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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT05770622
Registration number
NCT05770622
Ethics application status
Date submitted
5/03/2023
Date registered
15/03/2023
Titles & IDs
Public title
Improving Therapeutic Drug Monitoring and Dosing for Vancomycin in Young Infants With Infections (VANCAPP) (Part 2)
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Scientific title
The VANcomycin Cohort Study - Assessing Precise Dosing and Prompt Drug Monitoring to Improve Attainment of Target Concentrations (Part 2)
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Secondary ID [1]
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HREC2019.059 (part 2)
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Universal Trial Number (UTN)
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Trial acronym
VANCAPP
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Sepsis
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Infections
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Bacteremia
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0
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Condition category
Condition code
Infection
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Studies of infection and infectious agents
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Infection
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Other infectious diseases
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Blood
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Other blood disorders
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Other interventions - First-dose trough dose adjustment calculator - using early TDM (first-dose trough) to determine an early dose adjustment if the predicted steady-state trough is outside of target range (10-20mg/L)
Experimental: Vancomycin first-dose trough dose adjustment calculation - Participants will have individualised model-based intermittent vancomycin dosing using the Vanc App dosing calculator (as used in VANC APP Part 1, see clinicaltrials.gov ID: NCT04044703). A first-dose trough concentration will be measured for each participant and the clinician will then enter that concentration into the web application ('First-dose trough dose adjustment calculator'). A dose adjustment will be generated by the calculator if the predicted steady-state level is outside of target range. If the predicted steady-state level is within target range (10-20mg/L) the calculator will recommend continuing with the same dose. The vancomycin concentration is then measured at steady state to determine if the target concentration has been achieved.
Other interventions: First-dose trough dose adjustment calculator - using early TDM (first-dose trough) to determine an early dose adjustment if the predicted steady-state trough is outside of target range (10-20mg/L)
CALCULATOR: A 'First-dose trough dose adjustment calculator' was developed based on a population pharmacokinetic model. A participant's post-menstrual age, weight, creatinine, target trough concentration, dose, dosing interval and first-dose trough concentration (taken immediately before the second dose is due) are entered into the calculator. The calculator determines if a dose adjustment is required (based on whether the predicted steady-state trough concentration is \<10mg/L or \>20mg/L) and, if required, recommends a new adjusted dose.
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Intervention code [1]
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Other interventions
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Target concentration at first steady-state concentration
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Assessment method [1]
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The proportion of young infants achieving target trough serum vancomycin concentrations (10 to 20 mg/L) at first steady-state level when model-based dosing is used followed by early therapeutic drug monitoring (and dose adjustment) after the first dose
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Timepoint [1]
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From first vancomycin dose (immediately after consent) to steady state level taken at 24-48 hours post-first-dose
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Secondary outcome [1]
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Sub- and supratherapeutic concentrations at first steady-state concentration
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Assessment method [1]
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The proportion of young infants with supra- (defined as \>20mg/L) or sub- (defined as \<10mg/L) therapeutic vancomycin concentrations at the first steady state level when model-based dosing is used followed by early therapeutic drug monitoring (and dose adjustment) after the first dose
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Timepoint [1]
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From first vancomycin dose (immediately after consent) to steady state level taken at 24-48 hours post-first-dose
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Secondary outcome [2]
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Drug-related adverse effects
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Assessment method [2]
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The frequency of drug-related adverse effects (infusion-related and nephrotoxicity).
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Timepoint [2]
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From first vancomycin dose (immediately after consent) to completion of vancomycin therapy (as determined by clinical team, an average of 5 days)
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Eligibility
Key inclusion criteria
* Infants aged 0 - 90 days old
* Suspected infection requiring treatment with vancomycin for 48 hours or more (as determined by the clinical team)
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Minimum age
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Days
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Maximum age
90
Days
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
* Infants with a corrected gestational age of less than 25 weeks
* Infants weighing less than 500g.
* Known allergy to any glycopeptide antibiotic
* Vancomycin administered within the previous 72 hours
* Infants receiving any form of extracorporeal life support
* Renal impairment
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Study design
Purpose of the study
Treatment
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Allocation to intervention
NA
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Single group
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Other design features
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Phase
Phase 4
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Not yet recruiting
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
1/08/2024
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Actual
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
1/12/2025
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Actual
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Sample size
Target
40
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
VIC
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Recruitment hospital [1]
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Royal Children's Hospital Melbourne - Melbourne
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Recruitment hospital [2]
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Monash Newborn - Melbourne
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Recruitment hospital [3]
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Royal Hospital for Women - Sydney
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Recruitment hospital [4]
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The Children's Hospital at Westmead - Sydney
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Recruitment postcode(s) [1]
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3052 - Melbourne
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Recruitment postcode(s) [2]
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- Melbourne
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Recruitment postcode(s) [3]
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- Sydney
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Funding & Sponsors
Primary sponsor type
Other
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Name
Murdoch Childrens Research Institute
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Address
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Country
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Other collaborator category [1]
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Other
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Name [1]
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Royal Children's Hospital
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Address [1]
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Country [1]
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Other collaborator category [2]
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Other
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Name [2]
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Royal Hospital For Women
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Address [2]
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Country [2]
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Other collaborator category [3]
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Other
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Name [3]
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Sydney Children's Hospitals Network
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Address [3]
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Country [3]
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Other collaborator category [4]
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Other
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Name [4]
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Monash Health
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Address [4]
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Country [4]
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Ethics approval
Ethics application status
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Summary
Brief summary
A challenge to intermittent vancomycin dosing in young infants is the avoidable delay caused by the need to wait until steady state (i.e. when the drug concentrations are in equilibrium) to measure a vancomycin concentration, as this generally occurs 24 to 48 hours after starting treatment. If the target concentration is not achieved, the dose needs to be adjusted, resulting in further delays in an infant achieving the concentration required to treat their infection. The purpose of this study is to assess the use of early therapeutic drug monitoring (first-dose trough) and, if needed, early dose adjustment, in achieving target vancomycin concentrations at steady state. A dose adjustment calculator (available through a web application) will be used to determine the need for dose adjustment (based on predicted steady state concentration) and recommend an adjusted dose if required.
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Trial website
https://clinicaltrials.gov/study/NCT05770622
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Amanda Wilkins, MBBS
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Address
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Royal Children's Hospital Melbourne, Murdoch Children's Research Institute
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Country
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Phone
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Fax
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Email
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Contact person for public queries
Name
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Amanda Wilkins, MBBS
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Address
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Country
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Phone
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9345 5522
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
No documents have been uploaded by study researchers.
Results not provided in
https://clinicaltrials.gov/study/NCT05770622