Randomized, Double-Blind, Placebo- and Positive-Controlled Crossover Study of the Effects of Tebipenem Pivoxil Hydrobromide on QT/QTc Intervals in Healthy Subjects

Tebipenem pivoxil hydrobromide (TBP-PI-HBr) is an orally available prodrug of tebipenem (TBP), a carbapenem with in vitro activity against multidrug-resistant Gram-negative pathogens. This study evaluated the effects of single therapeutic and supratherapeutic doses of TBP-PI-HBr on the heart rate-corrected QT interval (QTc) by assessing the concentration-QT interval relationship using exposure-response modeling. This was a randomized, double-blind, placebo- and active-controlled, single-dose, four-way crossover study. Subjects received single oral doses of TBP-PI-HBr at 600 and 1,200 mg, placebo, and positive control (moxifloxacin at 400 mg). Cardiodynamic electrocardiograms (ECGs) and blood samples were collected in each period. Twenty-four subjects were enrolled. TBP-PI-HBr had no clinically significant adverse effects on heart rate or ECG parameters. The model-predicted slope suggests that the baseline-corrected difference in heart rate from placebo was not importantly affected by plasma TBP concentrations, supporting the use of the QT interval corrected by Fridericia’s method as an appropriate correction. The model-predicted difference in QTc at the mean maximum concentration (C(max)) for TBP had negative predicted values for each dose, and no QTc prolongation was detected following TBP-PI-HBr at 600 mg or 1,200 mg. Assay sensitivity was established with moxifloxacin at 400 mg. Exposure to TBP increased in a dose-dependent manner with 600- and 1,200-mg doses. The TBP area under the concentration-time curve from time zero to infinity and C(max) with the 1,200-mg dose were 1.8- and 1.3-fold greater, respectively, than those with the 600-mg dose. TBP-PI-HBr was generally safe and well tolerated, with no effect in QT interval prolongation.