Open-Label Phase 1 Study of Aerosolized Amikacin and Fosfomycin in Healthy Volunteers

This is a Phase 1 open-label study of three doses of amikacin/fosfomycin. Approximately 30
healthy volunteers will be dosed in five cohorts of six subjects each. The first (sentinel)
subject in each of the first three cohorts will be dosed alone. If no significant safety or
tolerability events occur, the remaining five subjects in each of the first three cohorts
will be dosed. The first cohort (n=6) will be administered the 30/12 mg dose of
amikacin/fosfomycin. The second cohort (n=6) will be administered the 60/24 mg dose of
amikacin/fosfomycin. The third cohort (n=6) will be administered the 90/36 mg dose of
amikacin/fosfomycin. All doses in cohorts 1, 2, and 3 will be delivered with the PARI
Investigational eFlow Nebulizer System. The fourth cohort (n=6) will be administered the
90/36 mg dose of amikacin/fosfomycin using the PARI LC Sprint Nebulizer. The fifth cohort
(n=6) will test the lowest dose level at which all subjects achieved > 0.3 µg/mL amikacin
peak serum concentration. The nebulizer used to deliver doses in cohort 5 will be determined
after amikacin concentrations from cohorts 1 through 4 are reviewed.

Inclusion Criteria:

- Males or females aged ≥18 years and ≤ 80 years of age (Cohorts 1, 2, 3, and 4). Males
or females aged ≥ 18 years and ≤ 65 years of age (Cohort 5).

- Females of childbearing potential must be using contraception. Acceptable methods of
contraception include male or female condom with spermicide gel or foam, hormonal
contraceptive combined with a condom, Intrauterine Device (IUD), tubal ligation,
diaphragm with spermicide, or total abstinence with a back-up if the subject becomes
active.

- Able to communicate with site personnel and to understand and voluntarily sign the
Informed Consent Form.

Exclusion Criteria:

- History of previous allergy or sensitivity to amikacin or fosfomycin.

- Use of oral fosfomycin in the 28 days prior to admission to Phase 1 facility.

- History of reactive airways disease (such as asthma or chronic obstructive pulmonary
disease [COPD]), cystic fibrosis, or bronchiectasis.

- Human Immunodeficiency Virus (HIV) positive.

- Active Hepatitis B or C.

- Cigarette/e-Cigarette smoking or use of other nicotine or tobacco containing products
within seven days prior to study drug administration.

- Positive for drugs of abuse or alcohol use at screening or admission to Phase 1
facility. A Breathalyzer test will be used to screen for the presence of alcohol. A
urine standard panel will be used to test for the following substances (with serum
testing for confirmation, as needed):

- Opiates

- Oxycodone

- Methadone

- Cocaine

- Tetrahydrocannabinol (THC)

- Benzodiazepines

- Amphetamines / Methamphetamines

- Barbiturates

- Methylenedioxy-methamphetamine (MDMA)

- Phenylcyclohexyl piperidine (PCP)

- Tricyclic Antidepressants

- Participation in a clinical study with administration of an investigational drug
product within the previous 30 days, or five half-lives of the previously administered
investigational product.

- Donation of blood or significant blood loss within the 8 weeks prior to admission to
Phase 1 facility.

- Donation of plasma within the week prior to admission to Phase 1 facility.

- Any other condition which in the view of the Investigator is likely to interfere with
the study or put the subject at risk.

- Pregnant or nursing.