Pharmacokinetics and Safety of Antimicrobial Agents Administered by Subcutaneous Route in Patients AGEd Over 65 Years

NCT ID: NCT03583749

Last Updated: 2021-02-16

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Total Enrollment

150 participants

Study Classification

OBSERVATIONAL

Study Start Date

2019-08-07

Study Completion Date

2021-09-05

Brief Summary

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Elderly people are more prone to develop infection with a poorer prognosis compared to young people. Physicians may encounter difficulties regarding antimicrobial agents administration route. In fact, poor venous access and behavioral disturbance are frequent issues. The subcutaneous (SC) route may be a safe alternative, but sparse data are available in the literature. The present study aims to describe Pharmacokinetics (PK) / Pharmacodynamics (PD) characteristics of antibiotics (amoxicillin/clavulanate, ceftriaxone and piperacillin/tazobactam) subcutaneous administration in patients aged over 65.

Detailed Description

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Antibiotic administration through subcutaneous (SC) injection is common practice in France, especially in Geriatrics as an alternative to intravenous (IV) route in case of poor venous access or delirium (Forestier et al. CMI 2015). Whereas tolerance of such a practice seems to be reasonable (Roubaud-Baudron et al. Age and Ageing 2017), sparse PK/PD data are available. Most PK/PD studies include young and healthy subjects, yet elderly patients often have multimorbidity , poly medication, renal insufficiency and cachexia which may disturb antibiotics PK/PD. Compared to intravenous (IV) route, SC route is less painful and less frequently associated with infectious or thrombotic complication. A recent study carried out in Bordeaux University Hospital comparing PK/PD data on ertapenem SC or IV administrations in patients aged over 75 showed that area under the curve (AUC) and probability to maintain free ertapenem concentration above the Minimum inhibitory concentration (MIC) during at least 40% of time (fT\>MIC\>40%) were not significantly different (manuscript in progress).

The investigator's hypothesis is that SC administration of amoxicillin-clavulanate, ceftriaxone and piperacillin-tazobactam has favorable pharmacokinetics and acceptable tolerance compared with IV infusion in elderly patients.

Patients receiving one of the three antibiotics by IV or SC route will be included at steady state (depending on antibiotic treatment) for several blood tests (3 or 4 depending of routes choice) and followed until 15 days after completion of antibiotic treatment in order to evaluate tolerance and efficacy of antibiotic treatment. Physicians in charge of patients will decide antibiotic prescription including administration route. The study will not influence these choices because patients will be included after antibiotic initiation.

Conditions

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Antimicrobials Subcutaneous Injection Antibiotic Older People

Study Design

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Observational Model Type

CASE_ONLY

Study Time Perspective

PROSPECTIVE

Study Groups

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amoxicillin-clavulanate

followed of SC and IV cohort without any randomization because the route will be chosen before inclusion by the physician in charge.

Subcutaneous (SC) route for antibiotic treatment

Intervention Type DRUG

Patients receiving one of the three antibiotics by SC route without any randomization because the route will be chosen before inclusion by the physician in charge.

Intravenous (IV) route for antibiotic treatment

Intervention Type DRUG

Patients receiving one of the three antibiotics by IV route without any randomization because the route will be chosen before inclusion by the physician in charge.

ceftriaxone

followed of SC and IV cohort without any randomization because the route will be chosen before inclusion by the physician in charge.

Subcutaneous (SC) route for antibiotic treatment

Intervention Type DRUG

Patients receiving one of the three antibiotics by SC route without any randomization because the route will be chosen before inclusion by the physician in charge.

Intravenous (IV) route for antibiotic treatment

Intervention Type DRUG

Patients receiving one of the three antibiotics by IV route without any randomization because the route will be chosen before inclusion by the physician in charge.

piperacillin-tazobactam

followed of SC and IV cohort without any randomization because the route will be chosen before inclusion by the physician in charge.

Subcutaneous (SC) route for antibiotic treatment

Intervention Type DRUG

Patients receiving one of the three antibiotics by SC route without any randomization because the route will be chosen before inclusion by the physician in charge.

Intravenous (IV) route for antibiotic treatment

Intervention Type DRUG

Patients receiving one of the three antibiotics by IV route without any randomization because the route will be chosen before inclusion by the physician in charge.

Interventions

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Subcutaneous (SC) route for antibiotic treatment

Patients receiving one of the three antibiotics by SC route without any randomization because the route will be chosen before inclusion by the physician in charge.

Intervention Type DRUG

Intravenous (IV) route for antibiotic treatment

Patients receiving one of the three antibiotics by IV route without any randomization because the route will be chosen before inclusion by the physician in charge.

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Aged over 65
* To receive ceftriaxone (1g daily) or amoxicillin-clavulanate (1g/0.2g every 8h) or piperacillin-tazobactam (4g/0.5g every 8h) by SC or IV infusion (30-60minutes) at steady state (48h, 24h and 24h respectively)
* Free, written and informed consent signed by the participant or by a proxy in case of delirium

Exclusion Criteria

* criteria for legislation (justice protection, subject participating to another research including a period of exclusion)
* previous inclusion in this study
Minimum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University Hospital, Bordeaux

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Claire ROUBAUD-BAUDRON, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Hospital University, Bordeaux

Locations

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CHU de Bordeaux

Bordeaux, , France

Site Status RECRUITING

Hospital Métropole Savoie

Chambéry, , France

Site Status RECRUITING

CHU de Grenoble Alpes

Grenoble, , France

Site Status RECRUITING

Hospices Civils de Lyon

Lyon, , France

Site Status RECRUITING

University Hospital, Poitiers

Poitiers, , France

Site Status RECRUITING

Countries

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France

Central Contacts

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Claire ROUBAUD-BAUDRON, MD, PhD

Role: CONTACT

+33 (0) 5 57 82 18 44

Aurélie CHERCHOULY

Role: CONTACT

+33 (0) 5 24 54 91 86

Facility Contacts

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Claire ROUBAUD-BAUDRON, MD, PhD

Role: primary

+335 57 65 66 10

Emmanuel FORESTIER, MD

Role: primary

+33 (0) 4 79 96 51 72

Gaëtan GAVAZZI, MD, PhD

Role: primary

+334 76 76 57 97

Tristan FERRY, MD, PhD

Role: primary

+334 72 07 11 07

Marc PACCALIN, MD, PhD

Role: primary

Other Identifiers

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CHUBX 2017/37

Identifier Type: -

Identifier Source: org_study_id

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