Innovations are urgently required for clinical development of antibacterials against multidrug-resistant organisms. Therefore, a European, public-private working group (STAT-Net; part of Combatting Bacterial Resistance in Europe [COMBACTE]), has reviewed and tested several innovative trials designs and analytical methods for randomized clinical trials, which has resulted in 8 recommendations. The first 3 focus on pharmacokinetic and pharmacodynamic modeling, emphasizing the pertinence of population-based pharmacokinetic models, regulatory procedures for the reassessment of old antibiotics, and rigorous quality improvement. Recommendations 4 and 5 address the need for more sensitive primary end points through the use of rank-based or time-dependent composite end points. Recommendation 6 relates to the applicability of hierarchical nested-trial designs, and the last 2 recommendations propose the incorporation of historical or concomitant trial data through Bayesian methods and/or platform trials. Although not all of these recommendations are directly applicable, they provide a solid, evidence-based approach to develop new, and established, antibacterials and address this public health challenge.

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Keywords randomized clinical trials, multidrug-resistant organisms, novel biostatistical methods, clinical trial design, antibacterial drug development.
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Journal Clinical Infectious Diseases
de Kraker, M, Sommer, H. (Harriet), de Velde, F, Gravestock, I. (Isaac), Weiss, E. (Emmanuel), McAleenan, A. (Alexandra), … Harbarth, S. (2018). Optimizing the Design and Analysis of Clinical Trials for Antibacterials Against Multidrug-resistant Organisms: A White Paper From COMBACTE's STAT-Net. Clinical Infectious Diseases, 67(12), 1922–1931. doi:10.1093/cid/ciy516