Pharmacokinetics of Antibiotics in Patients Undergoing Renal Replacement Therapies

Cleveland Clinic Abu Dhabi200 enrolled

Overview

The study is aiming to describe the pharmacokinetic and pharmacodynamic profile of intravenous meropenem, ertapenem, cefepime, colistin, Ceftazidime/Avibactam , Ceftolozane/Tazobactam , and piperacillin/tazobactam in the plasma and determine how much is removed by Renal Replacement Therapies to ensure adequate dosing

This pharmacokinetic evaluation and clinical outcomes will be an open-label study of 12-16 adult patients/antibiotic dose/modality to a total number of 180-240 patients, admitted to the acute care levels or intensive care unit at Cleveland Clinic Abu Dhabi receiving RRT and prescribed these seven antibiotics as recommended by their treating physicians. The collection of blood, ultrafiltrate or effluent fluids depending on RRT modality (HD or CRRT), and urine samples will begin after participants are administered first dose to determine if a loading dose will be required then after at least three doses (as prescribed by the treating physician) once these drugs will be at steady-state concentration. The study intervention duration will depend on dialysis modality expected to be 3 to 5 days depending on RRT modality and patients will be followed for outcomes (death or cure). Collected blood, effluent and urine samples will be assayed for drug concentration. The concentration data will be modeled by a computer program to determine the pharmacokinetic parameters used to predict future dosing in the case of RRT. Linear/logistic regression will be used as a component of statistical analysis to model the relationship between CRRT machine settings and the amount of the study drugs that will be removed by the filter. Information related to adverse events , clinical and microbiological cure will be collected in case report forms.

Study Type

OBSERVATIONAL

Enrollment

200

Conditions

Renal Replacement Therapy

Interventions

Blood collectionOTHER

Pharmacokinetics

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Adults \> 18 year old * Prescribed meropenem, ertapenem, cefepime, colistin, Ceftazidime/Avibactam , Ceftolozane/Tazobactam , or piperacillin/tazobactam for treatment of infection as part of standard medical care * Administered meropenem, ertapenem, cefepime, colistin, Ceftazidime/Avibactam , Ceftolozane/Tazobactam ,or piperacillin/tazobactam while on renal replacement therapy (IHD or CRRT) or renal replacement therapy started while on any of these antibiotics * Patients with hemoglobin \> 70 g/L without blood transfusion in the past 24 hours * Informed consent given by patient, next of kin or legally authorized representative Exclusion Criteria: * Less than 18 years of age * Pregnant females * Body mass index \< 18 or \> 35 kg/m2 * Presence of anemia (defined as hemoglobin \< 70 g/L), thrombocytopenia, or leukopenia as defined by hematocrit, platelet, or white blood cell count \< 75% of the lower limit of normal * Concomitant receipt of another cephalosporin interfering with assay * Participants likely to require surgical interventions during the study period if the surgery would interfere with dosing intervals or affect sampling process * Protected patients; prisoners, patients with HIV, patients with physical or mental disabilities, psychiatric patients. * Patients with documented life-threatening allergy (i.e anaphylaxis, angioedema) to any of the study drugs or their class. * Patients with conditions known to significantly affect PK; (i.e. severe burn, significant ascites, spinal cord injury and cystic fibrosis) * Any other reason felt by the investigators to potentially affect the outcomes of the study

Locations (1)

Cleveland Clinic Abu Dhabi

Abu Dhabi, United Arab Emirates

RECRUITING

Outcomes

Primary Outcomes

Serum antibiotic concentrations over time during dose interval

Blood will be collected at designated time points, serum samples will be assayed for drug concentration over time to describe pharmacokinetic disposition

Time frame: 24 months

Secondary Outcomes

Amount of antibiotic removed by dialysis

Dialysate will be collected and assayed for drug concentration to determine the amount of drug cleared by RRT with respect to different dialysis modalities and membranes

Time frame: 24 months

Time above minimum inhibitory concentration (T/MIC) for time dependent antibiotics

Concentration/time data will be modeled mathematically (population pharmacokinetics and Monte Carlo simulation) to identify adequate dosing in this patient population

Time frame: 24 months

Area under concentration time curve over minimum inhibitory concentration for (Cmax/MIC) for concentration dependent antibiotics

Concentration/time data will be modeled mathematically (population pharmacokinetics and Monte Carlo simulation) to identify adequate dosing in this patient population

Time frame: 24 months

Central Contacts

Wasim El Nekidy, PharmD

CONTACT

+971 2 6590200 ElnekiW@ClevelandClinicAbuDhabi.ae

Islam Ghazi, PharmD

CONTACT

+12152688908 i.ghazi@usciences.edu

Data from ClinicalTrials.gov

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