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Community-Acquired PneumoniaPhase 3CAT-CAPNCT05903352

Customized Antibiotic Treatment Duration Among Hospitalized Patients With Moderately Severe Community-Acquired Pneumonia

A Phase 3 study testing Stop antibiotic and Continue the antimicrobial treatment in people with Community-Acquired Pneumonia, run by Assistance Publique - Hôpitaux de Paris at 1 site in France.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

The primary objective of the study is to evaluate if the efficacy of an experimental strategy on antibiotic treatment duration based on stopping treatment when stability criteria are reached after at least 48 h of treatment, is non-inferior to the efficacy of standard antibiotic duration in CAP patients treated in the… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Community-Acquired Pneumonia
What is being tested?
Stop antibiotic and Continue the antimicrobial treatment
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
328 participants
Where
1 siteFrance
Study dates
5 Feb 2024to May 2027
Phase
Phase 3
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Adult patient (≥18 years old)
  • Admitted to hospital for suspected CAP defined by the presence of at least 2 of the following diagnostic clinical criteria:
  • Fever (temperature > 38°C) or hypothermia (< 36°C)
  • Dyspnea
  • Cough
  • Production of purulent sputum
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  • Crackles
  • Radiological evidence of a new infiltrate (chest X-ray or CT scan)
  • Negative viral respiratory testing
  • Treated for a minimum of 48 hours with antibiotics (excluding azithromycin due to its prolonged half-life)Presenting with an early clinical response within the last 24 hours (up to 7 days after the start of antibiotic treatment, if planned treatment duration > 7 days), defined by the presence of all the following criteria:apyrexia (T°C ≤ 37.8)heart rate < 100/minrespiratory rate < 24/min, according to the patient's usual mode of oxygenation,arterial oxygen saturation ≥ 92%, according to the patient's usual mode of oxygenation,Patient currently under antibiotic treatment for his suspected CAP (i.e. the last dose of ATB has been administered to the patient less than 24 hours ago)
  • Patient presenting a clinical response within the last 24 hours defined by the presence of all the following criteria:
  • apyrexia (T°C ≤ 37.8)
  • heart rate < 100/min
  • respiratory rate < 24/min, according to the patient's usual mode of oxygenation,
  • arterial oxygen saturation ≥ 92%, according to the patient's usual mode of oxygenation,
  • systolic blood pressure ≥ 90mmHg, The last occurring of these criteria must have appeared within the last 24 hours.
  • The antibiotic treatment for suspected CAP has started at least 48 hours ago and at most 6 days ago
  • No other site of infection besides respiratory
  • Affiliated to Health insurance
  • Has given informed consent
  • Patient understanding oral and written French, or presence of a relative who can explain and help him complete the study documents

Who cannot join

  • Signs of severe CAP (abscess, massive pleural effusion, serious chronic respiratory insufficiency)
  • Known immunosuppression (asplenia, neutropenia, agammaglobulinemia, transplant, myeloma, lymphoma, known HIV and CD4<200/mm3)
  • Suspected or confirmed legionellosis
  • Any other infection necessitating concomitant antibiotic treatment
  • Confirmed or suspected aspiration pneumonia or healthcare-associated pneumonia
  • Treatment of suspected CAP with azithromycin (due to its prolonged half-life)
Show all 13Show fewer
  • Concomitant steroid treatment (only for patients treated with fluoroquinolones antibiotics)
  • Pre-existing aortic aneurysm or dissection, family history of aortic aneurysm or dissection, Marfan syndrome, Ehlers-Danlos syndrome, Takayasu arthritis, uncontrolled arterial hypertension, atherosclerosis (only for patients treated with fluoroquinolones antibiotics)
  • Pregnant or breastfeeding woman
  • Life expectancy < 1 month
  • Patient under legal guardianship (French "tutelle" or "curatelle")
  • Patient without fixed address
  • Patient enrolled in another interventional clinical trial on CAP treatment

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Aurélien Dinh, MD, PhD contact

+ 33 (0)1 47 10 44 32

aurelien.dinh@aphp.fr

Jacques Ropers, PharmD contact

+ 33 01 42 16 03 48

jacques.ropers@aphp.fr

France1 site, 1 recruiting
  • Infectious diseases department, Raymond-Poincaré Hospital - APHP

    Garches, 92380

    Recruiting

Other trials in France

About this study

The primary objective of the study is to evaluate if the efficacy of an experimental strategy on antibiotic treatment duration based on stopping treatment when stability criteria are reached after at least 48 h of treatment, is non-inferior to the efficacy of standard antibiotic duration in CAP patients treated in the hospital setting.

As the secondary objectives, the study aims

  • To study if the efficacy of our experimental strategy on antibiotic treatment duration compared to standard of care in CAP patients treated in the hospital setting is non-inferior in terms of:
  • Persistence of cure at Day 30 of antibiotic treatment
  • All-cause mortality rate on Day 30 of antibiotic treatment
  • Patients evolution of pneumonia symptoms and quality of life via 2 scores (CAP score, CAP Sym) at Day 0 of treatment (retrospectively), at stability (Day S), at Day 7 , at Day 15, and at Day 30 of antibiotic treatment.
  • To compare between the 2 study arms at Day 30 of antibiotic treatment:
  • The duration of antibiotic treatment;
  • The length of hospital stay;
  • The frequency and severity of adverse events during the 30 days after the start of treatment.
  • To explore the impact of reduced antibiotic treatment duration for CAP on the oropharyngeal resistome.
Read the detailed description

Recent studies have suggested that community-acquired pneumonia (CAP) can be successfully treated with short-course antibiotic regimen when clinical improvement is rapidly obtained. Even if clinical response is obtained in 3 days in the majority of cases, it can vary widely among patients suggesting "one duration does not fit all". An individualised duration of therapy depending on the patient's response could help to ensure bacterial eradication while avoiding unnecessary antibiotic exposure and thus reduce antibiotic resistance. At present, this strategy has never been tested.

This is a phase III, pragmatic, non-inferiority randomised (1:1) national multicentre trial. Population of study participants will be patients admitted to hospital with suspected CAP and in need for antibiotics.

There is no need to establish a DSMB for this trial. The antibiotic treatments prescribed during this study are treatments used in current practice, with well-known adverse drug reactions. Furthermore, a 3-day treatment duration has already been studied in 2 previous randomized clinical trials, showing its safety for hospitalized CAP.

Statistical analysis:

Statistical inference for non-inferiority will be based on the confidence intervals (CI) of the difference in Day 15 cure proportions [proportion in reference arm - proportion in experimental arm] accounting for randomisation stratification factors (centre and delay from Day 0 to Day S (≤ 3 days or > 3 days).

The inferiority hypothesis will be rejected and non-inferiority will be claimed if the upper bound of the 95%CI of the difference is ≤ 10%.

Secondary efficacy endpoints evaluating the evolution of symptoms will be analysed using either a GMM or a GEE for categorical and continuous variables, respectively.

Other quantitative variables will be compared using the Student t-test (or a non-parametric test if the distribution remains skewed following transformation), while categorical variables will be analysed using either the Chi-squared or the Fisher-exact tests.

All statistical tests will be performed with a level of significance of 5%, except the primary endpoint which be analysed with a 2.5% level of significance.

Being tested
Stop antibiotic, Continue the antimicrobial treatment
Keywords
Community-Acquired Pneumonia, Antibiotic treatment duration, Antibiotic resistance, Infectious diseases
Medical subject headings
Community-Acquired Pneumonia, Communicable Diseases

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Stop antibioticOther

    Stop the antibiotic treatment on day S (stability criteria reached for 24 h or within 48 hours after the start of antibiotic treatment).

  • Continue the antimicrobial treatmentDrug

    Continue the antimicrobial treatment for a duration predetermined by the investigator (usual practice, at least 5 days of treatment in total).

Study groups in NCT05903352
Study groupRoleWhat they receive
Antibiotic treatmentPlacebo comparatorAntibiotic treatment duration left to the physician's judgment (usual practice: total treatment duration between 5 to 10 days according to French guidelines; more than 7 days of treatment should be justified).
Receives: Drug: Continue the antimicrobial treatment
Interruption of treatmentExperimentalInterruption of treatment based on the patient reaching all of the following stability criteria (body temperature ≤ 37.8°C; heart rate ≤ 100/min; systolic blood pressure > 90mmHg; oxygen saturation ≥ 92%; respiratory rate < 24/min; normal mental status (27)), with a treatment duration no shorter than 48 h.
Receives: Other: Stop antibiotic

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Rate of cure at Day 15 after treatment initiation

    Cure at Day 15 will be defined by the association of:

    • Persistence of stability criteria (body temperature ≤ 37.8°C; heart rate ≤ 100/min; systolic blood pressure > 90mmHg; oxygen saturation ≥ 92%; respiratory rate < 24/min; normal mental status);
    • No additional antibiotic treatment, targeting CAP, taken after the end of initial antibiotic treatment.

    Patients who died, or are not cured as defined above, will be classified as failure at Day 15.

    Measured: Day 15

Secondary outcomes (9)
  1. Rate of cure at Day 30

    Rate of cure at Day 30 after the start of treatment defined by the association of: persistence of stability criteria (body temperature ≤ 37.8°C; heart rate ≤ 100/min; systolic blood pressure > 90mmHg; O2 saturation ≥ 92%; respiratory rate < 24/min; normal mental status); absence of additional antibiotic treatment needed after the end of initial antibiotic treatment.

    Measured: Day 30

  2. Mortality on Day 30

    All-cause mortality on Day 30 after the start of antibiotic treatment.

    Measured: Day 30

  3. Patients' evolution of pneumonia symptoms

    Patients' evolution of pneumonia symptoms by CAP Score at Day 0 of treatment (retrospectively), at stability (Day S), at Day 7, at Day 15, and at Day 30 of antibiotic treatment.

    Measured: Day-0, Day S, Day 7, at Day 15, and at Day 30

  4. Patients' evolution of pneumonia symptoms

    Patients' evolution of pneumonia symptoms and quality of life by CAP Sym:

    validated self-questionnaires filled at Day 0 of treatment (retrospectively), at stability (Day S), at Day 7, at Day 15, and at Day 30 of antibiotic treatment.

    Measured: Day 15 and Day 30

  5. Duration of antibiotic treatment targeting CAP

    Duration of antibiotic treatment targeting CAP during the 30 days after the start of treatment.

    Measured: Day 30

  6. Duration of antibiotic treatment for all indications

    Duration of antibiotic treatment for all indications during the 30 days after the start of treatment.

    Measured: Day 30

  7. Length of hospitalization

    Length of initial hospital stay

    Measured: Day 30

  8. Incidence of adverse event

    Frequency and severity of adverse events during the 30 days after the start of treatment

    Measured: Day 30

  9. Number of resistance genes

    Calculating for each patient, the number of resistance genes normalised against the quantity of total bacterial DNA, the bacterial richness and diversity, among 300 patients.

    Measured: Day S and Day 30

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted15 Jun 2023
  2. Study start5 Feb 2024
  3. Primary completionMay 2027 (estimated)
  4. Study completionMay 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
All eligible patients with confirmed CAP and willing to participate will be included and randomly assigned (1:1 ratio) by the investigator, to either continue the antimicrobial treatment for a duration predetermined by the investigator (usual practice, at least 3 days of treatment in total), or to stop the antibiotic treatment.
Masking
None (open label)
Enrolment
328 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05903352
Sponsor's protocol ID
APHP220814
Other IDs
2023-504208-27-00, 2023
Acronym
CAT-CAP
Status last verified
Mar 2025
First submitted
6 Jun 2023
Last updated
20 Mar 2025
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Dinh A, Ropers J, Duran C, Davido B, Deconinck L, Matt M, Senard O, Lagrange A, Makhloufi S, Mellon G, de Lastours V, Bouchand F, Mathieu E, Kahn JE, Rouveix E, Grenet J, Dumoulin J, Chinet T, Pepin M, Delcey V, Diamantis S, Benhamou D, Vitrat V, Dombret MC, Renaud B, Perronne C, Claessens YE, Labarere J, Bedos JP, Aegerter P, Cremieux AC; Pneumonia Short Treatment (PTC) Study Group. Discontinuing beta-lactam treatment after 3 days for patients with community-acquired pneumonia in non-critical care wards (PTC): a double-blind, randomised, placebo-controlled, non-inferiority trial. Lancet. 2021 Mar 27;397(10280):1195-1203. doi: 10.1016/S0140-6736(21)00313-5.

    PubMed 33773631

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Stop antibiotic and Continue the antimicrobial treatment in people with Community-Acquired Pneumonia, run by Assistance Publique - Hôpitaux de Paris at 1 site in France.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 21 inclusion and 13 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 20 Mar 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in France. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Aurélien Dinh, MD, PhD (+ 33 (0)1 47 10 44 32, aurelien.dinh@aphp.fr), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Rate of cure at Day 15 after treatment initiation (time frame: Day 15). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05903352, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 20 Mar 2025.

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