A single-center, open-label clinical trial to determine the early bactericidal activity (EBA) and safety of the combination of meropenem and amoxicillin/clavulanate plus pyrazinamide vs. meropenem and amoxicillin/clavulanate plus bedaquiline administered for 14 consecutive days. This study forms part of a series of 2-week EBA studies to determine the relative bactericidal activity of several new or repurposed anti-tuberculosis agents from which to determine the most effective and safe combination to evaluate in larger and longer duration regimen-based trials.
Study design A single-center, open-label clinical trial. Study treatments include: 1. Meropenem 6g intravenously once daily plus amoxicillin/clavulante 2 x 1000mg/62.5mg orally once daily and pyrazinamide 20-30mg/kg orally once daily on days 1-14. Ten participants will be included in this treatment arm. 2. Meropenem 6g intravenously once daily plus amoxicillin/clavulanate 2 x 1000mg/62.5mg orally once daily and bedaquiline 400mg orally once daily on days 1-14. Ten participants will be included in this treatment arm. 3. Rifafour e- 275® (HRZE) orally once daily on days 1-14, with weight-banded dosing. Two participants will receive standard first line TB treatment as per the South African TB guidelines (Rifafour e- 275®) and is included as a control for the EBA quantitative mycobacteriology and to evaluate whether HRZE gives similar EBA results to that demonstrated in prior studies with this combination. Patient Population: A total of 22 male and female participants aged between 18 and 65 years (inclusive), with newly diagnosed, smear-positive, pulmonary TB will be included. Treatment The Investigational Product (IP) will be supplied as: * Meropenem 1g reconstitution vials * Amoxicillin/CA 1000/62.5mg tablets * Pyrazinamide 500mg tablets * Bedaquiline 100mg tablets Statistical Methods: This is a descriptive study with no inferential statistics or hypothesis testing. The planned sample size of 10 participants per treatment group is in keeping with other phase 2 trials of this type and accounts for the possibility of up to 3 drop-outs per arm, which based on previous studies of this type conducted at these sites, represents a conservative estimate of the expected drop-out rate. Trial Duration: 37 days (up to 9 days pre-treatment plus 15 days treatment period plus 14 days post- treatment follow- up).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
22
Meropenem IV 6 grams
Amx/CA oral 1000/62.5mg 2 tablets
Pyrazinamide 20-30mg/kg
Bedaquiline 400mg
Rifafour (HRZE) Standard dose
TASK Clinical Research Centre
Cape Town, Western Cape, South Africa
Early bactericidal activity (EBA) over 14 treatment days based on the rate of change in colony forming unit (CFU) count per treatment arm
CFU count will be determined from Mycobacterium tuberculosis (M.tb) grown on solid culture. The rate of change in CFU count per ml sputum will be determined from overnight sputum samples collected for at least 2 day before study treatment till day 4 on treatment, followed by alternate days till day 14 on treatment.
Time frame: 14 days
EBA over 14 treatment days based on the rate of change in time to positive culture (TTP) per treatment arm
TTP will be determined from M.tb grown in liquid culture media. The rate of change in TTP per ml sputum will be determined from overnight sputum samples collected for at least 2 day before study treatment till day 4 on treatment, followed by alternate days till day 14 on treatment.
Time frame: 14 days
Safety and tolerability of study treatments administered over 14 consecutive days
Incidence of treatment emergent adverse events (TEAEs) will be summarised by severity, relatedness to study treatments, and seriousness, leading to early withdrawal and/or leading to death, and summarised per treatment arm.
Time frame: 14 days
Cmax: Maximum observed plasma drug concentration.
The maximum observed plasma concentration (Cmax), will be estimated for all analytes in all treatment arm, excluding the standard of care arm. Parameter will be calculated separately using plasma concentrations.
Time frame: 14 days
Tmax: Time at which Cmax is observed (obtained without interpolation).(interventional arms only) after 14 consecutive days - Analyte, Meropenem; amoxicillin; CA; bedaquiline
The time to reach Cmax (Tmax), will be estimated for all analytes in all treatment arm, excluding the standard of care arm. Parameter will be calculated separately using plasma concentrations.
Time frame: 14 days
Cmin: Minimum observed plasma drug concentration 24 hours following the last dose.
The minimum observed plasma concentration (Cmin) 24 hours following intake of the first daily dosing on day 14, will be estimated for all analytes in all treatment arm, excluding the standard of care arm. Parameter will be calculated separately using plasma concentrations.
Time frame: 14 days
AUC(0-24): Area under the drug concentration-time curve calculated using linear trapezoidal summation from time zero to time 24 hours.
The 24 hours following intake of the first daily dosing on day 14, area under the plasma concentration time curve from zero to 24 hours (AUC(0- 24)) will be estimated for all analytes in all treatment arm, excluding the standard of care arm. Parameter will be calculated separately using plasma concentrations.
Time frame: 14 days
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