An observational study in Pyelonephritis, sponsored by Assistance Publique - Hôpitaux de Paris. Recruiting at 1 site in France. Open to participants aged 1 Day to 15 Years. Per ClinicalTrials.gov, last updated 2026-11-10.
Sponsored by Assistance Publique - Hôpitaux de Paris · Observational
Temocillin, a 6-alpha-methoxypenicillin derivative of ticarcillin, is a narrow-spectrum antibiotic, primarily restricted to Enterobacterales. Therefore, its prescription for the treatment of febrile urinary tract infections requiring hospitalization in pediatrics appears interesting.
However, and despite marketing authorization in pediatrics for the treatment of complicated urinary tract infections (including acute pyelonephritis), the pharmacokinetic parameters of this antibiotic have not been specifically evaluated in pediatrics, and the optimal dose is not known in this population.
Through this study, The investigators propose to determine the pharmacokinetic parameters of temocillin in children aged 0-15 years with a febrile urinary tract infection due to Gram-negative rod (GNR), without sepsis but requiring hospitalization. The results will help to establish dose recommendations for temocillin in the pediatric population, based on age and renal function.
Clinical Context of Temocillin Use:
Temocillin is an old antibiotic, a 6-alpha-methoxypenicillin derivative of ticarcillin, which has been rediscovered in recent years due to its narrow spectrum of activity and its ability to resist hydrolysis by most beta-lactamases, including ESBL. Temocillin is bactericidal, is not impacted by the inoculum effect, and has a low selection of resistant mutants. Due to its narrow spectrum (essentially limited to Enterobacterales), it appears to have a reduced overall impact on the fecal microbiota.
Studies have retrospectively reported clinical and microbiological efficacy of temocillin in urinary tract infections caused by ESBL-producing Enterobacterales in children and adults.
More generally, Enterobacterales have a high susceptibility to temocillin, with susceptibility rates exceeding 90-95% in several epidemiological studies in both children and adults. This is higher than that of third-generation cephalosporins, which still remain the first-line treatment in recent french guidelines (GPIP, SPILF), As a result, temocillin has been approved for the treatment of acute pyelonephritis (febrile urinary tract infections), including in the pediatric population. In France, it is primarily used for the treatment of ESBL-associated febrile urinary tract infections.
Since september 2024, Robert Debré University Hospital uses temocillin has an empiricial antibiotic therapy for hospitalized cases of febrile urinary tract infections, without any sign of sepsis, at the recommended high dose of 50 mg/kg/day in 2 intravenous injections of 30 min spaced 12 hours apart.
Pharmacokinetic Data of Temocillin:
Temocillin is a bactericidal antibiotic for parenteral use, belonging to the beta-lactam family. Temocillin binds strongly to plasma proteins (approximately 80% binding) and has a prolonged elimination half-life of approximately 5 hours. Its elimination is primarily renal.
As with other beta-lactams, the best pharmacokinetic/pharmacodynamic (PK/PD) criterion correlated with the efficacy of temocillin appears to be the cumulative percentage of time over 24 hours during which temocillin's free concentration exceeds the minimum inhibitory concentration (fT>MIC) at steady state. A target fT>MIC 40% of is associated with antibacterial effect and in vivo survival.
In adults, Monte Carlo pharmacokinetic simulations have demonstrated that an IV regimen of 2 grams every 12 hours allows a %ft>MIC of 40% to be achieved in 95% of treated patients and for MICs up to 8 mg/L.
In children up to 15 years of age, the standard recommended dosage is 25 mg/kg/day in 2 IV injections (max. 4g/day) but a higher dosage of 50 mg/kg/day in 2 IV injections (max. 4g/day) is indicated for the treatment of severe infections (including acute pyelonephritis requiring hospitalization). However, these proposed regimens recommendations do not originate from paediatric PK/PD studies but are derived from adult studies. To date, no study has evaluated the pharmacokinetic parameters of temocillin specifically in children (\<15 years), and the optimal dosage regimen maximizing the probability of reaching the target PK/PD criterion (fT>MIC of 40%) in the treatment of febrile urinary tract infections due to GNR is currently unknown.
79 studies on the registry are indexed under Pyelonephritis; 12 are open to participants now.
This study's planned enrollment of 50 is below the median of 153 across 15 observational studies indexed under Pyelonephritis.
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Patient aged 0 to 15 years (inclusive) presenting with a febrile urinary tract infection with BGN requiring hospitalization in the departments of the Robert-Debré University Hospital for a duration of at least 48 hours
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Exclusion Criteria:
Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
GFR (glomerular filtration rate) is how much blood the kidneys filter each minute. It is usually estimated from a blood test — eGFR, by formulas such as CKD-EPI or MDRD — and some studies ask for it to be measured directly instead. Usually given in mL/min/1.73 m².
Check the method, the units and the minimum the study states. A value of 90 or above is in the normal-or-high range, but kidney damage can show in other tests too.
GFR and eGFR (kidney filtering)
GFR (glomerular filtration rate) is how much blood the kidneys filter each minute. It is usually estimated from a blood test — eGFR, by formulas such as CKD-EPI or MDRD — and some studies ask for it to be measured directly instead. Usually given in mL/min/1.73 m².
Check the method, the units and the minimum the study states. A value of 90 or above is in the normal-or-high range, but kidney damage can show in other tests too.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
2 blood samples of 1 mL
Achievement of the theoretical PK/PD target of 40% of the time spent above the MIC of the bacteria in question (fT>MIC=40%) for a temocillin dose of 50mg/kg/day in 2 IV injections of 30 min spaced 12h apart,
Achievement of the theoretical PK/PD target of 40% of the time spent above the MIC of the bacteria in question (fT\>MIC=40%) for a temocillin dose of 50mg/kg/day in 2 IV injections of 30 min spaced 12h apart, on the population modellisation of the unbound plasma concentration of temocillin over 24h. Samples taken 1 hour after the start of a temocillin infusion then between 6 and 8 hours after the start of the infusion or sample taken 2 hours after the start of a temocillin infusion then between 10 and 12 hours after the start of the infusion
Time frame: 24 months
Plan to share: Undecided
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From the registry record's own update history. This site started tracking changes on Sep 25, 2026; for anything earlier, see the record history on ClinicalTrials.gov ↗
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