a safety and tolerability study of doripenem compared with cefepime in hospitalized children with bacterial pneumonia

Conditions: Pneumonia, Bacterial; Community-Acquired Infections; Nosocomial Infection; Pneumonia, Ventilator-Associated

Summary: the purpose of this study is to evaluate the safety and tolerability of doripenem compared to cefepime in children hospitalized with pneumonia.

this is a randomized (study assigned by chance), double-blind (neither physician nor patient knows the name of the assigned study drugs), double-dummy (all patients will be given both a placebo \[salt solution\] and study drug in alternating periods of time during the study), active comparator-controlled (compare the 'test' treatment to standard-of-care therapy), multinational, multicenter study to establish the safety and tolerability of doripenem (an antibiotic) compared with cefepime (an antibiotic) administered by intravenous (iv) infusion (slow injection of drug solution into the vein over a period of time) in children ages 3 months to less than 18 years hospitalized with pneumonia (includes nosocomial pneumonia \[np\], severe community-acquired pneumonia (cap), and ventilator-assisted pneumonia \[vap\]). the study includes 3 periods: a pretreatment (screening) period that will occur within 2 days prior to randomization (assignment of study drug); a treatment period of 10 to 14 days where patients will receive study drug treatment, and a posttreatment period consisting of 2 study visits. the maximum duration of study drug therapy is 14 days. the total duration of the study is approximately 7 to 8 weeks for each patient. the primary outcome measure in the study is safety and tolerability. safety and tolerability will be evaluated by examining the incidence, severity, and type of adverse events, changes in clinical laboratory tests, vital signs measurements, and findings from physical examinations observed during treatment and at each posttreatment visit. an independent monitoring committee (idmc) will be established for this study to ensure that the safety of the patients is not compromised. the idmc will consist of individuals who are not associated with the conduct of the study, and will include but will not be limited to individuals with expertise relevant to the care of pediatric patients, and including at least one infectious disease physician and at least one statistician. patients will receive iv doripenem (20 mg/kg up to a maximum of 500 mg/dose) and cefepime placebo or cefepime (50 mg/kg up to a maximum of 2 grams/dose and doripenem placebo once every 8 hours for up to 14 days. after receiving a minimum of 3 days of iv study drug therapy, patients may be switched to the oral antibiotic (amoxicillin/clavulanate potassium suspension or tablets) or an approved alternative oral agent to complete a total 10-14 days course of antibiotics.

Eligibility criteria:
inclusion criteria: * require parenteral antibacterial therapy for the treatment of pneumonia * have new or progressive radiographic infiltrate(s) (alveolar, lobar, or consolidation) consistent with a bacterial pneumonia that is not related to cardiac or other disease processes * must, based on the judgment of the investigator, require hospitalization initially and antibacterial therapy for 10 to 14 days for the treatment of the current pneumonia. (note that the patient must require at least 3 days of iv antibiotic therapy initially) * have a diagnosis of nosocomial pneumonia , severe community-acquired pneumonia, or ventilator-associated pneumonia, defined by the disease-specific criteria as stated in the study protocol * have a clinical presentation compatible with bacterial pneumonia( with fever or hypothermia and leukocytosis or leucopenia and at least 2 of the following clinical signs or symptoms in non-intubated patients: cough, new onset of lower respiratory tract secretions (including change in character of secretions or increase in the quantity of secretions or suctioning requirements), auscultatory findings of pneumonia or consolidation (rales, rhonchi bronchial breath sounds, decreased breath sounds, wheezing, and egophony), dyspnea, increased work of breathing expressed as retractions, nasal flaring, or grunting, hypoxemia or oxygen saturation less than 90% on room air, and tachypnea exclusion criteria: * received more than 24 hours of systemic antibacterial therapy in the 48 hours before the start of the infusion of the first dose of study drug for the current episode of pneumonia * known presence at randomization of pulmonary infection caused only by bacteria that is resistant to cefepime or doripenem (including methicillin resistant staphylococcus aureus) or presence at baseline of pulmonary infection with stenotrophomonas species, or burkholderia cepacia * has any of the following conditions at baseline that may interfere with the diagnosis or response to therapy: chest trauma with severe lung contusion, acute respiratory distress syndrome, empyema, flail chest (severe injury to the chest), history of active lung cancer, chronic bronchitis with an exacerbation within the last 30 days, bronchiectasis (an obstructive lung disease), lung abscess(s), anatomical bronchial obstruction, active pulmonary tuberculosis with treatment, suspected pulmonary tuberculosis, suspected or documented atypical viral pneumonia without bacterial superinfection, suspected or documented pertussis, chemical pneumonitis (eg, aspiration of gastric contents, inhalation injury), or cystic fibrosis * the patient has any of the following clinically significant laboratory abnormalities: hematocrit of less than 20% * absolute neutrophil count (anc) \ 5x the age specific upper limit of normal, acute or chronic renal insufficiency with a baseline creatinine clearance of \<60 ml/minute or requires dialysis therapy for any reason, or are profoundly immunodeficient and require prophylactic antimicrobial therapy for pneumocystis jirovicei, toxoplasma gondii, or herpes viruses, and/or chronic or intermittent immunoglobin replacement therapy.

Keywords: doripenem child, hospitalized cefepime infusions, intravenous severe community acquired pneumonia nosocomial pneumonia ventilator associated pneumonia