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Hospital-acquired Pneumonia (HAP)ROAD-RCTNCT07820501

Resistance-Optimised Antimicrobial Dosing in Critically Ill Patients, a Randomised Controlled Trial

A study testing Resistance-Optimised Precision Dosing in people with Hospital-acquired Pneumonia (HAP) and Ventilator-Associated Pneumonia (VAP), run by The University of Queensland.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
Search all trials

Trial summary

Critically ill people who need a breathing machine often develop hospital-acquired lung infections. These infections are commonly treated with the antibiotics piperacillin/tazobactam or meropenem. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Resistance-Optimised Precision Dosing
Could I receive a placebo?
No, everyone receives an active treatment
How many people
610 participants
Where
No sites listed yet
Study dates
Nov 2026to Sep 2029
Phase
Interventional
Are there results?
Not yet: the study is under way

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

Who may be able to join

  • The patient is ≥ 18 years of age.
  • The patient has been admitted to the hospital for ≥ 48 h or was discharged from a hospital within the preceding seven days and is currently admitted to the ICU.
  • The patient is intubated and mechanically ventilated.
  • The patient is diagnosed with a probable or definitive respiratory infection and exhibits at least one of the following clinical features:
  • New onset or worsening pulmonary symptoms or signs: increase in volume and/or purulence of respiratory secretions, worsening of hypoxaemia requiring an increase in the FiO2 and/or need for acute changes in the ventilator support system to support oxygenation.
  • Radiological findings deemed consistent with a respiratory infection. III. Clinical signs and symptoms of infection: fever > 38 °C, leucocytosis, increase in acute phase reactants such as C-reactive protein or procalcitonin.
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  • The patient has been commenced on empiric or targeted treatment with piperacillin/tazobactam or meropenem for the management of a respiratory infection, with an expected duration of treatment of > 72 h.
  • Piperacillin/tazobactam or meropenem have been commenced in an ICU that participates in ROAD-RCT.
  • The patient has an appropriate arterial or venous access for blood sampling.

Who cannot join

  • The patient is known or suspected to be pregnant.
  • The patient has a known allergy to piperacillin/tazobactam or meropenem.
  • The patient has a community-acquired respiratory infection or chemical pneumonitis in the context of bronchoaspiration.
  • The patient has received piperacillin/tazobactam or meropenem for more than 48 h.
  • The antimicrobial dose initiated empirically is > 4 g daily for meropenem and > 18 g daily (16 g piperacillin / 2 g tazobactam) for piperacillin/tazobactam (excluding the loading dose) in patients who are not receiving renal replacement therapy.
  • The antimicrobial dose initiated empirically is > 18 g daily (16 g piperacillin / 2 g tazobactam) for piperacillin/tazobactam and > 2 g daily for meropenem in patients receiving renal replacement therapy (Table 1).
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  • The patient's death is deemed imminent and inevitable.
  • The patient has previously been enrolled in ROAD-RCT.
  • The patient is or has been enrolled in another antimicrobial clinical trial that may interfere with the intervention as determined by the study investigators.
  • The patient has a baseline (at ICU admission or enrolment) positive rectal and/or nasopharyngeal screening swab, or is known to have been colonised within the past 6 months, with any of the following beta-lactam-resistant Gram-negative microorganism(s): carbapenem-resistant Enterobacterales, P. aeruginosa with DTR or carbapenem-resistant A. baumannii complex.
  • There is a prior known or likely reason that the patient would not consent if they were able to be asked.

Trial locations and contacts

No sites are listed yet. Contact the study team or a site near you to ask about taking part.

About this study

Critically ill people who need a breathing machine often develop hospital-acquired lung infections. These infections are commonly treated with the antibiotics piperacillin/tazobactam or meropenem. However, standard antibiotic doses may not always provide the right drug levels to fully treat the infection or help prevent antibiotic resistance.

The purpose of this study is to determine whether a resistance-optimized antibiotic dosing approach improves recovery compared with standard antibiotic dosing in critically ill adults with hospital-acquired respiratory infections.

Read more

Participants will be randomly assigned to 1 of 2 groups:

Resistance-optimized precision dosing - guided by therapeutic drug monitoring and dosing software.

Standard care - antibiotic dosing used at the participating hospital.

All participants will receive treatment with either piperacillin/tazobactam or meropenem as determined by their treating clinical team. The study will compare whether the precision dosing approach leads to better clinical recovery, reduces the development of antibiotic-resistant bacteria, and is safe for participants.

Approximately 610 mechanically ventilated adults will be enrolled from intensive care units in multiple countries. Participants will be followed for up to 28 days after starting study antibiotic treatment.

Read the detailed description

Critically ill adults who require mechanical ventilation commonly develop hospital-acquired respiratory infections. These infections are frequently treated with the beta-lactam antibiotics piperacillin/tazobactam or meropenem. Standard antibiotic dosing may not always achieve drug levels that provide the best balance between treating infection and reducing the development of antibiotic resistance.

The Resistance-Optimised Antimicrobial Dosing in Critically Ill Patients Randomized Controlled Trial (ROAD-RCT) is a multicentre, international, investigator-initiated, open-label, randomized, parallel-group superiority trial. The study aims to determine whether resistance-optimised precision dosing improves clinical cure compared with standard care dosing in mechanically ventilated critically ill adults with hospital-acquired respiratory infections.

A total of approximately 610 participants will be enrolled and randomized in a 1:1 ratio to one of two treatment strategies:

Resistance-optimised precision dosing guided by model-informed precision dosing (MIPD).

Standard care antibiotic dosing according to local clinical practice.

Participants will receive treatment with either piperacillin/tazobactam or meropenem as prescribed by their treating clinical team. In the intervention group, dosing recommendations will be supported by therapeutic drug monitoring (TDM), patient clinical information, and dosing software to help achieve antibiotic exposure targets associated with suppression of antimicrobial resistance while remaining within accepted safety limits. Participants assigned to standard care will receive antibiotic dosing determined by their treating clinicians.

The primary outcome is clinical cure at Day 14 after initiation of study antibiotic therapy.

Secondary outcomes include time to clinical cure, mortality, treatment-related adverse events, duration of organ support therapies, emergence of antibiotic resistance, acquisition of new resistant microorganisms, hospital and intensive care unit length of stay, quality of life, and health-economic outcomes.

Participants will be followed for up to 28 days after initiation of study antibiotic treatment.

The study hypothesis is that resistance-optimised precision dosing will improve clinical cure while reducing the emergence of antimicrobial resistance compared with standard care dosing.

The results of this study will provide evidence about the effectiveness, safety, feasibility, and potential scalability of precision antibiotic dosing strategies in critically ill patients with hospital-acquired respiratory infections.

Being tested
Resistance-Optimised Precision Dosing, Standard Care Dosing
Keywords
Hospital-Acquired Pneumonia, Ventilator-Associated Pneumonia, Nosocomial Respiratory Infection, Intensive Care Unit, Mechanical Ventilation, Antimicrobial Resistance, Therapeutic Drug Monitoring, Drug Dose Optimization, Randomized Controlled Trial, Precision Dosing
Medical subject headings
Healthcare-Associated Pneumonia, Pneumonia, Ventilator-Associated, Critical Illness

What participants receive

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

  • Resistance-Optimised Precision DosingBehavioural

    Participants assigned to the intervention group will receive piperacillin/tazobactam or meropenem using resistance-optimised precision dosing guided by model-informed precision dosing (MIPD). Dosing recommendations will be based on patient clinical characteristics and therapeutic drug monitoring results and are intended to achieve antibiotic exposure targets associated with suppression of antimicrobial resistance while remaining within established safety limits. Dosing will be reviewed and adjusted during treatment using MIPD recommendations.

  • Standard Care DosingBehavioural

    Participants assigned to the standard care group will receive piperacillin/tazobactam or meropenem according to routine clinical practice at the participating site. Antibiotic dose, infusion duration, dosing interval, and dose adjustments will be determined by the treating clinical team. Therapeutic drug monitoring may be performed if it is part of usual care at the study site.

Study groups in NCT07820501
Study groupRoleWhat they receive
Arm 1: Resistance-Optimised Precision DosingExperimentalParticipants will receive piperacillin/tazobactam or meropenem using resistance-optimised precision dosing guided by model-informed precision dosing (MIPD). Dosing recommendations will be based on patient clinical characteristics and therapeutic drug monitoring results to achieve predefined antibiotic exposure targets associated with suppression of antimicrobial resistance. Dosing will be reviewed and adjusted throughout treatment according to MIPD recommendations until cessation of study antibiotic therapy, intensive care unit discharge, or Day 14, whichever occurs first.
Receives: Behavioral: Resistance-Optimised Precision Dosing
Arm 2: Standard Care DosingActive comparatorParticipants will receive piperacillin/tazobactam or meropenem dosed according to routine clinical practice at the participating site. The initial choice of antibiotic, dose, infusion duration, dosing interval, and any subsequent dose adjustments will be determined by the treating clinical team in accordance with local standard care. Therapeutic drug monitoring may be performed if it is part of routine clinical practice at the study site. Treatment will continue until antibiotic cessation, intensive care unit discharge, or Day 14 after initiation of study antibiotic therapy, whichever occurs first.
Receives: Behavioral: Standard Care Dosing

What is being measured

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

  1. Clinical cure

    Clinical cure at Day 14 following initiation of study beta-lactam antimicrobial therapy. Clinical cure is defined as completion of the antimicrobial treatment course without recommencement of antimicrobial therapy for the same infectious episode within 48 hours of cessation, cessation of therapy not being due to palliative care, and survival for at least 48 hours after completion of the antimicrobial course.

    Measured: Day 14

Secondary outcomes (8)
  1. Time to Clinical Cure

    Time in hours from initiation of study antibiotic therapy to clinical cure.

    Measured: Up to Day 14

  2. All-cause mortality

    Any death documented within time frame

    Measured: 28 days

  3. Emergence of antibiotic resistance

    Antibiotic resistance emergence is defined as any of the following: emergence of resistance to beta-lactam antimicrobials in the index microorganism from the surveillance and/or clinical samples; acquisition of (a) new beta-lactam antimicrobials-resistant microorganism(s) in the surveillance and/or clinical samples, or the detection of new antimicrobial resistance gene classes (whole genome sequencing and metagenomic evaluation) in the surveillance and/or clinical samples.

    Measured: Day 14

  4. Incremental Cost-Utility Ratio

    Incremental Cost-Utility Ratio incorporating the Quality adjusted life years based on the EQ-5D-5L questionnaire, with costs converted using purchasing power parity.

    Measured: Day 28

  5. Treatment emergent adverse events

    Any adverse event attributed to the study drug per protocol definitions.

    Measured: Day 14

  6. C. difficile diarrhoea

    Diagnosis of C. difficile diarrhoea

    Measured: Day 14

  7. Duration of artificial organ support

    Duration of mechanical ventilation, renal replacement therapy, extracorporeal membrane oxygenation, and duration of vasopressor therapy.

    Measured: Day 14

  8. Intensive Care Unit Length of Stay

    Duration of ICU admission

    Measured: Day 28

Timeline

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

  1. First posted15 Sep 2026
  2. Study startNov 2026 (estimated)
  3. Primary completionAug 2029 (estimated)
  4. Study completionSep 2029 (estimated)

Resources

More details

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

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Participants will be randomized in a parallel-group design to receive either resistance-optimised precision dosing guided by MIPD or standard care antibiotic dosing. Participants will remain in their assigned group for the duration of the study intervention.
Masking
None (open label)
Enrolment
610 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07820501
Sponsor's protocol ID
ROAD-RCT
Other IDs
Grant Number 2039566
Acronym
ROAD-RCT
Status last verified
Aug 2026
First submitted
16 Aug 2026
Last updated
15 Sep 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Publications

  • Roberts JA, Heffernan AJ, Chai MG, et al. Resistance-Optimised Antibiotic Dosing (The ROAD Study): Is dosing of meropenem and piperacillin-tazobactam optimised to prevent the emergence of antibiotic resistance safe and feasible in the ICU? A pilot study. CMI Communications. 2025;2:105051.

Questions about this trial

What is this clinical trial studying?

A study testing Resistance-Optimised Precision Dosing in people with Hospital-acquired Pneumonia (HAP) and Ventilator-Associated Pneumonia (VAP), run by The University of Queensland.

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 9 inclusion and 11 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: opening soon, as of the sponsor's last update on 15 Sep 2026. Status can change between updates, so confirm with the study contact before making plans.

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?

This study is still under way. Results are not available in the source record yet.

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

Contact Aaron Heffernan (+610411588291, Aaron.Heffernan@health.qld.gov.au), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Clinical cure (time frame: Day 14). 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 NCT07820501, which also lists 1 linked publication.

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 15 Sep 2026; AzTrials last refreshed its copy on 26 Oct 2026.

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