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Trial registered on ANZCTR
Registration number
ACTRN12617001003369
Ethics application status
Approved
Date submitted
9/07/2017
Date registered
12/07/2017
Date last updated
12/07/2017
Type of registration
Retrospectively registered
Titles & IDs
Public title
Probenecid and food effects on flucloxacillin pharmacokinetics and pharmacodynamics in healthy volunteers
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Scientific title
Probenecid and food effects on flucloxacillin pharmacokinetics and pharmacodynamics in healthy volunteers
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Secondary ID [1]
292389
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None
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Skin infection
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Condition category
Condition code
Infection
303308
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0
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Other infectious diseases
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Volunteers were administered flucloxacillin 1000 mg orally on three study days separated by a 7-day ‘washout period’.
Arm 1: Flucloxacillin 1000 mg orally, single dose while fasting
Arm 2: Flucloxacillin 1000 mg orally plus probenecid 500 mg orally, both single dose while fasting
Arm 3: Flucloxacillin 1000 mg orally plus probenecid 500 mg orally, both single dose with food
On each study day, participants fasted for eight hours (overnight) but had free access to water. On fasting days only water could be consumed until two hours after receiving the study medication. On the fed day, each participant ingested two scrambled eggs made with two tablespoons of milk (full cream), two slices of mixed grain and toasted sesame bread with margarine and 250 mL of orange juice. Each meal contained 492 kcal of energy, 21.8 g of protein, 22 g of fat and 52.6 g of carbohydrate. Caffeine was permitted only after the 4-hour blood sample, and alcohol was forbidden until completion of the study. Adherence to fasting was assessed verbally.
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Intervention code [1]
298563
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Treatment: Drugs
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Comparator / control treatment
Arm 1: Flucloxacillin 1000 mg orally, single dose while fasting
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Control group
Active
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Outcomes
Primary outcome [1]
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Total flucloxacillin plasma concentrations were measured using an LC-MS/MS method
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Assessment method [1]
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Timepoint [1]
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Blood samples were taken at baseline then 0.5, 1, 1.5, 2, 2.5, 3, 4, 6, 8 and 12 hours after administration of flucloxacillin
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Primary outcome [2]
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Free flucloxacillin plasma concentrations were measured using an LC-MS/MS method
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Assessment method [2]
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Timepoint [2]
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Blood samples were taken at baseline then 0.5, 1, 1.5, 2, 2.5, 3, 4, 6, 8 and 12 hours after administration of flucloxacillin
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Secondary outcome [1]
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Adverse events, such as nausea, anorexia, diarrhoea, skin itch or rash were assessed by verbal questioning at the end of each study day
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Assessment method [1]
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Timepoint [1]
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0 to 12 hours after administration of study drugs
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Eligibility
Key inclusion criteria
Healthy volunteer
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Minimum age
18
Years
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Maximum age
40
Years
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Sex
Both males and females
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Can healthy volunteers participate?
Yes
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Key exclusion criteria
Food intolerance, pregnancy, chronic illness, renal impairment (creatinine clearance < 80 mL/min by Cockcroft-Gault formula), liver dysfunction, malabsorption or known intolerance of flucloxacillin or probenecid. Volunteers were excluded from the study if they took any regular medications (other than a hormonal oral contraceptive pill) or were intolerant of fasting for up to 10 hours.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Non-randomised trial
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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
Crossover
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Other design features
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Phase
Phase 1
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Type of endpoint/s
Pharmacokinetics
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Statistical methods / analysis
The number of volunteers chosen was pretty standard for a PK/PD study of this type. Treatment arms were compared for common PK parameters and for the concentrations achieved for 30%, 50% and 70% of the usual dose intervals. Statistics evaluated included repeated measures one-way ANOVA, ratios of each regimen over the others, post-hoc analysis using Bonferroni’s multiple comparison test, and if no differences were demonstrated, 90% confidence intervals for bioequivalence testing (mean ± 90% CI within 0.8 to 1.25). The probability of target attainment (PTAs) for each arm were plotted against a range of MICs of common skin-infecting bacteria
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
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Actual
7/01/2013
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Date of last participant enrolment
Anticipated
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Actual
11/02/2013
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Date of last data collection
Anticipated
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Actual
11/02/2013
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Sample size
Target
11
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Accrual to date
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Final
11
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Recruitment outside Australia
Country [1]
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New Zealand
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State/province [1]
9041
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Nelson/Tasman
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Funding & Sponsors
Funding source category [1]
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Other
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Name [1]
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Nelson Research and Education Trust Fund
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Address [1]
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c/o Dr Bruce King
Nelson Hospital
Private Bag 18
Nelson 7042
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Country [1]
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New Zealand
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Primary sponsor type
Individual
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Name
Richard Everts
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Address
Department of Medicine
Nelson Hospital
Private Bag 18
Nelson 7042
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Country
New Zealand
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Secondary sponsor category [1]
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None
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Name [1]
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Address [1]
295947
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Country [1]
295947
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
298149
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Northern B Health and Disability Ethics Committee
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Ethics committee address [1]
298149
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Ministry of Health Health and Disability Ethics Committees PO Box 5013 Wellington 6140
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Ethics committee country [1]
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New Zealand
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Date submitted for ethics approval [1]
298149
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05/11/2012
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Approval date [1]
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27/11/2012
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Ethics approval number [1]
298149
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12/NTB/56
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Summary
Brief summary
Introduction and methods Flucloxacillin is the first-line antibiotic agent in many parts of the world, including NZ and Australia, for treating Staphylococcus aureus and skin infections. It is often given by 24-hour intravenous (IV) infusion to outpatients with moderately severe infections, but this costs NZ$150-200/day and sometimes causes problems with the IV catheter. It is often given by mouth to patients with mild infections, but this requires four-times-daily dosing and is recommended to be taken 1 hour before or 2 hours after a meal. It would be very useful if there was a more effective and convenient oral flucloxacillin regimen that could be taken with or without food. In the early 1950s, probenecid was developed as a penicillin ‘booster’. In this study, we evaluated the effect of low dose probenecid (500 mg), with or without a small meal, on oral flucloxacillin pharmacokinetics in 11 healthy volunteers. We used modern testing methods, measured free flucloxacillin concentrations, and evaluated the results in terms of modern PK/PD targets for the likely bacteria involved. Results Probenecid delayed clearance of flucloxacillin from the body, approximately doubling the time the flucloxacillin was above the target minimum inhibitory concentration (MIC90 = 0.5 mg/L for Staphylococcus aureus. Food delayed the absorption of flucloxacillin but did not reduce it.. For a target of time above 0.5 mg/L for more than 50% of the day (e.g. for a deep S. aureus bone or joint infection), modeling at steady state showed that flucloxacillin 1 g with probenecid 500 mg taken 6- or 8-hourly with or without food would achieve this in almost all cases. For a target of time above 0.5 mg/L for more than 30% of the day (e.g. for a mild skin infection), modeling at steady state showed that flucloxacillin 1 g with probenecid 500 mg taken twice daily with or without food would achieve this in almost all cases. Conclusion These results show that probenecid is a powerful booster of flucloxacillin and that food did not negatively affect the relevant results. Taking probenecid and flucloxacillin together could enable patients with mild infections to have a more convenient twice daily regimen and could enable patients with moderate deep serious gram-positive infections to avoid home intravenous infusions.
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Trial website
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Trial related presentations / publications
A report of this work was presented verbally at the Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists (ASCEPT) annual scientific meeting in Melbourne, Australia, in December 2013 and at the Australasian Society for Infectious Diseases (ASID) annual scientific meeting in Adelaide, Australia, in March 2014. Abstracts were not published for non-attendees.
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Public notes
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Attachments [1]
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/AnzctrAttachments/369309-12-NTB-56_Approved_Letter.pdf
(Ethics approval)
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Attachments [2]
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/AnzctrAttachments/369309-probenecid flucloxacillin PK in volunteers study - protocol.doc
(Protocol)
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Attachments [3]
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/AnzctrAttachments/369309-Abstract ASID March 2014 - Everts et al - Flucloxacillin and Probenecid.docx
(Publication)
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Contacts
Principal investigator
Name
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Dr Richard Everts
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Address
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Department of Medicine
Nelson Hospital
Private Bag 18
Nelson 7042
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Country
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New Zealand
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Phone
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+64 3 539-1170
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Fax
60294
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+64 3 539-4958
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Email
60294
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[email protected]
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Contact person for public queries
Name
60295
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Richard Everts
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Address
60295
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Department of Medicine
Nelson Hospital
Private Bag 18
Nelson 7042
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Country
60295
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New Zealand
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Phone
60295
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+64 3 539-1170
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Fax
60295
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+64 3 539-4958
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Email
60295
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[email protected]
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Contact person for scientific queries
Name
60296
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Richard Everts
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Address
60296
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Department of Medicine
Nelson Hospital
Private Bag 18
Nelson 7042
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Country
60296
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New Zealand
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Phone
60296
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+64 3 539-1170
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Fax
60296
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+64 3 539-4958
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Email
60296
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
Source
Title
Year of Publication
DOI
Embase
Probenecid and food effects on flucloxacillin pharmacokinetics and pharmacodynamics in healthy volunteers.
2020
https://dx.doi.org/10.1016/j.jinf.2019.09.004
N.B. These documents automatically identified may not have been verified by the study sponsor.
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