Healthy Subjects Clinical Trial
Official title:
Phase I Study to Evaluate Pharmacokinetics, Pharmacodynamics and Safety/Tolerability of Two Dosing Regimens of Oral Fosfomycin Tromethamine in Healthy Adult Participants
Oral dosage regimens for fosfomycin tromethamine (Monurolâ„¢) are not established for the
treatment of cUTI. The most common and recommended adult dosage regimen in the literature is
a single-dose sachet containing the equivalent of 3 grams of fosfomycin administered every
other day (QOD) for a total of three doses.
There are a myriad of different oral fosfomycin dosing regimens currently being used in
clinical practice, including up to 3 grams orally twice daily for 7-21 days, but these
regimens are not based on solid pharmacokinetic, pharmacodynamic or safety rationale. Initial
pharmacokinetic studies performed with oral fosfomycin tromethamine primarily examined single
dose regimens and did not use modern day bioanalytical or pharmacokinetic techniques. As the
use of fosfomycin becomes more pervasive in concordance with the increase in multidrug
resistant pathogens, further pharmacokinetic and safety data are needed for more intensive
dosing regimens to support its continued use.
The rationale of this study is that oral fosfomycin tromethamine requires a modern
pharmacokinetic-pharmacodynamic study to identify alternative oral dosage regimens that are
appropriate and safe. This study provided safety/tolerability and clinical pharmacology
information regarding two oral dosing regimens that may have application to treat various
types of infections involving resistant pathogens or when other oral antibacterial options
are not available.
The study was designed as a randomized, two-way crossover trial involving up to 24 randomized
participants with an anticipated drop-out rate no higher than 25% to give a total of 18
evaluable healthy adult participants. The study was fully explained to each participant,
informed consent was obtained, and an IRB-approved informed consent form was signed before
any study procedures were initiated. All participants underwent screening assessments within
30 days prior to the initial dosing to determine their eligibility for enrollment into the
study. All participants met the inclusion and exclusion criteria and underwent screening
procedures that included a complete medical history, physical examination, assessment of
clinical laboratory parameters (chemistry and hematology), ECG, and pregnancy test (females
of child bearing potential only).
Randomization was stratified by gender, using permuted blocks. Within each gender, eligible
participants were randomized with equal probability to one of the 2 treatment sequences shown
in Table 3. According to the sequence to which the participant was randomized, the
participant initially received one of two oral dosage regimens of fosfomycin: 3 g every other
day x 3 doses or 3 g once-daily x 7 doses. After completion of the initial dosing regimen
each participant was crossed over to receive the other dosing regimen. There was a minimum
5-day, and a recommended maximum 14-day, washout period prior to starting the next dosing
regimen. Blood and urine samples were collected throughout the study as well as detailed drug
administration and adverse event data for each participant.
Fosfomycin tromethamine sachet (Monurolâ„¢) was used in this study. Each participant was
instructed how to stir and dissolve the single-dose sachet into 3 to 4 ounces of water, and
take each dose immediately after dissolving in water. Compliance was assessed by participant
interviews (every 2 days) and counting of empty of sachets.
Participants reported to the outpatient study center on Day -30 to -1 for study criteria
review, clinical assessment, and blood collection for screening laboratory tests prior to
fosfomycin administration. Each participant participated in the study up to 120 days (i.e.,
screening visit; day -1 for clinical assessment and blood collection; days 1-7 for fosfomycin
administration and sample collection period; and day 8-10 for follow-up assessment; crossed
over to receive the other dosing regimen and schedule of events.
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