Population Pharmacokinetics of Temocillin in Acute Enterobacterial Pyelonephritis in Children
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 入组人数
- 50
- 试验地点
- 1
- 主要终点
- Achievement of the theoretical PK/PD target of 40% of the time spent above the MIC of the bacteria in question (fT>MIC=40%) for a temocillin dose of 50mg/kg/day in 2 IV injections of 30 min spaced 12h apart,
研究概览
简要总结
Temocillin, a 6-alpha-methoxypenicillin derivative of ticarcillin, is a narrow-spectrum antibiotic, primarily restricted to Enterobacterales. Therefore, its prescription for the treatment of febrile urinary tract infections requiring hospitalization in pediatrics appears interesting.
However, and despite marketing authorization in pediatrics for the treatment of complicated urinary tract infections (including acute pyelonephritis), the pharmacokinetic parameters of this antibiotic have not been specifically evaluated in pediatrics, and the optimal dose is not known in this population.
Through this study, we propose to determine the pharmacokinetic parameters of temocillin in children aged 0-15 years with a febrile urinary tract infection due to Gram-negative rod (GNR), without sepsis but requiring hospitalization. The results will help to establish dose recommendations for temocillin in the pediatric population, based on age and renal function.
详细描述
Clinical Context of Temocillin Use:
Temocillin is an old antibiotic, a 6-alpha-methoxypenicillin derivative of ticarcillin, which has been rediscovered in recent years due to its narrow spectrum of activity and its ability to resist hydrolysis by most beta-lactamases, including ESBL. Temocillin is bactericidal, is not impacted by the inoculum effect, and has a low selection of resistant mutants. Due to its narrow spectrum (essentially limited to Enterobacterales), it appears to have a reduced overall impact on the fecal microbiota.
Studies have retrospectively reported clinical and microbiological efficacy of temocillin in urinary tract infections caused by ESBL-producing Enterobacterales in children and adults.
More generally, Enterobacterales have a high susceptibility to temocillin, with susceptibility rates exceeding 90-95% in several epidemiological studies in both children and adults. This is higher than that of third-generation cephalosporins, which still remain the first-line treatment in recent french guidelines (GPIP, SPILF), As a result, temocillin has been approved for the treatment of acute pyelonephritis (febrile urinary tract infections), including in the pediatric population. In France, it is primarily used for the treatment of ESBL-associated febrile urinary tract infections.
Since september 2024, Robert Debré University Hospital uses temocillin has an empiricial antibiotic therapy for hospitalized cases of febrile urinary tract infections, without any sign of sepsis, at the recommended high dose of 50 mg/kg/day in 2 intravenous injections of 30 min spaced 12 hours apart.
研究设计
- 研究类型
- Observational
- 观察模型
- Other
- 时间视角
- Prospective
入排标准
- 年龄范围
- 1 Day 至 15 Years（Child）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patient aged 0 to 15 years
- •Presenting with a febrile urinary tract infection due to GNR (a febrile urinary tract infection is defined as a urine culture showing significant leukocyturia (≥104) and direct examination showing GNR, in a patient with fever)
- •Requiring hospitalization in the general pediatrics, emergency (short-stay hospitalization unit), nephrology, or intensive care units of the Robert-Debré University Hospital for a presumed period of at least 48 hours.
- •Non-opposition of the legal representatives obtained by one of the investigator
排除标准
- •Presence of sepsis (Phoenix score ≥ 2)
- •Gram-positive cocci (GPC) urinary tract infection (Urinalysis before antibiotic therapy revealed significant leukocyturia (≥104) and direct examination revealed GPC)
- •Known allergy to beta-lactam antibiotics
- •Severe renal impairment (glomerular filtration rate <30 mL/min*1.73 m2)
结局指标
主要结局
Achievement of the theoretical PK/PD target of 40% of the time spent above the MIC of the bacteria in question (fT>MIC=40%) for a temocillin dose of 50mg/kg/day in 2 IV injections of 30 min spaced 12h apart,
时间窗: 24 months
Achievement of the theoretical PK/PD target of 40% of the time spent above the MIC of the bacteria in question (fT\>MIC=40%) for a temocillin dose of 50mg/kg/day in 2 IV injections of 30 min spaced 12h apart, on the population modellisation of the unbound plasma concentration of temocillin over 24h. Samples taken 1 hour after the start of a temocillin infusion then between 6 and 8 hours after the start of the infusion or sample taken 2 hours after the start of a temocillin infusion then between 10 and 12 hours after the start of the infusion
次要结局
未报告次要终点