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RecruitingNCT05248620PANTHEMUpdated Sep 10, 2026

Prophylactic Antibiotic Treatment in Hemodialysis

An interventional study of Amoxicillin Clavulanic 500/125mg or placebo in Hemodialysis, sponsored by Zealand University Hospital. Recruiting at 7 sites in Denmark. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-09-10.

Sponsored by Zealand University Hospital · Not applicable, Interventional, and Prevention

Phase
Not applicable
Study type
Interventional
Enrollment
800
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

The purpose of this study is to assess the efficacy of prophylactic antibiotic treatment on blood stream infections and severe culture negative infections, in patients on newly started hemodialysis(HD), with a central venous catheter as vascular access.

Read the detailed description

After being informed about the study and potential risks all eligible patients, giving written informed consent will be included in the study. At week 0 patients will be randomized in a single blinded manner (participants and care providers) in a 1:1 manner to receive 500/125mg amoxicillin/clavulanic acid 30-120 minutes before each hemodialysis with a central venous catheter (CVC) as vascular access, or corresponding placebo. The timing of antibiotic administration has been established in a pilot-study in order to secure a sufficient concentration of antibiotics during the dialysis session. In case of side effects to amoxicillin/clavulanic acid, the prophylactic antibiotic will be shifted to 600mg clindamycin. Total treatment period with prophylactic antibiotics is 6 months, with a 1 year follow-up.

02

Conditions studied

  • Hemodialysis

Keywords

  • Blood stream infections
  • Severe culture negative infections
  • Central venous catheter
  • Hemodialysis
  • Antibiotic prophylaxis
03

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • End Stage Kidney Disease (ESKD) patients who receive an uncuffed or cuffed CVC for expected chronic HD, regardless of previous ESKD treatment modality (PD or KTX) and hemodialysis access (AV-fistula or AV-graft))
  • ≥18 years
  • Ability to understand the study background, risk and benefit of treatment and to give written informed consent

Exclusion criteria

Exclusion Criteria:

  • Unable to give informed consent
  • Known intolerance to beta-lactam antibiotics and clindamycin
  • Active infection treated with antibiotics
  • Breastfeeding
  • Pregnancy. In women of childbearing age, an approved birth control must be ensured at least 1 month before and during all the 6 months of antibiotic/placebo treatment.

Patients may be rescreened later i.e. within a time period of one month from start of HD, if exclusion criteria are reversible.

04

Study design

Phase
Not applicable
Primary purpose
Prevention
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Triple (Participant, Care provider, Outcomes assessor)
Enrollment
800 participants (estimated)

Study arms

  • Active comparator
    Active

    Amoxicillin/clavulanic acid 500/125mg, tablets, will be administered before each hemodialysis for 6 months

    Drug: Amoxicillin Clavulanic 500/125mg or placebo

  • Placebo comparator
    Placebo

    Placebo tablets, similar to the active drug, will be administered before each hemodialysis for 6 months

    Drug: Amoxicillin Clavulanic 500/125mg or placebo

Interventions

  • DrugAmoxicillin Clavulanic 500/125mg or placebo

    Prophylactic antibiotic treatment

    Also known as: Aurobindo

05

What researchers measure

Primary outcomes

  1. Number of patients with Blood stream infection (BSI)

    Hospitalization for BSI

    Time frame: ≤ 6 months after randomization

  2. Number of patients with Severe blood culture negative infection

    Hospitalization ≥ 3 days, or dies within 3 days, due to infection defined as: C-reactive protein (CRP) ≥ 75 and negative blood cultures, treated with iv antibiotics

    Time frame: ≤ 6 months after randomization

Secondary outcomes

  1. Number of patients with BSI or severe blood culture negative infection

    Each of the components in the primary endpoint

    Time frame: ≤ 6 months after randomization

  2. Mortality

    All-cause mortality

    Time frame: ≤ 6 months after randomization

Other outcomes

  1. Number of patients with Sepsis

    Hospitalization due to sepsis or septic shock

    Time frame: ≤ 6 months after randomization

  2. Number of patients with Deep tissue infection

    Infective endocarditis, osteomyelitis, and spondylodiscitis

    Time frame: ≤ 6 months after randomization

  3. Number of patients with Autoinfection

    Frequency of BSI autoinfection

    Time frame: ≤ 6 months after randomization

  4. Number of patients with Clostridium difficile infection

    Clostridium difficile infection - numbers and days of admission

    Time frame: ≤ 6 months after randomization

  5. Mortality due to infection - number of patients

    Mortality due to infection

    Time frame: ≤ 6 months after randomization

  6. Number of CVC removals

    CVC removal due to CVC infection

    Time frame: ≤ 6 months after randomization

  7. Use of Antibiotics in Difined Daily Doses

    Total use of antibiotics in Defined Daily Doses

    Time frame: ≤ 6 months after randomization

  8. Healt-care economics

    Health-care related economic consequences due to hospitalization and treatment of the disease

    Time frame: ≤ 6 months after randomization

  9. Number of patients with Extended Spectrum Beta-Lactamase (ESBL) infection

    ESBL infections - number of patients and days of admission

    Time frame: ≤ 6 months after randomization

  10. Number of patients with Methicillin-resistant Staphylococcus aureus (MRSA) infection

    MRSA infections - number of patients and days of admission

    Time frame: ≤ 6 months after randomization

  11. Number of patients with Carbapenemase-Producing Organisms (CPO) infection

    CPO infections - number og patients and days of admission

    Time frame: ≤ 6 months after randomization

  12. Number of patients with Vancomycin-resistant enterococci (VRE) infection

    VRE infections - number of patients and days of admission

    Time frame: ≤ 6 months after randomization

  13. Number of patients with Cardiovascular events

    Hospitalization with acute myocardial infarction, worsening heart failure or stroke

    Time frame: ≤ 6 months after randomization

06

Study locations

4 of 7 sites recruiting
  • Rigshospitalet
    Copenhagen, Capital Region 2100, Denmark
    Not yet recruiting
  • Herlev-Gentofte Hospital
    Copenhagen, Capital Region 2730, Denmark
    Recruiting
  • North Zealand Hospital Hillerød
    Hillerød, Capital Region 3400, Denmark
    Not yet recruiting
  • Aarhus University Hospital
    Aarhus, Middle Region 8200, Denmark
    Not yet recruiting
  • Aalborg University Hospital
    Aalborg, North Region 9100, Denmark
    • Bo Madsen, Consultant · Contact · bom@rn.dk
    Recruiting
  • ZUH Roskilde
    Roskilde, Region Sjælland 4000, Denmark
    Recruiting
  • Odense University Hospital
    Odense, Region South 5000, Denmark
    Recruiting
07

References and documents

Publications

  • Gupta V, Yassin MH. Infection and hemodialysis access: an updated review. Infect Disord Drug Targets. 2013 Jun;13(3):196-205. doi: 10.2174/1871526511313030008. PubMed 24001331 ↗
  • Vogelzang JL, van Stralen KJ, Noordzij M, Diez JA, Carrero JJ, Couchoud C, Dekker FW, Finne P, Fouque D, Heaf JG, Hoitsma A, Leivestad T, de Meester J, Metcalfe W, Palsson R, Postorino M, Ravani P, Vanholder R, Wallner M, Wanner C, Groothoff JW, Jager KJ. Mortality from infections and malignancies in patients treated with renal replacement therapy: data from the ERA-EDTA registry. Nephrol Dial Transplant. 2015 Jun;30(6):1028-37. doi: 10.1093/ndt/gfv007. Epub 2015 Jan 29. PubMed 25637641 ↗
  • Aslam S, Vaida F, Ritter M, Mehta RL. Systematic review and meta-analysis on management of hemodialysis catheter-related bacteremia. J Am Soc Nephrol. 2014 Dec;25(12):2927-41. doi: 10.1681/ASN.2013091009. Epub 2014 May 22. PubMed 24854263 ↗
  • Sarnak MJ, Jaber BL. Mortality caused by sepsis in patients with end-stage renal disease compared with the general population. Kidney Int. 2000 Oct;58(4):1758-64. doi: 10.1111/j.1523-1755.2000.00337.x. PubMed 11012910 ↗
  • Jaber BL. Bacterial infections in hemodialysis patients: pathogenesis and prevention. Kidney Int. 2005 Jun;67(6):2508-19. doi: 10.1111/j.1523-1755.2005.00364.x. No abstract available. PubMed 15882306 ↗
  • de Jager DJ, Grootendorst DC, Jager KJ, van Dijk PC, Tomas LM, Ansell D, Collart F, Finne P, Heaf JG, De Meester J, Wetzels JF, Rosendaal FR, Dekker FW. Cardiovascular and noncardiovascular mortality among patients starting dialysis. JAMA. 2009 Oct 28;302(16):1782-9. doi: 10.1001/jama.2009.1488. PubMed 19861670 ↗
  • Chaudry MS, Gislason GH, Kamper AL, Rix M, Dahl A, Ostergaard L, Fosbol EL, Lauridsen TK, Oestergaard LB, Hassager C, Torp-Pedersen C, Bruun NE. The impact of hemodialysis on mortality risk and cause of death in Staphylococcus aureus endocarditis. BMC Nephrol. 2018 Sep 3;19(1):216. doi: 10.1186/s12882-018-1016-0. PubMed 30176809 ↗
  • Chaudry MS, Carlson N, Gislason GH, Kamper AL, Rix M, Fowler VG Jr, Torp-Pedersen C, Bruun NE. Risk of Infective Endocarditis in Patients with End Stage Renal Disease. Clin J Am Soc Nephrol. 2017 Nov 7;12(11):1814-1822. doi: 10.2215/CJN.02320317. Epub 2017 Oct 3. PubMed 28974524 ↗
  • Nelveg-Kristensen KE, Laier GH, Heaf JG. Risk of death after first-time blood stream infection in incident dialysis patients with specific consideration on vascular access and comorbidity. BMC Infect Dis. 2018 Dec 20;18(1):688. doi: 10.1186/s12879-018-3594-7. PubMed 30572826 ↗
  • Sakhuja A, Nanchal RS, Gupta S, Amer H, Kumar G, Albright RC, Kashani KB. Trends and Outcomes of Severe Sepsis in Patients on Maintenance Dialysis. Am J Nephrol. 2016;43(2):97-103. doi: 10.1159/000444684. Epub 2016 Mar 10. PubMed 26959243 ↗

Individual participant data

Plan to share: No — No plan

08

Registry details

Key details

Study ID
NCT05248620
Lead sponsor
Zealand University Hospital
Collaborators
Herlev Hospital, Rigshospitalet, Denmark, Holbaek Sygehus, Nordsjaellands Hospital, Odense University Hospital, Aarhus University Hospital, Kolding Sygehus, Gødstrup Hospital, Viborg Regional Hospital, Aalborg University Hospital, Esbjerg Hospital - University Hospital of Southern Denmark, Hospital of Southern Jutland
Responsible party
Sponsor
First posted
Feb 21, 2022
Start date
Feb 14, 2022
Primary completion
Oct 2028 (estimated)
Completion
May 2029 (estimated)
Last update
Sep 10, 2026

Study contacts

Niels E Bruun, Professor
Contact
nbru@regionsjaelland.dk
+4525159309
Kasper K Iversen, Professor
Contact
Kasper.Karmark.Iversen@regionh.dk
Niels E Bruun, Professor
principal investigator · Dept. cardiology, Zealand University Hospital, Roskilde, Denmark

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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