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CompletedNCT05607056SPAADAUpdated Oct 21, 2024

Efficacy and Safety of Sinquanon for Prevention of Antibiotic-associated Diarrhea in Adults

An interventional study of Sinquanon and Placebo in Antibiotic-associated Diarrhea, sponsored by Neopharm Bulgaria Ltd.. Completed at 3 sites in Bulgaria. Open to participants aged 18 Years to 60 Years. Per ClinicalTrials.gov, last updated 2024-10-21.

Sponsored by Neopharm Bulgaria Ltd. · Not applicable, Interventional, and Prevention

Phase
Not applicable
Study type
Interventional
Enrollment
565
Allocation
Randomized
Ages
18 Years to 60 Years
Sex
All
01

Study summary

The purpose of this study is to evaluate the efficacy of a probiotic, SINQUANON, on the reduction of the occurrence of diarrhea associated with antibiotic use in adults.

Read the detailed description

The study aims to evaluate the efficacy of a specialized multi-strain probiotic, SINQUANON, on the reduction of the incidence of antibiotic-associated diarrhea in adults and to demonstrate the benefit of administering the specialized multi-strain probiotic as a routine add-on to antibiotic therapy on prevention of antibiotic-associated diarrhea in adults who take antibiotics in the outpatient setting.

02

Conditions studied

  • Antibiotic-associated Diarrhea

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Keywords

  • Probiotics
  • Antibiotics
  • Antibiotic-associated diarrhea
  • High-dose
  • Multistrain
03

In context

Diarrhea

852 studies on the registry are indexed under Diarrhea; 78 are open to participants now.

This study's enrollment of 565 is above the median of 136 across 713 interventional studies indexed under Diarrhea.

Browse Diarrhea studies →

Lead sponsor

Neopharm Bulgaria Ltd. is the lead sponsor of 3 studies on the registry; 1 is open to participants now.

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

04

Who can participate

Ages eligible
18 Years to 60 Years
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Male or female subject aged 18 to 60 years.
  • The subject has given written informed consent after being provided orally with information about the study objective and design, including the administration regimen of the studied probiotic and the study procedures, the available safety data, as well as the rights and obligations of a participant.
  • The subject initiates oral antibiotic treatment in the ambulatory setting.
  • Acceptable antibiotic therapy:

    • Broad-spectrum penicillins
    • Cephalosporins
    • Quinolones
    • Tetracyclines

Sequential administration of two antibiotics from the allowed groups is permitted, if the total duration of the antibiotic treatment does not exceed 10 days.

  • Planned duration of the antibiotic treatment of 5 to 10 days.
  • Body mass index (BMI) of 18.0 to 29.9 kg/m2
  • In the opinion of the Investigator, the subject can adhere to the visit schedule, to be compliant with the trial treatment regimen and to complete the study.
  • The patient has a smartphone and can use it.

Exclusion criteria

Exclusion Criteria:

  • Antibiotics use within 60 days prior to randomization.
  • Daily consumption of probiotics, yogurt with probiotics and inability to stop this consumption.
  • Use of antidiarrheal medications, laxatives, enemas, or suppositories within 1 week prior to randomization and for the duration of the trial.
  • An episode of diarrhea within 30 days before screening, defined as ≥3 loose or liquid stools over 24 hours, regardless of the cause of the diarrhea.
  • Acute or chronic constipation - average number of formed stools \<3 per week.
  • Allergy or hypersensitivity to any of the ingredients of the trial product.
  • Allergy or hypersensitivity to the antibiotic prescribed on Day 1.
  • Prior documented infection with Clostridioides difficile ≤3 months before screening.
  • History of chronic gastrointestinal conditions, including irritable bowel syndrome, chronic constipation, chronic diarrhea, dyspepsia, gastroesophageal reflux disease, diverticulitis, ulcerative colitis, Crohn's disease or any other abnormality in the absorption or gastrointestinal dysfunction.
  • Use of proton-pump inhibitors (PPIs) within 30 days prior to Day 1 and for the duration of the study.
  • Surgery to the intestines, artificial heart valve, history of rheumatological heart disease or infectious endocarditis within one year prior to screening.
  • Immunosuppressive therapy or any condition causing immunosuppression (including hematologic malignancies, AIDS, long-lasting corticosteroid treatment).
  • Planned administration of antibiotics, different from those acceptable for the study.
  • Patients in severe condition requiring urgent hospitalization or planned hospitalization during the study.
  • Planned administration of antibiotics >10 days.
  • BMI ≥ 30 kg/m2.
  • Pregnant or lactating women; women who plan to get pregnant during the study.
  • Drug abuse or alcohol within the past year.
  • Unstable medical conditions, in the judgement of the Investigator.
  • Eating disorders (for example, anorexia, bulimia).
  • On a vegan diet.
  • Participation in a clinical trial within 60 days prior to randomization.
  • Inability to comply with the study protocol.
05

Study design

Phase
Not applicable
Primary purpose
Prevention
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Double (Participant, Investigator)
Enrollment
565 participants (actual)

Study arms

  • Experimental
    Probiotic

    During the antibiotic dosing (from 5 to 10 days): 2 capsules once a day 2 hours before or 2 hours after antibiotic administration. 14 days following completion of antibiotic dosing: 1 capsule a day.

    Dietary Supplement: Sinquanon

  • Placebo comparator
    Placebo

    During the antibiotic dosing (from 5 to 10 days): 2 capsules once a day 2 hours before or 2 hours after antibiotic administration. 14 days following completion of antibiotic dosing: 1 capsule a day.

    Dietary Supplement: Placebo

Interventions

  • Dietary supplementSinquanon

    This probiotic food supplement includes fourteen probiotic bacterial strains of Lactobacillus Spp, Bifidobacterium Spp., Bacillus coagulans, Saccharomyces boulardii, three prebiotics and Vitamin-B complex - B1, B2, B3, B6, B7, B9 in an enterosolvent cellulose capsule. The product includes supplementary substances: maltodextrin and magnesium stearate. 2 capsules once a day during the antibiotic dosing. 1 capsule a day for 14 days following completion of antibiotic dosing.

  • Dietary supplementPlacebo

    The placebo product will have the same appearance as the active product and the same composition but without the live bacteria, prebiotics, and vitamin-B complex. 2 capsules once a day during the antibiotic dosing. 1 capsule a day for 14 days following completion of antibiotic dosing.

06

What researchers measure

Primary outcomes

  1. Incidence of Antibiotic-Associated diarrhea (AAD)

    The incidence of AAD is defined as the number of subjects who experience at least one day of diarrhea compared to the total number of subjects enrolled in the given treatment arm. AAD is defined as 3 or more loose or liquid stools (types 5-7 according to Bristol Stool Scale \[BSS\]) over a period of 24 hours.

    Time frame: By 21+2 days after completion of antibiotic dosing.

Secondary outcomes

  1. Severity of AAD

    Investigator will assess AAD severity using the following modified scale defining AAD as: severe: ≥7 unformed/loose/liquid stools; moderate: 5-6 unformed/loose/liquid stools; mild: a change in the stool pattern 3-4 unformed/loose/liquid stools a day. Investigator's assessment will take into consideration the 24-hour period presenting with the worst severity.

    Time frame: By 21+2 days after completion of antibiotic dosing.

  2. Duration of diarrhea

    Number of sequential days with diarrhea. Defined as the time until the first normalization of the stool form according to BSS: presence of one or two sequential normal stools, i.e. "soft and formed" or "hard and formed" - types 1-4 per BSS (or lack of stool) for a period of 24 hours.

    Time frame: By 21+2 days after completion of antibiotic dosing.

  3. Antibiotic-associated adverse experiences (abdominal pain, bloating, passing gas, nausea)

    Presence of abdominal pain, bloating, passing gass, nausea - Yes/No.

    Time frame: By 21+2 days after completion of antibiotic dosing.

  4. Visual-analogue scale for the gastrointestinal quality of life (VAS-QoL)

    Measured via Visual-analogue scale for the gastrointestinal quality of life. The subjects will answer the question: "To what extent the abdominal problems impact your quality of life?" This scale has numerical points from 0 to 100. "100" indicates THE WORST quality of life one can imagine, "0" indicates NO problems and THE BEST quality of life one can imagine.

    Time frame: By 21+2 days after completion of antibiotic dosing.

  5. Adverse events (AE)

    Incidence of mild (for example, self-resolving), moderate (for example, those requiring medical evaluation) and serious AEs (for example, events requiring lasting hospitalization) adverse events.

    Time frame: By 21+2 days after completion of antibiotic dosing.

07

Study locations

3 sites
  • University Hospital "St George"
    Plovdiv, 4002, Bulgaria
  • University Hospital for Pulmonary Diseases " St. Sofia"
    Sofia, 1431, Bulgaria
  • University Hospital "Tsaritsa Yoanna - ISUL"
    Sofia, 1527, Bulgaria
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References and documents

Publications

  • Konstantinidis T, Tsigalou C, Karvelas A, Stavropoulou E, Voidarou C, Bezirtzoglou E. Effects of Antibiotics upon the Gut Microbiome: A Review of the Literature. Biomedicines. 2020 Nov 16;8(11):502. doi: 10.3390/biomedicines8110502. PubMed 33207631 ↗
  • Francino MP. Antibiotics and the Human Gut Microbiome: Dysbioses and Accumulation of Resistances. Front Microbiol. 2016 Jan 12;6:1543. doi: 10.3389/fmicb.2015.01543. eCollection 2015. PubMed 26793178 ↗
  • Mekonnen SA, Merenstein D, Fraser CM, Marco ML. Molecular mechanisms of probiotic prevention of antibiotic-associated diarrhea. Curr Opin Biotechnol. 2020 Feb;61:226-234. doi: 10.1016/j.copbio.2020.01.005. Epub 2020 Feb 19. PubMed 32087535 ↗
  • Barbut F, Meynard JL. Managing antibiotic associated diarrhoea. BMJ. 2002 Jun 8;324(7350):1345-6. doi: 10.1136/bmj.324.7350.1345. No abstract available. PubMed 12052785 ↗
  • Szajewska H, Kolodziej M. Systematic review with meta-analysis: Lactobacillus rhamnosus GG in the prevention of antibiotic-associated diarrhoea in children and adults. Aliment Pharmacol Ther. 2015 Nov;42(10):1149-57. doi: 10.1111/apt.13404. Epub 2015 Sep 13. PubMed 26365389 ↗
  • Szajewska H, Kolodziej M. Systematic review with meta-analysis: Saccharomyces boulardii in the prevention of antibiotic-associated diarrhoea. Aliment Pharmacol Ther. 2015 Oct;42(7):793-801. doi: 10.1111/apt.13344. Epub 2015 Jul 27. PubMed 26216624 ↗
  • Ouwehand AC. A review of dose-responses of probiotics in human studies. Benef Microbes. 2017 Apr 26;8(2):143-151. doi: 10.3920/BM2016.0140. Epub 2016 Dec 23. PubMed 28008787 ↗
  • Szajewska H, Canani RB, Guarino A, Hojsak I, Indrio F, Kolacek S, Orel R, Shamir R, Vandenplas Y, van Goudoever JB, Weizman Z; ESPGHAN Working Group for ProbioticsPrebiotics. Probiotics for the Prevention of Antibiotic-Associated Diarrhea in Children. J Pediatr Gastroenterol Nutr. 2016 Mar;62(3):495-506. doi: 10.1097/MPG.0000000000001081. PubMed 26756877 ↗
  • Goldenberg JZ, Lytvyn L, Steurich J, Parkin P, Mahant S, Johnston BC. Probiotics for the prevention of pediatric antibiotic-associated diarrhea. Cochrane Database Syst Rev. 2015 Dec 22;(12):CD004827. doi: 10.1002/14651858.CD004827.pub4. PubMed 26695080 ↗
  • Gao XW, Mubasher M, Fang CY, Reifer C, Miller LE. Dose-response efficacy of a proprietary probiotic formula of Lactobacillus acidophilus CL1285 and Lactobacillus casei LBC80R for antibiotic-associated diarrhea and Clostridium difficile-associated diarrhea prophylaxis in adult patients. Am J Gastroenterol. 2010 Jul;105(7):1636-41. doi: 10.1038/ajg.2010.11. Epub 2010 Feb 9. PubMed 20145608 ↗

Individual participant data

Plan to share: No

09

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Oct 21, 2024, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT05607056
Lead sponsor
Neopharm Bulgaria Ltd.
Responsible party
Sponsor
First posted
Nov 7, 2022
Start date
Nov 27, 2022
Primary completion
Mar 20, 2023
Completion
Apr 25, 2023
Last update
Oct 21, 2024

Study contacts

Georgi Momekov, Prof PhD
principal investigator · Department of Pharmacology, Pharmacotherapy and Toxicology, Medical University of Sofia
Karen Dzhambazov, Prof, PhD
principal investigator · University hospital for active treatment Sveti Georgi, Medical University-Plovdiv
Nikolay Sapundziev, Prof, PhD
principal investigator · Department of Neurosurgery and Otorhinolaryngology, Medical University - Varna
Milena Encheva, MD, PhD
principal investigator · Military Medical Academy, Bulgaria
Boris Bogov, Prof, PhD
principal investigator · UMHAT "Sveta Anna"
Rosen Nikolov, Prof, MD
principal investigator · UMHAT St Ivan Rilski
Rumen Benchev, Prof
principal investigator · Hill Clinic
Vladimir Hodzhev, Prof, PhD
principal investigator · University Hospital "St George"
Spiridon Todorov, Prof, PhD
principal investigator · University Hospital "Tsaritsa Yoanna - ISUL"
Vania Youroukova, Prof, PhD
principal investigator · University Hospital for Pulmonary Diseases " St. Sofia"

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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