Journal Article

Standard versus double dosing of beta-lactam antibiotics in critically ill patients with sepsis: The BULLSEYE study protocol for a multicenter randomized controlled trial

Koch, B. C. P., Thielen, F. W., Horstink, M. M. B., den Uil, C. A., Bosch, T. M., Beishuizen, A., Rietdijk, W. J. R., Haringman, J. J., van Vliet, P., Rijpstra, T. A., Abdulla, A., Deetman, P. E., Endeman, H., Muller, A. E., Geel, D. R., Bethlehem, C.

2025

Overview

Background Sepsis and septic shock are significant global healthcare challenges with high mortality rates. Effective management requires timely and adequate antimicrobial therapy. Beta-lactam antibiotics, commonly used in patients with sepsis, are crucial for treating these infections. However, standard dosing often leads to insufficient plasma levels due to dynamic physiological changes in critically ill patients. Previous randomized controlled trials highlighted the need for timely dose adjustments to improve clinical outcomes. This is the study protocol for the BULLSEYE trial in which we aim to optimize antibiotic treatment during the initial 48 h of sepsis by comparing standard to double dosing of beta-lactam antibiotics. Methods This open-label, multicenter, randomized controlled trial will compare standard to double dosing of beta-lactam antibiotics (cefuroxime, ceftazidime, ceftriaxone, cefotaxime, amoxicillin, amoxicillin/clavulanic acid, flucloxacillin, meropenem, and piperacillin/clavulanic acid) in critically ill patients with septic shock. Participants will be randomized into two arms: the control arm receiving standard care, and the intervention arm receiving double antibiotic doses for 48 h, irrespective of renal function. Following this period, all patients will receive standard doses as per local protocol. The primary outcome is all cause 28-day mortality, with secondary outcomes including 90-day, 365-day, hospital and ICU mortality, hospital and ICU length of stay, SOFA scores, time to shock reversal, microbiological eradication, clinical cure, pharmacodynamic target attainment, safety, quality of life, and medical consumption. Discussion The BULLSEYE trial aims to improve sepsis treatment in critically ill patients. Despite anticipated recruitment challenges, its large sample size ensures robust comparability. This pivotal trial could significantly impact sepsis treatment, leading to better clinical outcomes. Trial registration EU_CT 2024–512950-13–00. Protocol version 2.3, protocol date 09–12-2024. Prospectively registered on 09–01-2025 at Clinicaltrails.gov nr. NCT06766461.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Aged / Amides / Amoxicillin / Analysis / Anti-Bacterial Agents - administration & dosage / Anti-Bacterial Agents - therapeutic use / Antibiotics / Beta lactam antibiotics / Beta lactamases / Beta-lactam / beta-Lactams - administration & dosage / beta-Lactams - therapeutic use / Care and treatment / Cefotaxime / Ceftazidime / Ceftriaxone / Cefuroxime / Clavulanic acid / Clinical trials / Complications and side effects / Consent / Cost benefit analysis / Critical Illness / Critically ill / Data collection / Dosage / Dosage and administration / Drug dosages / Drug therapy / Female / Flucloxacillin / Global health / Health aspects / Health services / Hospitals / Humans / Infection / Infectious Diseases / Intensive care / Internal Medicine / Intervention / Male / Medical Microbiology / Medical research / Medicine / Medicine & Public Health / Medicine, Experimental / Meropenem / Methods / Mortality / Multicenter Studies as Topic / Parasitology / Patients / Pharmacodynamics / Physiological aspects / Piperacillin / Plasma levels / Quality of life / Randomized controlled trial / Randomized Controlled Trials as Topic / Renal function / Sample size / Sepsis / Sepsis - drug therapy / Sepsis - mortality / Septic shock / Software / Standard of care / Study Protocol / Tazobactam / Treatment Outcome / Tropical Medicine / β-Lactam antibiotics