AzTrials
AzTrials

Beta-lactam AntibioticsOPTIMAL TDMNCT03790631

The OPTIMAL TDM Study: Determining Optimal Beta-lactam Plasma Concentrations Through Therapeutic Drug Monitoring

An observational study of Beta-lactam Antibiotics and Therapeutic Drug Monitoring, run by University of Geneva, Switzerland at 1 site in Switzerland.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial summary

Little is known of beta-lactam antibiotics' true therapeutic plasma concentration range. The aims of this study are to define evidence-based, safe and effective upper and lower limits of the plasma concentrations of imipenem, meropenem, amoxicillin, flucloxacillin, piperacillin, ceftazidime and cefepime in patients at… Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
The study is observational.
How many people
771 participants
Where
1 siteSwitzerland
Study dates
14 Jan 2019to 31 Dec 2023
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: Included patients will be adults (≤18 years) hospitalized in the intensive-care, step-down, or hematology-oncology units of the Geneva University Hospitals and treated with one of the above-listed 7 beta-lactam antibiotics for a suspected or confirmed bacterial infections.

Who may be able to join

  • Hospitalized patients with suspected or confirmed systemic bacterial infection:
  • Receiving either imipenem-cilastatin, meropenem, amoxicillin (±clavulanic acid), flucloxacillin, piperacillin-tazobactam, ceftazidime or cefepime
  • Aged ≥18 years
  • Requiring intensive or intermediate-intensive (step-down) care OR severely immunosuppressed (see definitions)

Who cannot join

  • Planned imminent transfer to an outside hospital
  • Poor prognosis with life expectancy <1 week and/or intended transition to palliative care

Trial locations and contacts

1 site in 1 country.

Switzerland1 site
  • Geneva University Hospitals

    Geneva, Canton of Geneva, 1205

Other trials in Switzerland

About this study

Little is known of beta-lactam antibiotics' true therapeutic plasma concentration range. The aims of this study are to define evidence-based, safe and effective upper and lower limits of the plasma concentrations of imipenem, meropenem, amoxicillin, flucloxacillin, piperacillin, ceftazidime and cefepime in patients at increased risk of serious bacterial infections and currently understudied pharmacokinetics (the critically ill, the elderly, and the immunosuppressed).

This prospective observational study will include adult patients with suspected or confirmed systemic bacterial infection receiving one of the above-named antibiotics and hospitalized in intensive-care, step-down, or hematology-oncology units of the Geneva University Hospitals (HUG).

Read more

Eligible patients will be identified via the electronic health record (EHR). Patients receiving traditional intermittent dosing or prolonged infusions will undergo TDM for at least one intermediate (mid-interval) and one trough level at 24 hours (-12 or +48 hours) after the therapy's start. Patients receiving continuous infusions will undergo TDM for at least one steady-state level. Clinical course will be observed for 30 days from the start of the study antibiotic (1st day of study antibiotic =day 1).

The primary outcome is incidence of clinical toxicity through day 30 after start of study antibiotic (as stratified by BL trough concentration). Secondary outcomes are listed below.

Read the detailed description

Little is known of beta-lactam antibiotics' true therapeutic plasma concentration range. The aims of this study are to define evidence-based, safe and effective upper and lower limits of the plasma concentrations of imipenem, meropenem, amoxicillin, flucloxacillin, piperacillin, ceftazidime and cefepime in patients at increased risk of serious bacterial infections and currently understudied pharmacokinetics (the critically ill, the elderly, and the immunosuppressed).

This prospective observational study will include adult patients with suspected or confirmed systemic bacterial infection receiving one of the above-named antibiotics and hospitalized in intensive-care, step-down, or hematology-oncology units of the Geneva University Hospitals (HUG).

Eligible patients will be identified via the electronic health record (EHR). Patients receiving traditional intermittent dosing or prolonged infusions will undergo TDM for at least one intermediate (mid-interval) and one trough level at 24 hours (-12 or +48 hours) after the therapy's start. Patients receiving continuous infusions will undergo TDM for at least one steady-state level. Clinical course will be observed for 30 days from the start of the study antibiotic (1st day of study antibiotic =day 1).

The primary outcome is incidence of clinical toxicity through day 30 after start of study antibiotic (as stratified by BL trough concentration). Secondary outcomes are listed below.

Being tested
The study is observational.

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • The study is observational.Other

    The study is observational.

Study groups in NCT03790631
Study groupRoleWhat they receive
imipenem TDMAdult patients receiving imipenem for suspected or confirmed bacterial infection. TDM will be performed to assess intermediate and trough levels once the patient is at steady-state.
Receives: Other: The study is observational.
meropenem TDMAdult patients receiving meropenem for suspected or confirmed bacterial infection. TDM will be performed to assess intermediate and trough levels once the patient is at steady-state.
Receives: Other: The study is observational.
piperacillin TDMAdult patients receiving piperacillin (with or without tazobactam) for suspected or confirmed bacterial infection. TDM will be performed to assess intermediate and trough levels once the patient is at steady-state.
Receives: Other: The study is observational.
flucloxacillin TDMAdult patients receiving flucloxacillin for suspected or confirmed bacterial infection. TDM will be performed to assess intermediate and trough levels once the patient is at steady-state.
Receives: Other: The study is observational.
amoxicillin TDMAdult patients receiving amoxicillin for suspected or confirmed bacterial infection. TDM will be performed to assess intermediate and trough levels once the patient is at steady-state.
Receives: Other: The study is observational.
ceftazidime TDMAdult patients receiving ceftazidime for suspected or confirmed bacterial infection. TDM will be performed to assess intermediate and trough levels once the patient is at steady-state.
Receives: Other: The study is observational.
cefepime TDMAdult patients receiving cefepime for suspected or confirmed bacterial infection. TDM will be performed to assess intermediate and trough levels once the patient is at steady-state.
Receives: Other: The study is observational.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Incidence of clinical toxicity through day 30 after start of study antibiotic

    Incidence of clinical toxicity through day 30 after start of study antibiotic (as stratified by BL trough concentration)

    Measured: day 30 after start of antibiotic

Secondary outcomes (13)
  1. Clinical response: incidence of clinical cure

    Clinical response to therapy through day 30 will be measured study-wide. "Clinical response" is either clinical cure (resolution of symptoms) or clinical failure (lack of improvement in signs and symptoms of infection OR recurrence of signs/symptoms of infection after initial improvement OR death in the 30-day study period considered at least possibly due to the infection). Where the MIC is unavailable, EUCAST epidemiologic cutoffs (ECOFF) will be used; if no organism is isolated, non-species-related breakpoints for targeted organisms (e.g., Pseudomonas aeruginosa) will be used.

    Measured: day 30

  2. clinical response in patients with neutropenic fever: incidence of clinical cure in this subpopulation

    Clinical response (as in outcome no. 2) in the subgroup of patients with neutropenic fever at the time of BL therapy. ("Clinical response" is either clinical cure (resolution of symptoms) or clinical failure (lack of improvement in signs and symptoms of infection OR recurrence of signs/symptoms of infection after initial improvement OR death in the 30-day study period considered at least possibly due to the infection).)

    Measured: day 30

  3. 30-day mortality attributable to the treated infection

    30-day mortality attributable to the treated infection

    Measured: day 30

  4. 30-day all-cause mortality

    30-day all-cause mortality

    Measured: day 30

  5. incidence of reversible toxicity

    Proportion of adverse events (AE) that are reversible after discontinuation of the relevant BL antibiotic

    Measured: day 30

  6. Incidence of Clostridium difficile infection

    Incidence of Clostridium difficile infection

    Measured: day 30

  7. Incidence of clinical toxicity of piperacillin-tazobactam when co-administered with vancomycin

    Incidence of clinical toxicity of piperacillin-tazobactam (and other beta-lactam antibiotics) when co-administered with vancomycin

    Measured: day 30

  8. Incidence of emergence of resistance

    Prevalence of emerging resistance to study antibiotics in clinical isolates (from baseline)

    Measured: day 30

  9. Incidence of undetectable beta-lactam plasma concentrations

    Proportion of patients with undetectable beta-lactam trough and/or intermediate concentrations

    Measured: day 30

  10. Incidence of off-label prescribing

    Proportion of patients for whom (a) beta-lactam dosing is "off-label" according to Swiss recommendations and (b) there are no dosing recommendations (e.g., hemofiltration)

    Measured: day 30

  11. The correlation of free versus total flucloxacillin concentrations

    The correlation of free versus total flucloxacillin concentrations (in a subset of patients, free flucloxacillin plasma levels will also be measured and compared to those of total flucloxacillin).

    Measured: day 30

  12. Median intermediate and trough plasma concentrations of tazobactam

    In a subset of patients receiving piperacillin/tazobactam, median intermediate and trough plasma concentrations of tazobactam (beta-lactamase inhibitor) in proportion to piperacillin in patients receiving piperacillin-tazobactam

    Measured: through day 30

  13. Beta-lactam trough concentration/minimal inhibitory concentration (MIC) index

    The trough beta-lactam (BL) concentration/minimal inhibitory concentration (MIC) index on day 1 (±1) will be measured in all patients for later correlation analyses with clinical outcomes (clinical success versus failure).

    Measured: day 1 (±1)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted31 Dec 2018
  2. Study start14 Jan 2019
  3. Primary completion31 Dec 2023
  4. Study completion31 Dec 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
771 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03790631
Sponsor's protocol ID
2018-01830
Other IDs
2018
Acronym
OPTIMAL TDM
Status last verified
May 2025
First submitted
27 Dec 2018
Last updated
20 May 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided: Data may be housed in a publicly accessible, non-profit digital repository such as Dryad or EUDAT.

Publications

  • Bricheux A, Lenggenhager L, Hughes S, Karmime A, Lescuyer P, Huttner A. Therapeutic drug monitoring of imipenem and the incidence of toxicity and failure in hospitalized patients: a retrospective cohort study. Clin Microbiol Infect. 2019 Mar;25(3):383.e1-383.e4. doi: 10.1016/j.cmi.2018.11.020. Epub 2018 Dec 4.

    PubMed 30528370
  • Huwyler T, Lenggenhager L, Abbas M, Ing Lorenzini K, Hughes S, Huttner B, Karmime A, Uckay I, von Dach E, Lescuyer P, Harbarth S, Huttner A. Cefepime plasma concentrations and clinical toxicity: a retrospective cohort study. Clin Microbiol Infect. 2017 Jul;23(7):454-459. doi: 10.1016/j.cmi.2017.01.005. Epub 2017 Jan 19.

    PubMed 28111294
  • Muller AE, Huttner B, Huttner A. Therapeutic Drug Monitoring of Beta-Lactams and Other Antibiotics in the Intensive Care Unit: Which Agents, Which Patients and Which Infections? Drugs. 2018 Mar;78(4):439-451. doi: 10.1007/s40265-018-0880-z.

    PubMed 29476349
  • Huttner A, Harbarth S, Hope WW, Lipman J, Roberts JA. Therapeutic drug monitoring of the beta-lactam antibiotics: what is the evidence and which patients should we be using it for? J Antimicrob Chemother. 2015 Dec;70(12):3178-83. doi: 10.1093/jac/dkv201. Epub 2015 Jul 17.

    PubMed 26188037
  • Marti C, Stirnemann J, Lescuyer P, Tonoli D, von Dach E; OPTIMAL TDM Study Group; Huttner A. Therapeutic drug monitoring and clinical outcomes in severely ill patients receiving amoxicillin: a single-centre prospective cohort study. Int J Antimicrob Agents. 2022 Jun;59(6):106601. doi: 10.1016/j.ijantimicag.2022.106601. Epub 2022 May 6.

    PubMed 35533793

Questions about this trial

What is this clinical trial studying?

An observational study of Beta-lactam Antibiotics and Therapeutic Drug Monitoring, run by University of Geneva, Switzerland at 1 site in Switzerland.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 20 May 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Switzerland. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Incidence of clinical toxicity through day 30 after start of study antibiotic (time frame: day 30 after start of antibiotic). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03790631, which also lists 5 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 20 May 2025; AzTrials last refreshed its copy on 30 Oct 2026.

Free account

Keep searching with a free account

You’ve used your 3 free searches for this session. Log in or create a free AzTrials account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in