This is a PK and safety study in infants and children requiring prophylaxis of, or treatment for confirmed or suspected infection with clindamycin or TMP-SMX. Each subject will be involved in the study for up to 33 days (3 days of therapy, 30 days for serious adverse event monitoring).
STUDY PROCEDURES
Baseline/pre-dose assessment - After the parent or legally authorized representative has signed the IRB-approved informed consent form and after it has been determined that the subject satisfies all inclusion and no exclusion criteria, the following evaluations will be recorded in the CRF:
- Subject demographics including sex, date of birth, race, and ethnicity
- For infants ≤12 months of age: gestational age (GA) and body weight at birth
- Active medical history (from admission note in medical record)
- Concomitant medications
- For subjects receiving study drugs per standard of care, record the last 6 doses of clindamycin or TMP-SMX received prior to study drug administration (date, time, route of administration)
- Targeted physical examination, including weight and length/height
- Laboratory determinations within 48 hours prior to enrollment if performed per local standard of care. If serum creatinine was not collected as standard of care, it will be collected for this study to confirm eligibility.
- Microbiology determinations within 48 hours prior to enrollment if performed per local standard of care.
Treatment assessments/procedures (Day 1-3) - The following assessments will be conducted each day while the subject is on study:
- Date, time, route, site of administration, dose, and formulation of each study drug dose
- Concomitant medications
- PK sampling (blood and urine) with date, time, and site of collection
- Genetic sampling (once)
- Laboratory determinations if performed per standard of care
- Microbiologic determinations if performed per standard of care
- Serum sample for determination of alpha-1-acid glycoprotein concentration for subjects enrolled in the clindamycin arm only. Alpha-1-acid glycoprotein concentration will be measured in one of the plasma PK samples. A separate blood sample is not required.
- Study drug-related adverse events AEs and SAEs If available, record laboratory determinations daily; if several laboratory determinations are available for the same day, record test results closest to administration of study drug.
PK SAMPLING
Plasma pharmacokinetics sampling scheme.
Clindamycin: Sample collection windows are relative to the start of the infusion for IV clindamycin, except for the first post-infusion sample, which is relative to the end of the infusion.
Three plasma PK samples will be collected around the first dose according to the following sampling windows:
- 0-10 minutes after the end of the first dose
- 2-4 hours after the start of the first dose
- <30 minutes prior to second dose
Four plasma PK samples will be collected any time after dose 6 according to the following sampling windows.
- Pre-dose
- 0-10 minutes
- 2-4 hours
- <30 minutes prior to next scheduled dose
While treatment with IV clindamycin is necessary for inclusion in the clindamycin arm of the study, subjects may transition from IV to oral clindamycin and be eligible for PK sample collection during the oral phase.
TMP-SMX: Sample collection windows are relative to the administration of oral TMP-SMX.
Three plasma PK samples will be collected around the first dose according to the following sampling windows:
- 1-3 hours after the end of the first dose
- 6-8 hours after the start of the first dose
- <30 minutes prior to second dose
Four plasma PK samples will be collected any time after dose 6 according to the following sampling windows.
- Pre-dose
- 1-3 hours
- 6-8 hours
- <30 minutes prior to next scheduled dose
Urine PK samples - Urine PK samples are not required for a subject to complete the study. If possible, every effort should be made to collect urine PK samples according to the following schedule.
Clindamycin IV: One urine sample will be collected as timed aliquots of all urine excreted during one of the following intervals after dose 6:
- 0-2 hours
- 2-4 hours
- 4-8 hours
TMP-SMX: One urine sample will be collected as timed aliquots of all urine excreted during one of the following intervals after dose 6:
- 0-3 hours
- 3-6 hours
- 6-9 hours
- 9-12 hours
Opportunistic PK samples - Opportunistic samples of bone, skin, and synovial fluid will also be collected if obtained per standard of care.
Sampling for genotyping - All blood pellets left over after centrifugation of each plasma PK samples will be collected and combined into one whole blood pellet sample per subject. This combined whole blood pellet will be sent for genetic analysis of single nucleotide polymorphisms in the CYP3A family and CYP2C9 genes.
STATISTICS
All subjects who receive at least 1 dose of study drug will be included in the intention-to-treat (ITT) population used for the safety analysis. All subjects who provide at least 1 evaluable PK sample will be included in the PK analysis. Descriptive statistics such as number of observations, mean, median, standard deviation, standard error, minimum, and maximum will be presented for continuous variables (such as age, weight, etc.). Other descriptive statistics such as counts, proportions, and/or percentages will be presented to summarize discrete variables (such as race, sex, etc.). All descriptive analyses will be presented by appropriate treatment group (ITT or per-protocol) and overall. A detailed description of statistical methods and secondary analyses will be prepared and presented in the statistical analysis plan prior to data lock for final analyses.
