to improve after 24 hours of therapy * Illness continuing after 72 hours

    Time frame: 48 hours

Secondary outcomes

  1. Time to Last Unformed Stool

    Calculated as the time from taking the first dose of study medication until passage of the last unformed stool that meets diarrhea definition (grade 3-5 stool associated with 2 other loose stools in 24 hours or 1 other loose stool and associated symptoms in that same 24 hour block) after which subjects are declared well. Where, last unformed stool = last grade 3-5 stool occurring in a 24-hr period meeting the diarrhea definition.

    Time frame: 24, 48, 72 hours

07

Study locations

5 sites
  • UK Role 3 Joint Force Hospital
    Camp Bastion, Afghanistan
  • U.S. Naval Expeditionary Base
    Camp Lemonnier, Djibouti
  • Joint Task Force - Bravo
    Soto Cano Air Base, Honduras
  • British Army Training Unit Kenya
    Nanyuki, Kenya
  • Armed Forces Research Institute of Medical Sciences
    Bangkok, Thailand
08

References and documents

Publications

  • Johnson RC, Van Nostrand JD, Tisdale M, Swierczewski B, Simons MP, Connor P, Fraser J, Melton-Celsa AR, Tribble DR, Riddle MS. Fecal Microbiota Functional Gene Effects Related to Single-Dose Antibiotic Treatment of Travelers' Diarrhea. Open Forum Infect Dis. 2021 May 28;8(6):ofab271. doi: 10.1093/ofid/ofab271. eCollection 2021 Jun. PubMed 34189178 ↗
  • Riddle MS, Connor P, Fraser J, Porter CK, Swierczewski B, Hutley EJ, Danboise B, Simons MP, Hulseberg C, Lalani T, Gutierrez RL, Tribble DR; TrEAT TD Study Team. Trial Evaluating Ambulatory Therapy of Travelers' Diarrhea (TrEAT TD) Study: A Randomized Controlled Trial Comparing 3 Single-Dose Antibiotic Regimens With Loperamide. Clin Infect Dis. 2017 Nov 29;65(12):2008-2017. doi: 10.1093/cid/cix693. PubMed 29029033 ↗
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Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Nov 28, 2016, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT01618591
Lead sponsor
Uniformed Services University of the Health Sciences
Collaborators
Navy Bureau of Medicine and Surgery, Ministry of Defence, United Kingdom, Naval Medical Research Center, Naval Medical Research Unit- 3, United States Army Medical Unit - Kenya, United States Naval Medical Center, Portsmouth, Naval Medical Research Unit- 6
Responsible party
Mark Riddle, CDR, MC, USN (Head, Enteric Diseases Department, Naval Medical Research Center) — Principal investigator
First posted
Jun 13, 2012
Start date
Sep 2012
Primary completion
Mar 2016
Completion
Mar 2016
Last update
Nov 28, 2016

Study contacts

Mark Riddle, MD, DrPH
principal investigator · Naval Medical Research Center

Oversight

Data monitoring committee
Yes
View the source record on ClinicalTrials.gov ↗

Not currently enrolling

This study is terminated, as verified in Nov 2016. You cannot join it, but the record below documents what was studied.

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