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Antibiotic Tissue Penetration and Tissue Response in Head and Neck Infection and Reconstructive Surgery (ANTIBIOTIKA)

1 novembre 2026 aggiornato da: Tejs Ehlers Klug

Antibiotic Penetration and Tissue Response in Infection and Reconstructive Surgery of the Head and Neck Region: A Microdialysis Study of Cefuroxime, Cloxacillin, Dicloxacillin, and Amoxicillin/Clavulanic Acid

The goal of this study is to measure how well commonly used antibiotics reach the tissue in the head and neck region in adults with a postoperative neck infection or undergoing reconstructive nasal surgery with an inferior turbinate flap. The study also describes markers of ischemia and inflammation in the newly created flap during the first days after surgery.

The main question it aims to answer is: For how long do the free concentrations of cefuroxime, cloxacillin, dicloxacillin, and amoxicillin/clavulanic acid stay above the minimal inhibitory concentration (T>MIC) in infected tissue, non-infected tissue, the flap, and plasma?

Participants will receive the antibiotics on a fixed, protocol-defined schedule for about two days. Small microdialysis catheters will be placed in the tissue to collect fluid continuously, and serial blood samples will be drawn. Participation ends when the last sample is collected and the catheters are removed.

Panoramica dello studio

Stato

Reclutamento

Condizioni

Intervento / Trattamento

Descrizione dettagliata

Infections in the head and neck region and reconstructive surgery in the nasal and sinus area are associated with considerable morbidity and require effective antibiotic treatment. Treatment is based mainly on systemic antibiotic concentrations, but little is known about actual tissue penetration in infected tissue and in reconstructed flaps, where perfusion, edema, ischemia, and inflammation may alter drug distribution. Microdialysis is a minimally invasive method for continuous sampling of free, pharmacologically active drug concentrations and metabolic and inflammatory markers in the extracellular fluid.

This is a prospective, non-randomized, open-label, exploratory interventional study with two sub-studies and a total of 16 participants. All study drugs are marketed antibiotics used in routine clinical practice; they are administered in a protocol-defined regimen to allow pharmacokinetic sampling.

Sub-study 1 (n=8): Adults admitted with a postoperative infection in the neck. Treatment is started on day 1 with cefuroxime 750 mg IV four times daily and dicloxacillin 1000 mg orally four times daily. On day 2, microdialysis catheters are placed in infected and non-infected subcutaneous tissue of the neck, and sampling is performed over two consecutive dosing intervals: (1) cefuroxime 750 mg IV plus dicloxacillin 1000 mg orally, sampled for 6 hours; and (2) cefuroxime 1500 mg IV plus cloxacillin 1000 mg IV, sampled for 8 hours. This allows comparison of two cefuroxime doses and of oral dicloxacillin versus intravenous cloxacillin.

Sub-study 2 (n=8): Adults undergoing reconstructive surgery with an inferior turbinate flap (IFT flap). Postoperatively, amoxicillin/clavulanic acid 500/125 mg and dicloxacillin 1000 mg are given orally three times daily. Microdialysis catheters are placed in the flap and in the nasal septal mucosa (reference tissue). Ischemia markers (glucose, lactate, pyruvate, glycerol) and inflammatory proteins are sampled hourly during the first 6 postoperative hours and in the morning and evening of day 2. Antibiotic concentrations are measured over one dosing interval after the morning dose on day 2.

In both sub-studies, dialysate is collected in 30-60 minute intervals and serial blood samples are drawn for plasma concentrations. Catheters are calibrated in vivo at the end of sampling. Drug concentrations are analysed by LC-MS. Clinically indicated treatment can be changed by the treating physician at any time.

Tipo di studio

Interventistico

Iscrizione (Stimato)

16

Fase

  • Fase 4

Contatti e Sedi

Questa sezione fornisce i recapiti di coloro che conducono lo studio e informazioni su dove viene condotto lo studio.

Contatto studio

Backup dei contatti dello studio

  • Nome: Tejs Ehlers Klug, MD, DMSc
  • Numero di telefono: +45 51604046
  • Email: tejsklug@rm.dk

Luoghi di studio

      • Aarhus N, Danimarca, 8200
        • Reclutamento
        • Aarhus University Hospital, Department of Otorhinolaryngology, Head and Neck Surgery

Criteri di partecipazione

I ricercatori cercano persone che corrispondano a una certa descrizione, chiamata criteri di ammissibilità. Alcuni esempi di questi criteri sono le condizioni generali di salute di una persona o trattamenti precedenti.

Criteri di ammissibilità

Età idonea allo studio

18 anni e precedenti (Adulto, Adulto più anziano)

Accetta volontari sani

No

Sessi ammissibili allo studio

Tutto

Descrizione

Inclusion Criteria:

  • Signed informed consent
  • Either a postoperative infection in the neck (sub-study 1) or planned reconstruction with an inferior turbinate flap (sub-study 2)
  • Age 18 years or older

Exclusion Criteria:

  • Known allergy or hypersensitivity to any of the study antibiotics (cefuroxime, cloxacillin, dicloxacillin, or amoxicillin/clavulanic acid)
  • eGFR below 30 mL/min/1.73 m2
  • Pregnancy or planned pregnancy

Piano di studio

Questa sezione fornisce i dettagli del piano di studio, compreso il modo in cui lo studio è progettato e ciò che lo studio sta misurando.

Come è strutturato lo studio?

Dettagli di progettazione

  • Scopo principale: Scienza basilare
  • Assegnazione: Non randomizzato
  • Modello interventistico: Assegnazione parallela
  • Mascheramento: Nessuno (etichetta aperta)

Armi e interventi

Gruppo di partecipanti / Arm
Intervento / Trattamento
Sperimentale: Sub-study 1: Postoperative Neck Infection

Adults with a postoperative infection in the neck (n=8). Cefuroxime 750 mg IV four times daily and dicloxacillin 1000 mg orally four times daily from day 1. On day 2, microdialysis in infected and non-infected subcutaneous tissue over two consecutive dosing intervals: (1) cefuroxime 750 mg IV + dicloxacillin 1000 mg orally (6 hours); (2) cefuroxime 1500 mg IV + cloxacillin 1000 mg IV (8 hours), with serial plasma samples.

Sub-study 1: Cefuroxime 750 mg intravenously four times daily from day 1. On day 2, one dosing interval of cefuroxime 750 mg IV (sampled over 6 hours) followed by one dosing interval of cefuroxime 1500 mg IV (sampled over 8 hours), to compare tissue penetration of the two doses.

Dicloxacillin 1000 mg orally. Sub-study 1: four times daily from day 1, with tissue and plasma sampling during the first dosing interval on day 2 (6 hours). Sub-study 2: three times daily postoperatively from day 1, with tissue and plasma sampling over one dosing interval after the morning dose on day 2.

Sub-study 1: Cloxacillin 1000 mg intravenously as a single dose in the second dosing interval on day 2 (given together with cefuroxime 1500 mg IV), with tissue and plasma sampling over 8 hours, to compare with oral dicloxacillin.

CE-marked microdialysis catheters perfused with isotonic saline (0.5-1 microL/min) are placed in the target tissues: infected and non-infected subcutaneous neck tissue (sub-study 1), or the inferior turbinate flap and nasal septal mucosa as reference tissue (sub-study 2). Dialysate is collected in 30-60 minute intervals, with serial blood samples drawn for plasma concentrations. Catheters are calibrated in vivo at the end of sampling and then removed.

Sperimentale: Sub-study 2: Inferior Turbinate Flap Reconstruction

Adults undergoing reconstructive surgery with an inferior turbinate flap (n=8). Amoxicillin/clavulanic acid 500/125 mg and dicloxacillin 1000 mg orally three times daily postoperatively from day 1. Microdialysis in the flap and in nasal septal mucosa (reference tissue): ischemia markers and inflammatory proteins hourly for the first 6 postoperative hours and morning/evening on day 2; amoxicillin and dicloxacillin concentrations over one dosing interval after the morning dose on day 2, with serial plasma samples.

Dicloxacillin 1000 mg orally. Sub-study 1: four times daily from day 1, with tissue and plasma sampling during the first dosing interval on day 2 (6 hours). Sub-study 2: three times daily postoperatively from day 1, with tissue and plasma sampling over one dosing interval after the morning dose on day 2.

CE-marked microdialysis catheters perfused with isotonic saline (0.5-1 microL/min) are placed in the target tissues: infected and non-infected subcutaneous neck tissue (sub-study 1), or the inferior turbinate flap and nasal septal mucosa as reference tissue (sub-study 2). Dialysate is collected in 30-60 minute intervals, with serial blood samples drawn for plasma concentrations. Catheters are calibrated in vivo at the end of sampling and then removed.

Sub-study 2: Amoxicillin/clavulanic acid 500/125 mg orally three times daily postoperatively from day 1 (together with dicloxacillin), with tissue and plasma sampling of amoxicillin over one dosing interval after the morning dose on day 2.

Cosa sta misurando lo studio?

Misure di risultato primarie

Misura del risultato
Misura Descrizione
Lasso di tempo
Time Above the Minimal Inhibitory Concentration (T>MIC) in Tissue and Plasma
Lasso di tempo: Sub-study 1: two consecutive dosing intervals on day 2 (0-6 hours and 0-8 hours after dosing). Sub-study 2: one dosing interval (approximately 8 hours) after the morning dose on postoperative day 2.

Time during which the free concentration of each study antibiotic (cefuroxime, cloxacillin, dicloxacillin, and amoxicillin/clavulanic acid) exceeds the minimal inhibitory concentration in each measured tissue (microdialysis) and in plasma (serial blood samples), calculated from concentration-time profiles. Pre-specified MIC targets: cefuroxime 4 mg/L; cloxacillin 2 mg/L; dicloxacillin 2 mg/L; amoxicillin/clavulanic acid 2 mg/L (amoxicillin component). Reported as time (hours) and as percentage of the dosing interval.

Sub-study 1: two consecutive dosing intervals on day 2 (0-6 hours and 0-8 hours after dosing). Sub-study 2: one dosing interval (approximately 8 hours) after the morning dose on postoperative day 2.

Misure di risultato secondarie

Misura del risultato
Misura Descrizione
Lasso di tempo
Area Under the Concentration-Time Curve (AUC) in Tissue and Plasma
Lasso di tempo: Sub-study 1: two consecutive dosing intervals on day 2 (0-6 hours and 0-8 hours after dosing). Sub-study 2: one dosing interval (approximately 8 hours) after the morning dose on postoperative day 2.

AUC of the free concentration of each study antibiotic in each measured tissue compartment (microdialysis) and in plasma.

Sub-study 1: two consecutive dosing intervals on day 2 (0-6 hours and 0-8 hours after dosing). Sub-study 2: one dosing interval (approximately 8 hours) after the morning dose on postoperative day 2.
Tissue Penetration Ratio (AUC Tissue / AUC Plasma)
Lasso di tempo: Sub-study 1: two consecutive dosing intervals on day 2 (0-6 hours and 0-8 hours after dosing). Sub-study 2: one dosing interval (approximately 8 hours) after the morning dose on postoperative day 2.

Ratio of the AUC of the free antibiotic concentration in each tissue compartment to the AUC in plasma, for each study antibiotic.

Sub-study 1: two consecutive dosing intervals on day 2 (0-6 hours and 0-8 hours after dosing). Sub-study 2: one dosing interval (approximately 8 hours) after the morning dose on postoperative day 2.
Maximum Concentration (Cmax) in Tissue and Plasma
Lasso di tempo: Sub-study 1: two consecutive dosing intervals on day 2 (0-6 hours and 0-8 hours after dosing). Sub-study 2: one dosing interval (approximately 8 hours) after the morning dose on postoperative day 2.

Peak free concentration of each study antibiotic in each measured tissue compartment and in plasma.

Sub-study 1: two consecutive dosing intervals on day 2 (0-6 hours and 0-8 hours after dosing). Sub-study 2: one dosing interval (approximately 8 hours) after the morning dose on postoperative day 2.
Time to Maximum Concentration (Tmax) in Tissue and Plasma
Lasso di tempo: Sub-study 1: two consecutive dosing intervals on day 2 (0-6 hours and 0-8 hours after dosing). Sub-study 2: one dosing interval (approximately 8 hours) after the morning dose on postoperative day 2.

Time from dose administration to peak free concentration of each study antibiotic in each measured tissue compartment and in plasma.

Sub-study 1: two consecutive dosing intervals on day 2 (0-6 hours and 0-8 hours after dosing). Sub-study 2: one dosing interval (approximately 8 hours) after the morning dose on postoperative day 2.
Elimination Half-Life (T1/2) in Tissue and Plasma
Lasso di tempo: Sub-study 1: two consecutive dosing intervals on day 2 (0-6 hours and 0-8 hours after dosing). Sub-study 2: one dosing interval (approximately 8 hours) after the morning dose on postoperative day 2.

Elimination half-life of each study antibiotic in each measured tissue compartment and in plasma, derived from the concentration-time profiles.

Sub-study 1: two consecutive dosing intervals on day 2 (0-6 hours and 0-8 hours after dosing). Sub-study 2: one dosing interval (approximately 8 hours) after the morning dose on postoperative day 2.
Lactate/Pyruvate Ratio in the Inferior Turbinate Flap
Lasso di tempo: Hourly during the first 6 postoperative hours (day 1), and in the morning and evening of postoperative day 2.

Lactate/pyruvate ratio measured in microdialysate from the inferior turbinate flap and the nasal septal reference tissue, as a marker of tissue ischemia (sub-study 2).

Hourly during the first 6 postoperative hours (day 1), and in the morning and evening of postoperative day 2.
Tissue Ischemia Markers (Glucose, Lactate, Pyruvate, and Glycerol)
Lasso di tempo: Sub-study 2: hourly during the first 6 postoperative hours (day 1), and in the morning and evening of postoperative day 2. Sub-study 1: during the sampling period on day 2 (up to approximately 14 hours).

Concentrations of glucose, lactate, pyruvate, and glycerol in microdialysate from the measured tissue compartments.

Sub-study 2: hourly during the first 6 postoperative hours (day 1), and in the morning and evening of postoperative day 2. Sub-study 1: during the sampling period on day 2 (up to approximately 14 hours).
Inflammatory Proteins in Microdialysate
Lasso di tempo: Hourly during the first 6 postoperative hours (day 1), and in the morning and evening of postoperative day 2.

Levels of inflammatory proteins measured in microdialysate from the inferior turbinate flap and the nasal septal reference tissue, to characterize the early postoperative inflammatory tissue response (sub-study 2).

Hourly during the first 6 postoperative hours (day 1), and in the morning and evening of postoperative day 2.

Collaboratori e investigatori

Qui è dove troverai le persone e le organizzazioni coinvolte in questo studio.

Sponsor

Collaboratori

Investigatori

  • Investigatore principale: Tejs Ehlers Klug, MD, DMSc, Aarhus University Hospital

Studiare le date dei record

Queste date tengono traccia dell'avanzamento della registrazione dello studio e dell'invio dei risultati di sintesi a ClinicalTrials.gov. I record degli studi e i risultati riportati vengono esaminati dalla National Library of Medicine (NLM) per assicurarsi che soddisfino specifici standard di controllo della qualità prima di essere pubblicati sul sito Web pubblico.

Studia le date principali

Inizio studio (Stimato)

1 novembre 2026

Completamento primario (Stimato)

1 settembre 2028

Completamento dello studio (Stimato)

1 dicembre 2028

Date di iscrizione allo studio

Primo inviato

20 ottobre 2026

Primo inviato che soddisfa i criteri di controllo qualità

20 ottobre 2026

Primo Inserito (Effettivo)

26 ottobre 2026

Aggiornamenti dei record di studio

Ultimo aggiornamento pubblicato (Effettivo)

4 novembre 2026

Ultimo aggiornamento inviato che soddisfa i criteri QC

1 novembre 2026

Ultimo verificato

1 novembre 2026

Maggiori informazioni

Termini relativi a questo studio

Altri numeri di identificazione dello studio

  • 2026-526995-22-00
  • 2026-526995-22-00 (Ctis)

Piano per i dati dei singoli partecipanti (IPD)

Hai intenzione di condividere i dati dei singoli partecipanti (IPD)?

NO

Descrizione del piano IPD

Individual participant data will not be shared publicly due to Danish and EU data protection legislation (GDPR). Aggregated results will be published in peer-reviewed journals and reported in CTIS.

Informazioni su farmaci e dispositivi, documenti di studio

Studia un prodotto farmaceutico regolamentato dalla FDA degli Stati Uniti

No

Studia un dispositivo regolamentato dalla FDA degli Stati Uniti

No

Queste informazioni sono state recuperate direttamente dal sito web clinicaltrials.gov senza alcuna modifica. In caso di richieste di modifica, rimozione o aggiornamento dei dettagli dello studio, contattare register@clinicaltrials.gov. Non appena verrà implementata una modifica su clinicaltrials.gov, questa verrà aggiornata automaticamente anche sul nostro sito web .