The ARREST trial

• Research type

  Research Study

• Full title

  Adjunctive Rifampicin to Reduce Early mortality from Staphylococcus aureus bacteraemia: a randomised controlled trial

• IRAS ID

  98414

• Contact name

  Guy Thwaites

• Sponsor organisation

  Medical Research Council

• Eudract number

  2012-000344-10

• ISRCTN Number

  ISRCTN37666216

• Research summary

  Staphylococcus aureus can cause a range of different infections, from boils to food poisoning, but when the bacteria involves the blood stream (bacteraemia) it is particularly serious, resulting in death in 25% of cases. Last year 12,500 cases of S. aureus bacteraemia occurred in the UK, killing an estimated 3000 patients and costing the NHS around œ225 million. Current UK guidelines recommend at least 14 days of antibiotic treatment for S. aureus bacteraemia. Rifampicin is often considered as a second antibiotic: it can be given orally, kills bacteria in cells and tissues where other antibiotics work less well, serious side-effects are relatively rare, and it is cheap (daily oral dose: 15p). Surprisingly, however, only 3 trials involving 246 patients in total have investigated whether rifampicin improves outcome from severe S. aureus disease. The combined results suggest rifampicin may halve the risk of treatment failure and death. Other studies indicate rifampicin may sterilise the blood faster, which is important as death or complications are more likely the longer bacteria remain in the blood. The proposed trial is designed to demonstrate conclusively that adding rifampicin to standard therapy for S. aureus bacteraemia improves survival from this infection. Patients with S. aureus bacteraemia in 17 NHS hospitals will be randomly assigned to 14 days rifampicin or identical placebo in addition to their standard treatment. We will compare rifampicin??s effectiveness by recording the proportions that die or fail treatment. We will also investigate the relationship between the blood concentrations of rifampicin and other antibiotics and their clinical effect. We will seek informed consent from each participant, or a legal representative if they lack capacity. Elderly and very sick patients will be included in this trial because they are a group who could particularly benefit in future.

• REC name

  London - Westminster Research Ethics Committee

• REC reference

  12/LO/0637

• Date of REC Opinion

  24 May 2012

• REC opinion

  Further Information Favourable Opinion