Antibiotic Prophylaxis for Endoscopic Ultrasound Guided Fine Needle Aspiration of Pancreatic Cystic Lesions

Study Overview
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Brief Summary
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The purpose of this study is to determine whether the use of antibiotic prophylaxis is appropriate when performing a pancreatic cyst fine needle aspiration guided by endoscopic ultrasonography.

Detailed Description
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The incidence of infection after a pancreatic cyst fine needle aspiration guided by endoscopic ultrasonography (EUS-FNA) is not well known. Antibiotic prophylaxis is recommended in clinical guidelines despite the lack of evidence of its usefulness. Our hypothesis is that the risk of infection will not be higher with placebo, and risks associated to the use of antibiotics might even increase with the use of prophylaxis. The main objective of the project is to assess the risk of infection after the procedure and to determine whether the use of antibiotic prophylaxis is appropriate. The study is a phase IV, multicenter, double-blinded, randomized, placebo-controlled, and non-inferiority trial . We have designed a study with two parallel treatment groups. Patients will be randomized to the prophylaxis or to the placebo group. All patients will be followed for 21 days or until resolution of complications. To evaluate this primary objective with a non inferiority study, we have estimated that a total of 218 patients will be needed (109 per group) . The main secondary objective is to assess the incidence of complications related to the use of antibiotic prophylaxis (i.e. allergic reactions, secondary infections or drug-resistant infections).

Official Title
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Multicenter, Randomized and Double-blinded Clinical Trial on the Use of Antibiotic Prophylaxis for EUS Guided FNA of Pancreatic Cystic Lesions

Conditions
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Pancreatic Cystic Lesion

Intervention / Treatment
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* Drug: Placebo
* Drug: Ciprofloxacin


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with a pancreatic cyst requiring EUS-FNA to complete evaluation. Participant is willing and able to give informed consent for participation in the study. Age 18 years or older. Ability to understand study procedures and to comply with them for the entire length of the study. Exclusion Criteria: Patients with other co-morbidities requiring antibiotic prophylaxis for endoscopic invasive procedures (such as those with cardiac valve prosthesis). Cystic lesion of the intestinal wall (foregut or duplication cyst). Use of antibiotic treatment for any other indication during the 5 days prior to the procedure. Pregnant woman. Known allergy/sensitivity to ciprofloxacin. Inability or unwillingness of individual or legal guardian/representative to give written informed consent.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Placebo<br>1 intravenous dose followed by 1 oral dose each 12 hours (complete 3 days) | Drug: Placebo<br>* Evaluate usefullness of antibiotic prophylaxis<br>|
| Active Comparator: Antibiotic<br>Ciprofloxacin 400 mg intravenous one dose followed by ciprofloxacin 500 mg oral each 12 hours (complete 3 days) | Drug: Ciprofloxacin<br>* Ciprofloxacine 400 mg intravenous one dose followed by ciprofloxacine oral each 12 hours (complete 3 days)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Risk of infection of a pancreatic cyst or infection related to the procedure | The infection can be defined as confirmed if there is a positive culture of the lesion content or if there is suspicion by clinical and image techniques (CT, MRI), and a positive blood culture is obtained. It will be defined as suspected when clinical and/or image is suggestive of cyst infection, but microbial confirmation is not obtained. | 21 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Risk of fever | This will be measured prior to discharge. In case of clinical suspicion of bacteraemia at any moment during the follow up, blood cultures will be obtained. | 21 days | 
| secondary effects, allergic reactions, and drug resistant or secondary infections |  | 21 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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cyst, pancreatic cyst, EUS-FNA, antibiotic prophylaxis