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Yoshida T, Yoshida S, Okada H, Suzuki A, Niwa T, Suzuki K, Ohmori T, Kobayashi R, Baba H, Suzuki K, Murakami N, Itoh Y, Ogura S. Risk factors for decreased teicoplanin trough concentrations during initial dosing in critically ill patients. Pharmazie 2019; 74:120-124. [PMID: 30782263 DOI: 10.1619/ph.2019.8731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Aim of the study: Here, we investigated the risk factors for decreased teicoplanin plasma trough concentrations relative to the initial dosing in critically ill patients. Patients and methods: Data obtained from 80 eligible critically ill patients who received intravenous teicoplanin were retrospectively analyzed. Risk factors for decreases in teicoplanin trough concentrations 72 h after administration of teicoplanin of more than 30% relative to predicted concentrations based on initial dosing setting were identified by logistic regression analysis. Results: Although prediction trough concentration and total dose of two days no significant differences were seen between the variation group and the non-variation group, actual trough concentration was significantly different between two groups (19.9±5.6 μg/ml vs 10.3±2.2 μg/ml, p < 0.001). In multivariate analysis, serum albumin ≤ 2.2 mg/dl (odds ratio [OR] = 3.003, 95% CI 1.072-8.408; p = 0.036) and SOFA score ≥ 9 (OR = 3.498, 95% CI 1.171-10.450; p = 0.025) were significant risk factors for decreased teicoplanin plasma trough concentrations. Conclusion: In critically ill patients, high SOFA score and low serum albumin were risk factors for decreased teicoplanin plasma trough concentration during initial dosing.
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Lacroix C, Kheloufi F, Montastruc F, Bennis Y, Pizzoglio V, Micallef J. Serious central nervous system side effects of cephalosporins: A national analysis of serious reports registered in the French Pharmacovigilance Database. J Neurol Sci 2019; 398:196-201. [PMID: 30683462 DOI: 10.1016/j.jns.2019.01.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/19/2018] [Accepted: 01/14/2019] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Among antibiotics, Central Nervous System (CNS) adverse drug reactions (ADRs) are often under-suspected and overlooked. Cephalosporins are an important cause of drug-induced CNS ADRs but the characteristics of such ADR have not been fully explored. We aimed to characterize the profile of cephalosporins serious CNS ADRs. METHOD We performed an analysis of serious reports recorded in the French Pharmacovigilance database from 1987 to 2017. RESULTS A total of 511 serious ADRs reports was analyzed. Patients had a mean age of 67.1 years and were mainly men (52.5%), with a mean creatinine clearance of 32.9 ml/min. The most involved molecules were cefepime (33.1%), ceftriaxone (29.7%), ceftazidime (19.6%), cefotaxime (9%) and cefazoline (2.9%), mostly administered intravenously (87.3%). A CNS history was observed in 25% of the reports (n = 128). Patients exhibited encephalopathy (30.3%), confusional state (19.4%), convulsion (15.1%), myoclonia (9.4%), status epilepticus (9.2%), coma (6.3%) and hallucination (4.3%). The mean time of onset was 7.7 days and the mean duration was 6 days. Cephalosporin plasma levels were recorded for 153 patients (29.9%) and 107 were above the standards including 62 (57.9%) related to renal impairment. Electroencephalograms were performed in 38.2% (n = 195) of the patients and 81% (n = 158) were abnormal. CONCLUSION This study characterizes an off-target CNS ADRs of several cephalosporins. Ceftriaxone represented a large part of our reports after cefepime and it would be relevant to warn healthcare professionals. Investigations (EEG, though plasma levels and renal function) can be precious tools for clinicians to make a prompt diagnosis and improve patients' outcomes.
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Affiliation(s)
- C Lacroix
- Centre Régional de Pharmacovigilance, Service de Pharmacologie Clinique et Pharmacovigilance, APHM, INSERM, Inst Neurosci Syst, Aix Marseille Univ, Marseille, France
| | - F Kheloufi
- Centre Régional de Pharmacovigilance, Service de Pharmacologie Clinique et Pharmacovigilance, APHM, INSERM, Inst Neurosci Syst, Aix Marseille Univ, Marseille, France
| | - F Montastruc
- Centre Midi-Pyrénées de Pharmacovigilance, Pharmacoépidémiologie et d'Informations sur le Médicament, Centre Hospitalier Universitaire, Faculté de Médecine, Service de Pharmacologie Médicale et Clinique, Toulouse, France; Unité clinique de Pharmacologie psychiatrique, Faculté de Médecine, Centre Hospitalier Universitaire, Toulouse, France
| | - Y Bennis
- Centre Régional de Pharmacovigilance, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | - V Pizzoglio
- Centre Régional de Pharmacovigilance, Hospices Civils de Lyon, Lyon, France
| | - J Micallef
- Centre Régional de Pharmacovigilance, Service de Pharmacologie Clinique et Pharmacovigilance, APHM, INSERM, Inst Neurosci Syst, Aix Marseille Univ, Marseille, France.
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Chambers J, Page-Sharp M, Salman S, Dyer J, Davis TME, Batty KT, Manning L. Ertapenem for osteoarticular infections in obese patients: a pharmacokinetic study of plasma and bone concentrations. Eur J Clin Pharmacol 2018; 75:511-517. [PMID: 30511329 DOI: 10.1007/s00228-018-2597-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 11/04/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Ertapenem is used off-label to treat osteoarticular infections but there are few pharmacokinetic (PK) data to guide optimal dosing strategies in patients who may be obese with multiple co-morbidities including diabetes and peripheral vascular disease. METHODS Participants undergoing lower limb amputation or elective joint arthroplasty received a dose of intravenous ertapenem prior to surgery. Eight plasma samples were collected over 24 h, together with at least one bone sample per patient. Ertapenem concentrations in plasma and bone were measured using liquid-chromatography/mass-spectroscopy and analysed using non-linear mixed effects PK modelling. RESULTS Plasma and bone concentrations were obtained from 10 participants. The final population PK model showed that a fat free body mass was the most appropriate body size adjustment. Ertapenem diffused rapidly into bone but concentrations throughout the 24 h dosing period were on average 40-fold higher in plasma, corresponding to a bone to plasma ratio of 0.025, and highly variable between individuals. Simulations demonstrated a high probability of target attainment (PTA) for free plasma concentrations when the minimum inhibitory concentrations (MIC) were ≤ 0.25 mg/L. By contrast, at MICs of 0.5 mg/L and ≥ 1 mg/L, the fractions of patients attaining this target was ~ 80% and 40%, respectively. In bone, the PTA was ≤ 45% when the MIC was ≥ 0.25 mg/L. CONCLUSION Local bone and free plasma concentrations appear adequate for osteoarticular infections where Enterobacteriaceae are the main causative pathogens, but for Staphylococcus aureus and other bacteria, conventional dosing may lead to inadequate PTA.
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Affiliation(s)
- Jonathan Chambers
- Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Madhu Page-Sharp
- School of Pharmacy and Biomedical Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Sam Salman
- Faculty of Health and Medical Sciences, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - John Dyer
- Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Timothy M E Davis
- Faculty of Health and Medical Sciences, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - Kevin T Batty
- School of Pharmacy and Biomedical Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Laurens Manning
- Faculty of Health and Medical Sciences, Harry Perkins Research Institute, Fiona Stanley Hospital, University of Western Australia, PO Box 404, Bull Creek 6149, Murdoch, Western Australia, Australia.
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Komirenko AS, Riddle V, Gibbons JA, Van Wart S, Seroogy JD. A Phase 1 Study To Assess the Pharmacokinetics of Intravenous Plazomicin in Adult Subjects with Varying Degrees of Renal Function. Antimicrob Agents Chemother 2018; 62:e01128-18. [PMID: 30275092 PMCID: PMC6256775 DOI: 10.1128/aac.01128-18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/29/2018] [Indexed: 12/31/2022] Open
Abstract
Plazomicin is an FDA-approved aminoglycoside for the treatment of complicated urinary tract infections. In this open-label study, 24 adults with normal renal function or mild, moderate, or severe renal impairment (n = 6 per group) received a single 7.5-mg/kg of body weight dose of plazomicin as a 30-min intravenous infusion. Total clearance declined with renal impairment, resulting in 1.98-fold and 4.42-fold higher plazomicin exposures, as measured by the area under the concentration-time curve from 0 h to infinity, in subjects with moderate and severe impairment, respectively, than in subjects with normal renal function. (This study has been registered at ClinicalTrials.gov under identifier NCT01462136.).
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Affiliation(s)
| | | | | | - Scott Van Wart
- Institute for Clinical Pharmacodynamics, Schenectady, New York, USA
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Asada M, Nagata M, Mizuno T, Uchida T, Kurashima N, Takahashi H, Makita K, Arai H, Echizen H, Yasuhara M. Effects of cardiopulmonary bypass on the disposition of cefazolin in patients undergoing cardiothoracic surgery. Pharmacol Res Perspect 2018; 6:e00440. [PMID: 30410768 PMCID: PMC6218359 DOI: 10.1002/prp2.440] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 09/27/2018] [Accepted: 10/02/2018] [Indexed: 11/21/2022] Open
Abstract
The aim of the study was to evaluate the disposition of plasma unbound cefazolin in patients undergoing cardiothoracic surgery with cardiopulmonary bypass (CPB). Adult patients undergoing cardiothoracic surgery with CPB were enrolled in the study. Cefazolin sodium was given intravenously before skin incision (1 g) and at the beginning of CPB (2 g). Thereafter, an additional dose (1 g) was given every 4 hours. Seven to ten blood samples were collected before and during surgery. Plasma total and unbound (ultrafiltrated) cefazolin concentrations were analyzed using an HPLC-UV method. Plasma protein binding was analyzed with the Langmuir model. Twenty-seven patients (aged 70 ± 12 years, body weight 62 ± 12 kg, mean ± SD) with GFR >30 mL min-1 completed the study. There was a significant (P < 0.001) increase in median plasma unbound fraction of cefazolin from 21% before skin incision to 45% during CPB (P < 0.001), which was accompanied by a significant (P < 0.001) reduction in median plasma albumin concentration from 36 to 27 g L-1. Plasma concentrations of unbound cefazolin exceeded the assumed target thresholds of 2 μg mL-1 in all samples and of 8 μg mL-1 in all but one of 199 samples. The increased plasma unbound fraction of cefazolin would be attributable to dilutional reduction of serum albumin at the beginning of CPB and to saturable plasma protein binding of cefazolin. These data reveal CPB may alter the plasma protein binding and possibly distribution of cefazolin. Further studies are warranted to reappraise the protocol of antimicrobial prophylaxis with cefazolin in patients undergoing surgery with CPB.
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Affiliation(s)
- Mizuho Asada
- Department of PharmacyMedical HospitalTokyo Medical and Dental University (TMDU)TokyoJapan
| | - Masashi Nagata
- Department of PharmacyMedical HospitalTokyo Medical and Dental University (TMDU)TokyoJapan
- Department of Pharmacokinetics and PharmacodynamicsGraduate School of Medical and Dental SciencesTokyo Medical and Dental University (TMDU)TokyoJapan
| | - Tomohiro Mizuno
- Department of Cardiovascular SurgeryGraduate School of Medical and Dental ScienceTokyo Medical and Dental University (TMDU)TokyoJapan
| | - Tokujiro Uchida
- Department of AnesthesiologyGraduate School of Medical and Dental SciencesTokyo Medical and Dental University (TMDU)TokyoJapan
| | - Naoki Kurashima
- Medical Engineering CenterMedical Hospital of Tokyo Medical and Dental University (TMDU)TokyoJapan
| | - Hiromitsu Takahashi
- Department of PharmacyMedical HospitalTokyo Medical and Dental University (TMDU)TokyoJapan
| | - Koshi Makita
- Department of AnesthesiologyGraduate School of Medical and Dental SciencesTokyo Medical and Dental University (TMDU)TokyoJapan
| | - Hirokuni Arai
- Department of Cardiovascular SurgeryGraduate School of Medical and Dental ScienceTokyo Medical and Dental University (TMDU)TokyoJapan
| | - Hirotoshi Echizen
- Department of PharmacotherapyMeiji Pharmaceutical UniversityTokyoJapan
| | - Masato Yasuhara
- Department of Pharmacokinetics and PharmacodynamicsGraduate School of Medical and Dental SciencesTokyo Medical and Dental University (TMDU)TokyoJapan
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Moczarnik J, Berger DJ, Noxon JO, LeVine DN, Lin Z, Coetzee JF, Mochel JP. Relative Oral Bioavailability of Two Amoxicillin-Clavulanic Acid Formulations in Healthy Dogs: A Pilot Study. J Am Anim Hosp Assoc 2018; 55:14-22. [PMID: 30427713 DOI: 10.5326/jaaha-ms-6872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The use of human generic amoxicillin-clavulanic acid formulations in veterinary medicine is currently lacking supportive evidence. This pilot study was conducted to determine preliminary pharmacokinetic parameters and relative oral bioavailability of a human generic and veterinary proprietary 4:1 amoxicillin-clavulanic acid formulation in healthy dogs to evaluate whether drug exposure was similar and to determine if further comparative investigation is warranted. Each dog received a single oral dose of each formulation containing 500:125 mg of amoxicillin-clavulanic acid at two separate instances with a 2 wk washout period between product administration. Following drug administration, blood was collected at fixed times over 24 hr to measure plasma amoxicillin and clavulanic acid concentrations using liquid chromatography-mass spectrometry. There were no statistically significant differences between pharmacokinetic parameters of either formulation. Clavulanic acid showed greater between-dog variation in drug exposure between formulations compared with amoxicillin and was also observed to be more variable within the veterinary proprietary formulation. The average relative oral bioavailability was 98.2% (23.6% coefficient of variation) for amoxicillin and 152.6% (64.3% coefficient of variation) for clavulanic acid between formulations. This pilot investigation supports the need for further bioequivalence studies regarding these formulations before commenting on product interchangeability.
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Affiliation(s)
- Jennifer Moczarnik
- From the Lloyd Veterinary Medical Center (J.M.), Department of Veterinary Clinical Sciences (D.J.B., J.O.N., D.N.L.), and Department of Biomedical Sciences (J.P.M.), College of Veterinary Medicine, Iowa State University, Ames, Iowa; and Department of Anatomy and Physiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas (Z.L., J.F.C.)
| | - Darren J Berger
- From the Lloyd Veterinary Medical Center (J.M.), Department of Veterinary Clinical Sciences (D.J.B., J.O.N., D.N.L.), and Department of Biomedical Sciences (J.P.M.), College of Veterinary Medicine, Iowa State University, Ames, Iowa; and Department of Anatomy and Physiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas (Z.L., J.F.C.)
| | - James O Noxon
- From the Lloyd Veterinary Medical Center (J.M.), Department of Veterinary Clinical Sciences (D.J.B., J.O.N., D.N.L.), and Department of Biomedical Sciences (J.P.M.), College of Veterinary Medicine, Iowa State University, Ames, Iowa; and Department of Anatomy and Physiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas (Z.L., J.F.C.)
| | - Dana N LeVine
- From the Lloyd Veterinary Medical Center (J.M.), Department of Veterinary Clinical Sciences (D.J.B., J.O.N., D.N.L.), and Department of Biomedical Sciences (J.P.M.), College of Veterinary Medicine, Iowa State University, Ames, Iowa; and Department of Anatomy and Physiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas (Z.L., J.F.C.)
| | - Zhoumeng Lin
- From the Lloyd Veterinary Medical Center (J.M.), Department of Veterinary Clinical Sciences (D.J.B., J.O.N., D.N.L.), and Department of Biomedical Sciences (J.P.M.), College of Veterinary Medicine, Iowa State University, Ames, Iowa; and Department of Anatomy and Physiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas (Z.L., J.F.C.)
| | - Johann F Coetzee
- From the Lloyd Veterinary Medical Center (J.M.), Department of Veterinary Clinical Sciences (D.J.B., J.O.N., D.N.L.), and Department of Biomedical Sciences (J.P.M.), College of Veterinary Medicine, Iowa State University, Ames, Iowa; and Department of Anatomy and Physiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas (Z.L., J.F.C.)
| | - Jonathan P Mochel
- From the Lloyd Veterinary Medical Center (J.M.), Department of Veterinary Clinical Sciences (D.J.B., J.O.N., D.N.L.), and Department of Biomedical Sciences (J.P.M.), College of Veterinary Medicine, Iowa State University, Ames, Iowa; and Department of Anatomy and Physiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas (Z.L., J.F.C.)
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Gwee A, Cranswick N, Donath SM, Hunt R, Curtis N. Protocol for a randomised controlled trial of continuous infusions of vancomycin to improve the attainment of target vancomycin levels in young infants: The VANC trial. BMJ Open 2018; 8:e022603. [PMID: 30391914 PMCID: PMC6231575 DOI: 10.1136/bmjopen-2018-022603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 09/14/2018] [Accepted: 09/17/2018] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Vancomycin is frequently used in the treatment of late-onset sepsis in young infants and is routinely administered as intermittent infusions (IIV); however, existing IIV dosing guidelines achieve target vancomycin levels in less than half of infants. Continuous infusions of vancomycin (CIV) are an attractive alternative as adult studies report a higher attainment of target vancomycin levels, simpler drug monitoring and fewer drug side effects. METHODS This is a multicentre, randomised controlled trial in which 200 young infants (aged 0-90 days) requiring vancomycin will be randomised to CIV or IIV for a duration determined by the treating clinician. Vancomycin levels will be measured immediately after the first dose in both arms. Trough and peak levels will be determined in the IIV arm and steady-state levels 18-30 hours after commencement of infusion will be measured in the CIV arm. Full blood count, urea and electrolytes, and C reactive protein level will be monitored throughout treatment. For all Gram-positive bacteria isolated from blood culture, a vancomycin Etest will be done to determine the minimum inhibitory concentration of the bacterium. ANALYSIS Primary outcome: the proportion of infants with levels within target range at their first steady-state concentration. SECONDARY OUTCOMES (1) the proportion of drug-related adverse effects; (2) the time to achieve target levels in the blood; (3) the pharmacodynamics of vancomycin (using non-linear mixed effect modelling). ETHICS AND DISSEMINATION The study has been approved by The Royal Children's Hospital Melbourne Human Research Ethics Committee (HREC) (No. 34030) and the South Eastern Sydney Local Health District HREC (SSA 16/G/335). Results will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT02210169.
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Affiliation(s)
- Amanda Gwee
- Departments of General Medicine and Neonatal Medicine, The Royal Children’s Hospital, Melbourne, Victoria, Australia
- Infectious Diseases & Microbiology, Neonatal Research, Clinical Epidemiology & Biostatistics Unit, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Noel Cranswick
- Departments of General Medicine and Neonatal Medicine, The Royal Children’s Hospital, Melbourne, Victoria, Australia
- Infectious Diseases & Microbiology, Neonatal Research, Clinical Epidemiology & Biostatistics Unit, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Susan M Donath
- Infectious Diseases & Microbiology, Neonatal Research, Clinical Epidemiology & Biostatistics Unit, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Rodney Hunt
- Departments of General Medicine and Neonatal Medicine, The Royal Children’s Hospital, Melbourne, Victoria, Australia
- Infectious Diseases & Microbiology, Neonatal Research, Clinical Epidemiology & Biostatistics Unit, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Nigel Curtis
- Departments of General Medicine and Neonatal Medicine, The Royal Children’s Hospital, Melbourne, Victoria, Australia
- Infectious Diseases & Microbiology, Neonatal Research, Clinical Epidemiology & Biostatistics Unit, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
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Mader MMD, Czorlich P, König C, Fuhrmann V, Kluge S, Westphal M, Grensemann J. Intrathecal penetration of meropenem and vancomycin administered by continuous infusion in patients suffering from ventriculitis-a retrospective analysis. Acta Neurochir (Wien) 2018; 160:2099-2105. [PMID: 30242495 DOI: 10.1007/s00701-018-3680-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 09/12/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Vancomycin and meropenem are frequently used as empiric treatment for ventriculitis. Penetration into the cerebrospinal fluid (CSF) depends on various factors with a high inter-individual variability. Because attaining and maintaining adequate concentrations of meropenem and vancomycin in the CSF is crucial for their bactericidal effect, we introduced a routine therapeutic drug monitoring (TDM) from CSF and serum for both antibiotics. We studied the antibiotic penetration into the CSF. METHODS Patient data including serum and CSF concentrations for meropenem and vancomycin were collected in a retrospective fashion. Antibiotic CSF penetration ratio was calculated for each patient. Antibiotics were administered by continuous infusion aiming for serum target concentrations of 20-30 mg/L for vancomycin and 16-32 mg/L for meropenem. RESULTS Twenty-two patients with 36 CSF/serum pairs for meropenem and 43 pairs for vancomycin were studied. No patient suffered from renal or liver insufficiency. Mean vancomycin serum concentration was 22 ± 8 mg/L and the mean CSF concentration 4.5 ± 2.6 mg/L. CSF penetration was 20 ± 11% (coefficient of determination (R2) 0.02). For meropenem, the mean serum concentration was 30.7 ± 14.9 mg/L, mean CSF concentration 5.5 ± 5.2 mg/L, and a penetration of 18 ± 12%, R2 = 0.42. CONCLUSION Penetration of meropenem and vancomycin into the CSF is low while showing a high interindividual variability. Various patients in our study cohort were at risk for insufficient target attainment in CSF. Continuous administration of antibiotics under routine TDM appears to be a feasible and reasonable approach for optimization of intrathecal drug levels in patients suffering from ventriculitis. TDM might guide individual dosing adaptation and efforts to predict the CSF penetration of meropenem and vancomycin in cases of ventriculitis.
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Affiliation(s)
- Marius Marc-Daniel Mader
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Patrick Czorlich
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Christina König
- Hospital Pharmacy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Valentin Fuhrmann
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Jörn Grensemann
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
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Wichitnithad W, Kiatkumjorn T, Jithavech P, Thanawattanawanich P, Na Bhuket PR, Rojsitthisak P. A simple and sensitive HPLC-fluorescence method for the determination of moxifloxacin in human plasma and its application in a pharmacokinetic study. Pharmazie 2018; 73:625-629. [PMID: 30396379 DOI: 10.1691/ph.2018.8148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A simple sample preparation technique coupled with the specific and sensitive fluorescence detection for the determination of moxifloxacin in human plasma was developed and fully validated. Levofloxacin was chosen as an internal standard. Chromatographic separation was achieved using a Shiseido C18 MGII (250×4.6mm i.d.; 5 μm) column under an isocratic mobile phase comprising of 50 mM potassium dihydrogen phosphate (pH 2.4) - acetonitrile (77:23, v/v) at a flow rate of 1.5 mL/min. Fluorescence detection was optimized for the determination of moxifloxacin in human plasma at an excitation wavelength of 296 nm and an emission wavelength of 504 nm. The total chromatographic run time was 8 min with the retention times of moxifloxacin and internal standard at 6.5 and 3.0 min, respectively. Calibration curves were established over the dynamic range of 20-3000 ng/mL. The analytical method was validated as per US-FDA and EMA guidelines for specificity, sensitivity, linearity, accuracy, precision, recovery, hemolytic effect, lipemic effect, dilution integrity and stability. The validated analytical method was successfully applied in a pharmacokinetic study of a single-dose oral administration of a moxifloxacin 400 mg tablet in Thai healthy volunteers.
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Rigo-Bonnin R, Gomez-Junyent J, García-Tejada L, Benavent E, Soldevila L, Tubau F, Murillo O. Measurement of ceftolozane and tazobactam concentrations in plasma by UHPLC-MS/MS. Clinical application in the management of difficult-to-treat osteoarticular infections. Clin Chim Acta 2018; 488:50-60. [PMID: 30385280 DOI: 10.1016/j.cca.2018.10.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 10/11/2018] [Accepted: 10/28/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Ceftolozane, in combination with the β-lactamase inhibitor tazobactam, is a new option in the pipeline against multidrug-resistant Gram-negative bacilli. As for other β-lactam antibiotics, optimizing the use of ceftolozane-tazobactam is advisable, especially in difficult-to-treat infections. In this regard, therapeutic drug monitoring would be required to guide the treatment of ceftolozane-tazobactam. Thus, we aimed to develop and validate procedures based on UHPLC-MS/MS for measurement of ceftolozane and tazobactam plasma concentrations in clinical practice. MATERIAL AND METHODS Analyses were conducted using an Acquity® UPLC® integrated system coupled to an Acquity® TQD® tandem-quadrupole mass spectrometer. Ceftolozane, tazobactam and their internal standards (ceftazidime-D5 and sulbactam) were detected by electrospray ionization mass spectrometry in positive and negative ion multiple reaction monitoring modes, using transitions of 667.2 → 199.3/139.0 and 551.9 → 467.9 for ceftolozane and ceftazidime-D5, and 299.0 → 138/254.9 and 232.0 → 140.0 for tazobactam and sulbactam. Measurement procedures developed were used for guiding the treatment and adjusting daily dose of ceftolozane-tazobactam in patients with osteoarticular infections. RESULTS Coefficients of variation and absolute relative biases were <7.9% and 6.5% in all cases. The lower limit of quantification, linearity, normalized-recoveries, normalized-matrix effects and measurement uncertainties for ceftolozane were: 0.97 mg/L, (0.97-125) mg/L, ≤113.6%, ≤108.7%, and ≤ 18.7%, respectively; and for tazobactam: 1.04 mg/L, (1.04-125) mg/L, ≤103.6%, ≤101.9%, and ≤ 20.0%. No interferences and carry-over were observed. Patients plasma concentrations were higher than the recommended 3-4 times the minimal inhibitory concentrations. CONCLUSIONS Our measurement procedures are suitable for therapeutic drug monitoring of ceftolozane-tazobactam in patients with osteoarticular infections.
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Affiliation(s)
- Raúl Rigo-Bonnin
- Laboratori Clínic Department, IDIBELL, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Joan Gomez-Junyent
- Infectious Diseases Department, IDIBELL, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Laura García-Tejada
- Laboratori Clínic Department, IDIBELL, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Eva Benavent
- Infectious Diseases Department, IDIBELL, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Laura Soldevila
- Infectious Diseases Department, IDIBELL, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Fe Tubau
- Microbiology Department, IDIBELL, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Spanish Network for Biomedical Research in Respiratory Diseases (CIBERES CB06/060037), Instituto de Salud Carlos III, Madrid, Spain
| | - Oscar Murillo
- Infectious Diseases Department, IDIBELL, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Spanish Network for Research in Infectious Diseases (REIPI RD12/0012), Instituto de Salud Carlos III, Madrid, Spain
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Olbrisch K, Kisch T, Thern J, Kramme E, Rupp J, Graf T, Wicha SG, Mailänder P, Raasch W. After standard dosage of piperacillin plasma concentrations of drug are subtherapeutic in burn patients. Naunyn Schmiedebergs Arch Pharmacol 2018; 392:229-241. [PMID: 30368548 DOI: 10.1007/s00210-018-1573-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 10/19/2018] [Indexed: 12/21/2022]
Abstract
Infections are a major problem in patients with burn diseases. Mortality is high despite antibiotic therapy as studies are controversial concerning drug underdosing. The aims of this prospective, observational study were to monitor plasma concentrations of piperacillin during standard piperacillin/tazobactam treatment in 20 burn patients and 16 controls from the intensive care unit (ICU) and to optimize doses by in silico analyses. Piperacillin/tazobactam (4/0.5 g, tid) was administered over 0.5 h. Blood samples were taken at 1, 4, and 7.5 h after the end of the infusion. Free piperacillin plasma concentrations were determined. Pharmacokinetic parameters and in silico analysis results were calculated using the freeware TDMx. The primary target was defined as percentage of the day (fT>1xMIC; fT>4xMIC) when piperacillin concentrations exceeded 1xMIC/4xMIC (minimum inhibitory concentration), considering a MIC breakpoint of 16 mg/L for Pseudomonas aeruginosa. In an off-label approach, two burn patients were treated with 8/1 g piperacillin/tazobactam, 3 h qid. fT>1xMIC (55 ± 22% vs. 77 ± 24%) and fT>4xMIC (17 ± 11% vs. 30 ± 11%) were lower in burn than in ICU patients after 4/0.5 g, 0.5 h, tid. In silico analyses indicated that fT>1xMIC (93 ± 12% burn, 97 ± 4% ICU) and fT>4xMIC (62 ± 23% burn, 84 ± 19% ICU) values increase by raising the piperacillin dosage to 8/1 g qid and prolonging the infusion time to 3 h. Off-label treatment results were similar to in silico data for burn patients (84%fT>1xMIC and 47%fT>4xMIC). Standard dosage regimens for piperacillin/tazobactam resulted in subtherapeutic piperacillin concentrations in burn and ICU patients. Dose adjustments via in silico analyses can help to optimize antibiotic therapy and to predict respective concentrations in vivo. Trial registration: NCT03335137, registered 07.11.2017, retrospectively.
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Affiliation(s)
- Katharina Olbrisch
- Institute of Experimental and Clinical Pharmacology and Toxicology, University of Lübeck, Lübeck, Germany
- Department of Pharmacy, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Tobias Kisch
- Clinic of Plastic Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Julia Thern
- Department of Pharmacy, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Evelyn Kramme
- Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Jan Rupp
- Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Tobias Graf
- University Heart Centre Lübeck, Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Sebastian G Wicha
- Clinical Pharmacy, Institute of Pharmacy, University of Hamburg, Hamburg, Germany
| | - Peter Mailänder
- Clinic of Plastic Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Walter Raasch
- Institute of Experimental and Clinical Pharmacology and Toxicology, University of Lübeck, Lübeck, Germany.
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany.
- CBBM (Center of Brain, Behavior and Metabolism), University of Lübeck, Lübeck, Germany.
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Tucker IG, Jain R, Alawi F, Nanjan K, Bork O. Translational studies on a ready-to-use intramuscular injection of penethamate for bovine mastitis. Drug Deliv Transl Res 2018; 8:317-328. [PMID: 28512690 DOI: 10.1007/s13346-017-0388-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Bovine mastitis caused by bacterial infections of the mammary gland (udder) of dairy cows is a costly pathology for the dairy industry due to direct and indirect losses in production. Penethamate, a pro-drug of benzylpenicillin, is used by intramuscular injection (IM). The existing products are powders which must be reconstituted in water-for-injection and this presents difficulties in the field. Penethamate is too unstable to be formulated as an aqueous formulation but a chemically stable suspension formulation was possible in certain oils; however, some literature suggests that such formulations would have unacceptable prolonged release. The translational research proceeded iteratively from lab to the target species, rather than via laboratory animal trials. Pilot studies in cows suggested that some oily suspensions would give concentrations of benzylpenicillin, (in both blood and milk) comparable with those of the reconstituted product. A physicochemical screen and a low level in vitro-in vivo correlation (IVIVC) was cautiously used to guide selection of formulations for subsequent animal trials which have resulted in a lead formulation for good laboratory practices (GLP), good clinical practices (GCP) studies.
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Affiliation(s)
- I G Tucker
- School of Pharmacy, University of Otago, P.O. Box 56, Dunedin, 9010, New Zealand.
| | - R Jain
- School of Pharmacy, University of Otago, P.O. Box 56, Dunedin, 9010, New Zealand
| | - F Alawi
- APAC Development Centre, Bayer New Zealand Limited, 3 Argus Place, Hillcrest, Auckland, 0627, New Zealand
| | - K Nanjan
- APAC Development Centre, Bayer New Zealand Limited, 3 Argus Place, Hillcrest, Auckland, 0627, New Zealand
| | - O Bork
- School of Pharmacy, University of Otago, P.O. Box 56, Dunedin, 9010, New Zealand
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63
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Lee JM, Lee JW, Jeong TS, Bang ES, Kim SH. Single-Center Pharmacokinetic Study and Simulation of a Low Meropenem Concentration in Brain-Dead Organ Donors. Antimicrob Agents Chemother 2018; 62:e00542-18. [PMID: 30061281 PMCID: PMC6153783 DOI: 10.1128/aac.00542-18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 07/25/2018] [Indexed: 11/20/2022] Open
Abstract
Meropenem is an ultrabroad-spectrum antibiotic of the carbapenem family. In brain-dead organ donors, administration of standard meropenem dosages does not reach therapeutic levels. Our objectives were to determine the plasma concentration of meropenem after the administration of standard meropenem dose and to estimate an improved dosage regimen for these patients. One gram of meropenem was administered as a 1-h infusion every 8 h for 1 to 3 days, and blood samples were collected. The plasma concentration of meropenem was measured and subjected to pharmacokinetic analysis. Simcyp simulation was performed to predict the optimum plasma levels and dosage based on the patients' individual pharmacokinetic parameters. The maximum plasma concentration of meropenem was 3.29 μg/ml, which was lower than four times the MIC of 8 μg/ml. Although the mean creatinine clearance of patients was moderately low (67.5 ml/min), the apparent volume of distribution at steady state (Vss) and time-averaged total body clearance (CL) of meropenem were markedly elevated (4.97 liters/kg and 2.06 liters/h/kg, respectively), owing to massive fluid loading to decrease the high sodium levels and to treat shock or dehydration. The simulation revealed that dose and infusion time of meropenem should be increased based on patients' Vss and CL, and a loading dose is recommended to reach rapidly the target concentration. In conclusion, a standard meropenem regimen is insufficient to achieve optimal drug levels in brain-dead patients, and an increase in dose and extended or continuous infusion with intravenous bolus administration of a loading dose are recommended for these patients.
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Affiliation(s)
- Jae-Myeong Lee
- Department of Surgery, Ajou University School of Medicine, Yeongtong-gu, Suwon, Republic of Korea
| | - Joo Won Lee
- College of Pharmacy and Research Institute of Pharmaceutical Science and Technology, Ajou University, Yeongtong-gu, Suwon, Republic of Korea
| | - Tae Seok Jeong
- College of Pharmacy and Research Institute of Pharmaceutical Science and Technology, Ajou University, Yeongtong-gu, Suwon, Republic of Korea
| | - Eun Sook Bang
- Office of Pharmacy, Ajou University Hospital, Yeongtong-gu, Suwon, Republic of Korea
| | - So Hee Kim
- College of Pharmacy and Research Institute of Pharmaceutical Science and Technology, Ajou University, Yeongtong-gu, Suwon, Republic of Korea
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Shang R, Zhang C, Yi Y, Liu Y, Pu W. Determination of a New Pleuromutilin Derivative in Broiler Chicken Plasma by RP-HPLC-UV and Its Application to a Pharmacokinetic Study. J Chromatogr Sci 2018; 56:604-610. [PMID: 29668863 DOI: 10.1093/chromsci/bmy033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 03/28/2018] [Indexed: 11/14/2022]
Abstract
A simple, sensitive and reproducible high-performance liquid chromatography method was developed and validated for the determination of 14-O-[(2-amino-1,3,4-thiadiazol-5-yl) thioacetyl] mutilin (ATTM), a new synthesized pleuromutilin derivative with potent antibacterial activity, in broiler chicken plasma after a single intravenous (i.v.), intramuscular (i.m.) or oral (p.o.) administration. Satisfactory separation was achieved on a ZORBAX Ecliplus C18 column (250 × 4.6, 5 μm) with UV detection at 279 nm, using a mobile phase comprising acetonitrile and ultrapure water (50:50, v/v). The elution was isocratic at ambient temperature with a flow rate of 1.0 mL/min. The method exhibited good linearity (R2 > 0.999) over the assayed concentration range (0.12-120.00 μg/mL) and demonstrated good intra- and inter-day precision and accuracy. The method was validated and successfully applied to the pharmacokinetic study of ATTM in chicken plasma after i.v. and p.o. administration.
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Affiliation(s)
- Ruofeng Shang
- Key Laboratory of New Animal Drug Project of Gansu Province, Key Laboratory of Veterinary Pharmaceutical Development, Ministry of Agriculture, Lanzhou Institute of Husbandry and Pharmaceutical Sciences of CAAS, Lanzhou, Gansu Province, China
| | - Chao Zhang
- Lianyungang Animal Health Inspection Institute, Lianyungang, Jiangsu Province, China
| | - Yunpeng Yi
- Key Laboratory of New Animal Drug Project of Gansu Province, Key Laboratory of Veterinary Pharmaceutical Development, Ministry of Agriculture, Lanzhou Institute of Husbandry and Pharmaceutical Sciences of CAAS, Lanzhou, Gansu Province, China
| | - Yu Liu
- Key Laboratory of New Animal Drug Project of Gansu Province, Key Laboratory of Veterinary Pharmaceutical Development, Ministry of Agriculture, Lanzhou Institute of Husbandry and Pharmaceutical Sciences of CAAS, Lanzhou, Gansu Province, China
| | - Wanxia Pu
- Key Laboratory of New Animal Drug Project of Gansu Province, Key Laboratory of Veterinary Pharmaceutical Development, Ministry of Agriculture, Lanzhou Institute of Husbandry and Pharmaceutical Sciences of CAAS, Lanzhou, Gansu Province, China
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Lee B, Kim SJ, Park JD, Park J, Jung AH, Jung SH, Choi YH, Kang HG, Ha IS, Cheong HI. Factors affecting serum concentration of vancomycin in critically ill oliguric pediatric patients receiving continuous venovenous hemodiafiltration. PLoS One 2018; 13:e0199158. [PMID: 29927988 PMCID: PMC6013195 DOI: 10.1371/journal.pone.0199158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 06/02/2018] [Indexed: 12/02/2022] Open
Abstract
Vancomycin is known to be unintentionally eliminated by continuous renal replacement therapy, and the protein bound fraction of vancomycin is also known to be different in adults and children. However, there are only a few studies investigating the relationship between the dose of continuous venovenous hemodiafiltration (CVVHDF) parameters and serum concentration of vancomycin in pediatric patients. The aim of this study was to determine clinical and demographic parameters that significantly affect serum vancomycin concentrations. This retrospective cohort study was conducted at a pediatric intensive care unit in a tertiary university children’s hospital. Data from oliguric patients who underwent CVVHDF and vancomycin therapeutic drug monitoring were collected. The correlation between factors affecting serum concentration of vancomycin was analyzed using mixed effect model. A total of 177 serum samples undergoing vancomycin therapeutic drug monitoring were analyzed. The median age of study participants was 2.23 (interquartile range, 0.3–11.84) years, and 126 (71.19%) were male patients. Serum concentration of vancomycin decreased significantly as the effluent flow rate (EFR; P < 0.001), dialysate flow rate (DFR; P = 0.009), replacement fluid flow rate (RFFR; P = 0.008), the proportion of RFFR in the sum of DFR and RFFR (P = 0.025), and residual urine output increased. The adjusted R2 of the multivariate regression model was 0.874 (P < 0.001) and the equation was as follows: Vancomycin trough level (mg/L) = (0.283 × daily dose of vancomycin [mg/kg/d]) + (365.139 / EFR [mL/h/kg])–(15.842 × residual urine output [mL/h/kg]). This study demonstrated that the serum concentration of vancomycin was associated with EFR, DFR, RFFR, the proportion of RFFR, and residual urine output in oliguric pediatric patients receiving CVVHDF.
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Affiliation(s)
- Bongjin Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Pediatrics, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Soo Jung Kim
- Department of Pharmacy, Seoul National University Hospital, Seoul, Republic of Korea
| | - June Dong Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
- * E-mail:
| | - Jiun Park
- Department of Pharmacy, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ae Hee Jung
- Department of Pharmacy, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sun Hoi Jung
- Department of Pharmacy, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yu Hyeon Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Il Soo Ha
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hae Il Cheong
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
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Seng JJB, Yong MHA, Peh ZX, Soong JL, Tan MH. Appropriateness of vancomycin therapeutic drug monitoring and its outcomes among non-dialysis patients in a tertiary hospital in Singapore. Int J Clin Pharm 2018; 40:977-981. [PMID: 29948742 DOI: 10.1007/s11096-018-0670-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 05/31/2018] [Indexed: 11/25/2022]
Abstract
Background Vancomycin therapeutic drug monitoring (TDM) is commonly performed to ensure safe and effective use of the antibiotic. Aim of Study To evaluate appropriateness of vancomycin TDM and its outcomes in Singapore General Hospital. Method A retrospective, cross-sectional study was conducted between 1 January 2014 and 28 February 2014 involving patients who received ≥ 1 dose of intravenous vancomycin with TDM. Patient demographics and relevant vancomycin TDM data were collected from medical records. Results Of 746 vancomycin troughs measured among 234 patients, 459 troughs (61.5%) were taken inappropriately, with a median time of 2.6 h (interquartile range 1.1-4.3) before the next scheduled dose. Inappropriate interpretation of vancomycin troughs resulted in 41 unnecessary dose suspensions, 24 dose changes, and 102 unchanged vancomycin doses. The cost incurred due to inappropriate interpretation and measurement after discontinuation of treatment was US$7286. No differences in rates of vancomycin related nephrotoxicity, ototoxicity, recurrent infection, development of infection secondary to vancomycin resistant microorganism and mortality were observed (p > 0.05). Conclusion This study highlighted a high incidence of inappropriate vancomycin TDM which has led to increased healthcare cost.
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Affiliation(s)
| | - Mei Hui Amanda Yong
- Department of Pharmacy, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Zi Xin Peh
- Department of Pharmacy, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Jie Lin Soong
- Department of Pharmacy, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Mooi Heong Tan
- Department of Pharmacy, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
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Tsai YW, Wang YC, Shie SS, Chen MC, Huang YC, Chen CJ. Serum trough level as a postmarketing quality measure of generic vancomycin products. J Microbiol Immunol Infect 2018; 53:300-306. [PMID: 29907539 DOI: 10.1016/j.jmii.2018.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/03/2018] [Accepted: 04/27/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND The vancomycin trough level (VTL) is the most widely used pharmacokinetic parameter for monitoring its clinical efficacy. Whether the VTL is affected in patients receiving different vancomycin products has not previously been determined. METHODS From 2005 to 2015, five vancomycin products, including the innovator (designated as VAN-Lilly) and four generic versions (designated as VAN-A, VAN-B, VAN-C and VAN-D), were sequentially used in a teaching hospital. The initial VTLs were compared between patients who received different vancomycin products after propensity score (PS) weighting and matching for clinical covariates. RESULTS Among 8735 patients with initial VTL levels available for analysis, a significant association was identified between the VTL and different vancomycin products in children aged 1 month to 12 years (P < 0.0001). The PS weighting analysis in the paediatric group disclosed children on VAN-C had higher VTL compared to those on other four products (P = 0.0008). PS matching analysis revealed that children who received VAN-C had significantly higher VTLs than those who received VAN-Lily (P = 0.0001), VAN-A (P = 0.0008), VAN-B (P = 0.0002) or VAN-D (P = 0.0015). Furthermore, the coefficient of variation of the VTL was much greater in patients who received VAN-C than in those who received the other four versions, suggesting an unstable quality of this product. CONCLUSION A generic version of vancomycin generated significantly higher concentrations and greater variation of VTLs than the innovator and other generic vancomycin products in children. The VTL can serve as an indicator to monitor the quality of vancomycin products after marketing.
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Affiliation(s)
- Ya-Wen Tsai
- School of Medicine, College of Medicine, Chang Gung University, 333 Taoyuan, Taiwan
| | - Yu-Chiang Wang
- School of Medicine, College of Medicine, Chang Gung University, 333 Taoyuan, Taiwan
| | - Shian-Sen Shie
- School of Medicine, College of Medicine, Chang Gung University, 333 Taoyuan, Taiwan; Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, 333 Taoyuan, Taiwan
| | - Min-Chi Chen
- School of Medicine, College of Medicine, Chang Gung University, 333 Taoyuan, Taiwan
| | - Yhu-Chering Huang
- School of Medicine, College of Medicine, Chang Gung University, 333 Taoyuan, Taiwan; Division of Paediatric Infectious Diseases, Department of Paediatrics, Chang Gung Memorial Hospital, 333 Taoyuan, Taiwan
| | - Chih-Jung Chen
- School of Medicine, College of Medicine, Chang Gung University, 333 Taoyuan, Taiwan; Division of Paediatric Infectious Diseases, Department of Paediatrics, Chang Gung Memorial Hospital, 333 Taoyuan, Taiwan.
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Rawson TM, Charani E, Moore LSP, Gilchrist M, Georgiou P, Hope W, Holmes AH. Exploring the Use of C-Reactive Protein to Estimate the Pharmacodynamics of Vancomycin. Ther Drug Monit 2018; 40:315-321. [PMID: 29561305 PMCID: PMC6485622 DOI: 10.1097/ftd.0000000000000507] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND C-reactive protein (CRP) pharmacodynamic (PD) models have the potential to provide adjunctive methods for predicting the individual exposure response to antimicrobial therapy. We investigated CRP PD linked to a vancomycin pharmacokinetic (PK) model using routinely collected data from noncritical care adults in secondary care. METHODS Patients receiving intermittent intravenous vancomycin therapy in secondary care were identified. A 2-compartment vancomycin PK model was linked to a previously described PD model describing CRP response. PK and PD parameters were estimated using a Non-Parametric Adaptive Grid technique. Exposure-response relationships were explored with vancomycin area-under-the-concentration-time-curve (AUC) and EC50 (concentration of drug that causes a half maximal effect) using the index, AUC:EC50, fitted to CRP data using a sigmoidal Emax model. RESULTS Twenty-nine individuals were included. Median age was 62 (21-97) years. Fifteen (52%) patients were microbiology confirmed. PK and PD models were adequately fitted (r 0.83 and 0.82, respectively). There was a wide variation observed in individual Bayesian posterior EC50 estimates (6.95-48.55 mg/L), with mean (SD) AUC:EC50 of 31.46 (29.22). AUC:EC50 was fitted to terminal CRP with AUC:EC50 >19 associated with lower CRP value at 96-120 hours of therapy (100 mg/L versus 44 mg/L; P < 0.01). CONCLUSIONS The use of AUC:EC50 has the potential to provide in vivo organism and host response data as an adjunct for in vitro minimum inhibitory concentration data, which is currently used as the gold standard PD index for vancomycin therapy. This index can be estimated using routinely collected clinical data. Future work must investigate the role of AUC:EC50 in a prospective cohort and explore linkage with direct patient outcomes.
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Affiliation(s)
- Timothy M Rawson
- National Institute for Health Research Health Protection Research
Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial
College London, Hammersmith Campus, Du Cane Road, London. W12 0NN. United
Kingdom
| | - Esmita Charani
- National Institute for Health Research Health Protection Research
Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial
College London, Hammersmith Campus, Du Cane Road, London. W12 0NN. United
Kingdom
| | - Luke SP Moore
- National Institute for Health Research Health Protection Research
Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial
College London, Hammersmith Campus, Du Cane Road, London. W12 0NN. United
Kingdom
- Imperial College Healthcare NHS Trust, Du Cane Road, London.W12 0HS.
United Kingdom
| | - Mark Gilchrist
- Imperial College Healthcare NHS Trust, Du Cane Road, London.W12 0HS.
United Kingdom
| | - Pantelis Georgiou
- Department of Electrical and Electronic Engineering, Imperial
College London, South Kensington Campus, London, SW7 2AZ, United Kingdom
| | - William Hope
- Department of Molecular and Clinical Pharmacology, University of
Liverpool, Liverpool, L69 3GE, United Kingdom
| | - Alison H Holmes
- National Institute for Health Research Health Protection Research
Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial
College London, Hammersmith Campus, Du Cane Road, London. W12 0NN. United
Kingdom
- Imperial College Healthcare NHS Trust, Du Cane Road, London.W12 0HS.
United Kingdom
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Park SJ, Lim NR, Park HJ, Yang JW, Kim MJ, Kim K, In YW, Lee YM. Evaluation of risk factors for vancomycin-induced nephrotoxicity. Int J Clin Pharm 2018; 40:1328-1334. [PMID: 29744794 DOI: 10.1007/s11096-018-0634-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 04/04/2018] [Indexed: 11/30/2022]
Abstract
Background Vancomycin is a glycopeptide antibiotic of choice for the treatment of serious infections caused by multi-resistant Gram-positive bacteria. However, vancomycin-associated nephrotoxicity (VAN) often limits its use. Previous data suggested a few risk factors of VAN, including higher mean vancomycin trough level, higher daily doses, old age, long duration of vancomycin therapy, and concomitant nephrotoxins. Objective To evaluate the incidence and risk factors of VAN and determine whether higher vancomycin trough concentrations were associated with a greater risk for VAN. Settings A retrospective, observational, single-center study at the 1960-bed university-affiliated tertiary care hospital (Samsung Medical Center), Seoul, Korea. Method A retrospective analysis of adult patients who received vancomycin parenterally in a tertiary care medical center from March 1, 2013 to June 30, 2013 was performed. We excluded patients with a baseline serum creatinine level > 2 mg/dL and those who had a history of end-stage renal disease and dialysis at baseline. The clinical characteristics were compared between patients with nephrotoxicity and those without nephrotoxicity to identify the risk factors associated with VAN. Main outcome measure Incidence of VAN and VAN-associated risk factors were analyzed. Results Of the 315 vancomycin-treated patients, nephrotoxicity occurred in 15.2% of the patients. In multivariate analysis, higher vancomycin trough concentrations of > 20 mg∕L (OR 9.57, 95% CI 2.49-36.83, p < 0.01) and intensive care unit (ICU) residence (OR 2.86, 95% CI 1.41-5.82, p < 0.01) were independently associated with VAN. Conclusion Our findings suggest that higher vancomycin trough levels and ICU residence might be associated with a greater risk for VAN. More careful monitoring of vancomycin serum trough levels and patient status might facilitate the timely prevention of VAN.
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Affiliation(s)
- So Jin Park
- Samsung Medical Center, Gangnam-gu, Seoul, Republic of Korea
| | - Na Ri Lim
- Samsung Medical Center, Gangnam-gu, Seoul, Republic of Korea
| | - Hyo Jung Park
- Samsung Medical Center, Gangnam-gu, Seoul, Republic of Korea.
| | - Jae Wook Yang
- Samsung Medical Center, Gangnam-gu, Seoul, Republic of Korea
- Department of Pharmaceutical Sciences, Sahmyook University, Seoul, Korea
| | - Min-Ji Kim
- Samsung Medical Center, Gangnam-gu, Seoul, Republic of Korea
- Statistics and Data center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - Kyunga Kim
- Samsung Medical Center, Gangnam-gu, Seoul, Republic of Korea
- Statistics and Data center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - Yong Won In
- Samsung Medical Center, Gangnam-gu, Seoul, Republic of Korea
| | - Young Mee Lee
- Samsung Medical Center, Gangnam-gu, Seoul, Republic of Korea
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Hoover RK, Alcorn H, Lawrence L, Paulson SK, Quintas M, Cammarata SK. Delafloxacin Pharmacokinetics in Subjects With Varying Degrees of Renal Function. J Clin Pharmacol 2018; 58:514-521. [PMID: 29251785 PMCID: PMC5901045 DOI: 10.1002/jcph.1041] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 10/12/2017] [Indexed: 11/29/2022]
Abstract
Delafloxacin, a fluoroquinolone, has activity against gram-positive organisms including methicillin-resistant Staphylococcus aureus and fluoroquinolone-susceptible and -resistant gram-negative organisms. This study was conducted to determine delafloxacin pharmacokinetics after a single intravenous infusion or oral dose administration in subjects with varying degrees of renal function. The study was an open-label, parallel-group crossover study in subjects with normal renal function or with mild, moderate, or severe renal impairment. Subjects received 300 mg delafloxacin intravenously, placebo intravenously, and 400 mg delafloxacin orally in 3 periods separated by ≥14-day washouts. Blood and urine pharmacokinetic parameters were calculated using noncompartmental methods. Delafloxacin total clearance decreased with decreasing renal function, with a corresponding increase in AUC0-∞ . After intravenous administration, mean total clearance was 13.7 and 7.07 L/h, and mean AUC0-∞ was 22.6 and 45.0 μg·h/mL in normal and severe renal subjects, respectively. Mean renal clearance as determined by urinary excretion was 6.03 and 0.44 L/h in normal and severe renal impairment subjects, respectively. Total clearance exhibited linear relationships to eGFR and CLCR . Similar observations were found after oral administration of delafloxacin. Single doses of delafloxacin 300 mg intravenously and 400 mg orally were well tolerated in all groups. In conclusion, renal insufficiency has an effect on delafloxacin clearance; a dosing adjustment for intravenous dosing is warranted for patients with severe renal impairment (eGFR < 30 mL/min).
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Saisho Y, Katsube T, White S, Fukase H, Shimada J. Pharmacokinetics, Safety, and Tolerability of Cefiderocol, a Novel Siderophore Cephalosporin for Gram-Negative Bacteria, in Healthy Subjects. Antimicrob Agents Chemother 2018; 62:e02163-17. [PMID: 29311072 PMCID: PMC5826143 DOI: 10.1128/aac.02163-17] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/14/2017] [Indexed: 12/30/2022] Open
Abstract
Cefiderocol is a novel parenteral siderophore cephalosporin that shows potent efficacy against various Gram-negative bacteria, including carbapenem-resistant strains, in vitro and in preclinical models of infection. The aim of the present study was to evaluate the pharmacokinetics (PK), safety, and tolerability of cefiderocol after both single and multiple dosing by intravenous infusion over 60 min in healthy adult subjects. A single-ascending-dose study at doses of 100, 250, 500, 1,000, and 2,000 mg was conducted in 40 healthy Japanese males and females (6 individuals receiving the active drug and 2 individuals receiving a placebo per cohort). A multiple-ascending-dose study at doses of 1,000 (two groups) and 2,000 mg every 8 h (q8h) was conducted in 30 healthy Japanese and Caucasian males (8 individuals receiving the active drug and 2 individuals receiving a placebo per cohort). There were no serious or clinically significant adverse events (AEs) observed in either study. A single subject receiving 1,000 mg cefiderocol q8h was withdrawn due to AEs. Dose-proportional increases in the maximum plasma concentration (Cmax), the area under the concentration-time curve (AUC) from time zero to the time of the last quantifiable concentration after dosing, and the area under the concentration-time curve extrapolated from time zero to infinity were observed across the dose range of 100 to 2,000 mg. The mean plasma half-life of cefiderocol was 1.98 to 2.74 h. Cefiderocol was primarily excreted unchanged in the urine (61.5% to 68.4% of the dose). There was little accumulation of Cmax and AUC by dosing q8h, and the PK of cefiderocol did not change with multiple dosing. This study indicates that single and multiple intravenous doses of cefiderocol at up to 2,000 mg are well tolerated in healthy subjects and exhibit linear PK at doses up to 2,000 mg.
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Affiliation(s)
- Yutaka Saisho
- Medical Affairs Department, Shionogi & Co., Ltd., Osaka, Japan
| | - Takayuki Katsube
- Clinical Research Department, Shionogi & Co., Ltd., Osaka, Japan
| | - Scott White
- Glaxo SmithKline, Philadelphia, Pennsylvania, USA
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Yuan G, Liu H, Shaikh AS, Zhang R, Li P, Wang B, Guo R. Comparison of New Liquid Chromatography-Mass Spectrometry Method and Enzyme-Multiplied Immunoassay Technique for Routine Therapeutic Drug Monitoring of Vancomycin in Chinese Patients. Clin Lab 2018; 64:277-285. [PMID: 29739110 DOI: 10.7754/clin.lab.2017.170926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Therapeutic drug monitoring of vancomycin is very valuable due to the good correlation between trough levels and clinical outcome. Therefore, it is important to accurately determine the concentration of vancomycin in patient plasma for adequate dose-adjustment. The objective of this study was to develop a new liquid chromatography-mass spectrometry (LC-MS) method for determination of vancomycin in patient plasma and compare the results with those obtained from enzyme-multiplied immunoassay technique (EMIT). METHODS After extraction by simple protein precipitation, vancomycin and bergenin (internal standard) were separated on a C18 column (150×4.6 mm, 5 µm) at 40°C by gradient elution with 0.1% formic acid and acetonitrile as the mobile phase and measured by electrospray ionization source in positive selective ion monitoring mode. Seventy-nine plasma samples from patients with severe infection were analyzed by enzyme-multiplied immunoassay technique and LC-MS method. MedCalc 15.2 software with Bland-Altman analysis and Passing-Bablok regression analysis was used for statistical analysis. RESULTS The weighted (1/x2) calibration curve of the validated LC-MS was linear within the concentration range of 0.25 - 40 µg/mL. The inter- and intra-day precisions (%RSD) were less than 10.0%. No significant matrix effect was observed in the relevant time ranges. Comparison of the two methods indicated that results of the LC-MS were close to that of EMIT with a correlation coefficient of 0.957. Upon Bland-Altman analysis, the bias amounted to 2.9 µg/mL (95% confidence intervals of -3.4 - 9.2 µg/mL). CONCLUSIONS The established LC-MS method and EMIT were both suitable for routine TDM of vancomycin.
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73
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Chen H, Liu S, Xu XR, Diao ZH, Sun KF, Hao QW, Liu SS, Ying GG. Tissue distribution, bioaccumulation characteristics and health risk of antibiotics in cultured fish from a typical aquaculture area. J Hazard Mater 2018; 343:140-148. [PMID: 28946134 DOI: 10.1016/j.jhazmat.2017.09.017] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 08/05/2017] [Accepted: 09/10/2017] [Indexed: 06/07/2023]
Abstract
UNLABELLED The negative impacts of residual antibiotics in the environment on ecosystem and human health are big concerns. However, little information is available on the antibiotic bioaccumulation in aquaculture farms. In this study, the bioaccumulative potentials of 21 antibiotics in the plasma, bile, liver and muscle of cultured fish from a typical aquaculture area were systematically investigated. RESULTS indicated that antibiotic distribution in the cultured fish was mainly influenced by species and specific substances. The mean values of log bioaccumulation factors (Log BAFs) for the detected antibiotics were in the range of 0.43-3.70, 0.36-4.75, -0.31-4.48, and 0.23-4.33 in the fish plasma, bile, liver and muscle tissues, respectively. For grass carp, both ciprofloxacin and enrofloxacin showed high transportability from the plasma to the muscle and liver. The correlations of various antibiotic concentrations between the plasma and the other three tissues indicated that the concentrations of ciprofloxacin and enrofloxacin in the fish tissues could be predicted by their concentrations in the plasma. Based on the calculated hazard quotients, human health risk evaluation of antibiotic exposure by fish consumption indicated that the consumption of these cultured fish posed low risks to human health.
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Affiliation(s)
- Hui Chen
- Key Laboratory of Tropical Marine Bio-resources and Ecology, Guangdong Provincial Key Laboratory of Applied Marine Biology, South China Sea Institute of Oceanology, Chinese Academy of Sciences, Guangzhou 510301, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Shan Liu
- Key Laboratory of Tropical Marine Bio-resources and Ecology, Guangdong Provincial Key Laboratory of Applied Marine Biology, South China Sea Institute of Oceanology, Chinese Academy of Sciences, Guangzhou 510301, China.
| | - Xiang-Rong Xu
- Key Laboratory of Tropical Marine Bio-resources and Ecology, Guangdong Provincial Key Laboratory of Applied Marine Biology, South China Sea Institute of Oceanology, Chinese Academy of Sciences, Guangzhou 510301, China.
| | - Zeng-Hui Diao
- Key Laboratory of Tropical Marine Bio-resources and Ecology, Guangdong Provincial Key Laboratory of Applied Marine Biology, South China Sea Institute of Oceanology, Chinese Academy of Sciences, Guangzhou 510301, China
| | - Kai-Feng Sun
- Key Laboratory of Tropical Marine Bio-resources and Ecology, Guangdong Provincial Key Laboratory of Applied Marine Biology, South China Sea Institute of Oceanology, Chinese Academy of Sciences, Guangzhou 510301, China
| | - Qin-Wei Hao
- Key Laboratory of Tropical Marine Bio-resources and Ecology, Guangdong Provincial Key Laboratory of Applied Marine Biology, South China Sea Institute of Oceanology, Chinese Academy of Sciences, Guangzhou 510301, China
| | - Shuang-Shuang Liu
- State Key Laboratory of Organic Geochemistry, Guangzhou Institute of Geochemistry, Chinese Academy of Sciences, Guangzhou 510640, China
| | - Guang-Guo Ying
- State Key Laboratory of Organic Geochemistry, Guangzhou Institute of Geochemistry, Chinese Academy of Sciences, Guangzhou 510640, China
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Kawaguchi N, Katsube T, Echols R, Wajima T. Population Pharmacokinetic Analysis of Cefiderocol, a Parenteral Siderophore Cephalosporin, in Healthy Subjects, Subjects with Various Degrees of Renal Function, and Patients with Complicated Urinary Tract Infection or Acute Uncomplicated Pyelonephritis. Antimicrob Agents Chemother 2018; 62:e01391-17. [PMID: 29038272 PMCID: PMC5786804 DOI: 10.1128/aac.01391-17] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 10/05/2017] [Indexed: 12/02/2022] Open
Abstract
Cefiderocol, a novel parenteral siderophore cephalosporin, exhibits potent efficacy against most Gram-negative bacteria, including carbapenem-resistant strains. The aim of this study was to perform a population pharmacokinetic (PK) analysis based on plasma cefiderocol concentrations in healthy subjects, subjects with various degrees of renal function, and patients with complicated urinary tract infection (cUTI) or acute uncomplicated pyelonephritis (AUP) caused by Gram-negative pathogens and to calculate the fraction of the time during the dosing interval where the free drug concentration in plasma exceeds the MIC (fTMIC). Population PK models were developed with three renal function markers, body surface area-adjusted estimated glomerular filtration rate (eGFR), absolute eGFR, and creatinine clearance, on the basis of 2,571 plasma concentrations from 91 subjects without infection and 238 patients with infection. The population PK models with each renal function marker adequately described the plasma cefiderocol concentrations. Clear relationships of total clearance (CL) to all renal function markers were observed. Body weight and disease status (with or without infection) were also significant covariates. The CL in patients with infection was 26% higher than that in subjects without infection. The fTMIC values were more than 75% in all patients (and were 100% in most patients), suggesting that a sufficient exposure to cefiderocol was provided by the tested dose regimens (2 g every 8 h as the standard dose regimen) for the treatment of cUTI or AUP caused by Gram-negative pathogens.
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Affiliation(s)
- Nao Kawaguchi
- Project Management Department, Shionogi & Co., Ltd., Osaka, Japan
| | - Takayuki Katsube
- Project Management Department, Shionogi & Co., Ltd., Osaka, Japan
| | - Roger Echols
- Infectious Disease Drug Development Consulting, LLC, Easton, Connecticut, USA
| | - Toshihiro Wajima
- Project Management Department, Shionogi & Co., Ltd., Osaka, Japan
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75
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Lodise TP, Bosso J, Kelly C, Williams PJ, Lane JR, Huang DB. Pharmacokinetic and Pharmacodynamic Analyses To Determine the Optimal Fixed Dosing Regimen of Iclaprim for Treatment of Patients with Serious Infections Caused by Gram-Positive Pathogens. Antimicrob Agents Chemother 2018; 62:e01184-17. [PMID: 29133566 PMCID: PMC5786772 DOI: 10.1128/aac.01184-17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 10/27/2017] [Indexed: 11/20/2022] Open
Abstract
Iclaprim is a bacterial dihydrofolate reductase inhibitor that is currently being evaluated in two phase 3 trials for the treatment of patients with acute bacterial skin and skin structure infections (ABSSSI). Prior animal infection model studies suggest that the pharmacokinetic/pharmacodynamic (PK/PD) drivers for efficacy are area under the concentration-time curve from 0 to 24 h at steady state (AUC0-24ss), AUC/MIC, and time above the MIC during the dosing interval (T > MIC), while QTc prolongation was associated with the maximal concentration at steady state (Cmaxss) in a thorough QTc phase 1 study. Using PK data collected from 470 patients from the previously conducted phase 3 complicated skin and skin structure infection (cSSSI) trials, population PK modeling and Monte Carlo simulation (MCS) were used to identify a fixed iclaprim dosage regimen for the ongoing phase 3 ABSSSI studies that maximizes AUC0-24ss, AUC/MIC, and T > MIC while minimizing the probability of a Cmaxss of ≥800 ng/ml relative to the values for the previously employed cSSSI regimen of 0.8 mg/kg of body weight infused intravenously over 0.5 h every 12 h. The MCS analyses indicated that administration of 80 mg as a 2-h infusion every 12 h provides 28%, 28%, and 32% increases in AUC0-24ss, AUC/MIC, and T > MIC, respectively, compared to values for the 0.8-mg/kg cSSSI regimen, while decreasing the probability of a Cmaxss of ≥800 ng/ml, by 9%. Based on PK/PD analyses, 80 mg iclaprim administered over 2 h every 12 h was selected as the dosing scheme for subsequent phase 3 clinical trials.
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Affiliation(s)
- Thomas P Lodise
- Albany College of Pharmacy and Health Sciences, Albany, New York, USA
| | - John Bosso
- Medical University of South Carolina College of Pharmacy, Charleston, South Carolina, USA
| | | | | | - James R Lane
- Trials by Design, LLC, Stockton, California, USA
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Waldoch JA, Cox SK, Armstrong DL. Pharmacokinetics of a Single Intramuscular Injection of Long-Acting Ceftiofur Crystalline-Free Acid in Cattle Egrets ( Bubulcus ibis). J Avian Med Surg 2018; 31:314-318. [PMID: 29327960 DOI: 10.1647/2016-222] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We determined the pharmacokinetic properties of ceftiofur crystalline-free acid (CCFA), a long-acting antibiotic, after a single intramuscular injection in cattle egrets ( Bubulcus ibis). A dose of 20 mg/kg was administered intramuscularly to 18 birds and blood samples were collected via jugular venipuncture at 1, 2, 4, 8, 12, 24, 48, 72, 96, 120, 144, 168, 192, 216, and 240 hours after CCFA administration. Plasma concentrations of ceftiofur free acid equivalents (CFAEs) were measured via high-performance liquid chromatography. The minimum inhibitory concentration (MIC) of 1 μg/mL was reached by 1 hour after administration and remained higher than the MIC for at least 72 hours in all birds. This target concentration is effective for many bacterial infections in avian species. The area under the plasma concentration versus time curve was 451.3 h*μg/mL, maximum plasma concentration was 16.22 μg/mL, time to maximum plasma concentration was 3.2 hours, mean harmonic half-life was 37.92 hours, and time that the concentrations of CFAEs were higher than the target MIC was a minimum of 72 hours.
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77
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Kasai H, Tsuji Y, Hiraki Y, Tsuruyama M, To H, Yamamoto Y. Population pharmacokinetics of teicoplanin in hospitalized elderly patients using cystatin C as an indicator of renal function. J Infect Chemother 2017; 24:284-291. [PMID: 29292178 DOI: 10.1016/j.jiac.2017.12.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/20/2017] [Accepted: 12/04/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Serum cystatin C (CysC) has recently been proposed as an alternative marker to serum creatinine (SCR) for estimating renal clearance. In the present study, we performed a population pharmacokinetic analysis of teicoplanin (TEIC), which is mainly eliminated through the kidneys, using CysC as a predictor for renal clearance. METHODS Thirty-six patients with MRSA infections who were administrated to the National Hospital Organization Beppu Medical Center between January 2012 and December 2013 were enrolled and gave 123 sets of blood TEIC concentration data. Renal clearance was estimated by the Hoek equation using CysC, by creatinine clearance predicted by the Cockcroft-Gault equation using SCR, or directly by CysC. One compartment open model with inter-individual variabilities for renal clearance and the volume of distribution as well as an additional residual error model was used to estimate population pharmacokinetic parameters for TEIC. RESULTS The model with the best predictability was that with CysC as a predictor for renal clearance; it showed better significance than the models using estimated the glomerular filtration rate by the Hoek equation or CLcr. The final model was as follows: CL (L/hr) = 0.510 × (CysC/1.4)-0.68 × Total body weight/600.81, omega (CL) = 19.8% CV, VC (L) = 78.1, omega (V) = 42.7% CV. CONCLUSION The present results show the usefulness of CysC to more accurately predict the pharmacokinetics of drugs mainly eliminated through the kidneys, such as TEIC. However, since the sample size in this study was relatively small, further investigations on renal clearance predictability using CysC are needed.
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Affiliation(s)
- Hidefumi Kasai
- Department of Medical Pharmaceutics, Faculty of Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan; Certara G.K., 4-2-12, Minato-ku, Tokyo, 105-0001, Japan
| | - Yasuhiro Tsuji
- Department of Medical Pharmaceutics, Faculty of Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan.
| | - Yoichi Hiraki
- Department of Pharmacy, National Hospital Organization Beppu Medical Center, 1473 Uchikamado, Beppu, Oita, 874-0011, Japan
| | - Moeko Tsuruyama
- Department of Pharmacy, National Hospital Organization Beppu Medical Center, 1473 Uchikamado, Beppu, Oita, 874-0011, Japan
| | - Hideto To
- Department of Medical Pharmaceutics, Faculty of Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
| | - Yoshihiro Yamamoto
- Department of Clinical Infectious Diseases, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
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Wang H, Li X, Sun S, Mao G, Xiao P, Fu C, Liang Z, Zheng M, Huang Y, Tang H, Ou R, Yang N, Ling X, Zhao Z. Population Pharmacokinetics and Dosing Simulations of Ceftazidime in Chinese Neonates. J Pharm Sci 2017; 107:1416-1422. [PMID: 29274818 DOI: 10.1016/j.xphs.2017.12.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 12/05/2017] [Accepted: 12/14/2017] [Indexed: 11/17/2022]
Abstract
An accurate dosage determination is required in neonates when antibiotics are used. The adult data cannot be simply extrapolated to the pediatric population due to significant individual differences. We aimed to identify factors impacting ceftazidime exposure in neonates and to provide drug dosing guidance to clinicians. Forty-three neonates aged less than 60 days with proven or suspected infections were enrolled in this study. After intravenous administration, blood samples were collected, and plasma ceftazidime concentration was determined using a HPLC method. Pharmacokinetic data were fitted using a nonlinear mixed-effects model approach. One-compartmental model could nicely characterize the ceftazidime in vivo behavior. The covariate test found that the postmenstrual age (day) was strongly associated with systemic drug clearance (L/h), and the effect of body weight (kg) was identified as the covariate on distribution volume (L). Compared with the base model, the addition of covariates improved the goodness-of-fit of the final model. Model validation (bootstrap, visual predictive check, and prediction-corrected visual predictive check) suggested a robust and reliable pharmacokinetic model was developed. Personalized dosage regimens were provided based on model simulations. The intravenous dose should be adjusted according to postmenstrual age, body weight, and minimum inhibitory concentration.
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Affiliation(s)
- Honghong Wang
- Department of Pharmacy, Liuzhou Maternity and Child Care Hospital, Guangxi, China
| | - Xingang Li
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Precision Medicine Research Center for Neurological Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shusen Sun
- College of Pharmacy and Health Sciences, Western New England University, Springfield, Massachusetts 01119
| | - Guifu Mao
- Department of Pharmacy, Liuzhou Traditional Chinese Medical Hospital, Guangxi, China
| | - Ping Xiao
- Department of Pharmacy, Liuzhou Maternity and Child Care Hospital, Guangxi, China
| | - Chan Fu
- Department of Neonatology, Liuzhou Maternity and Child Care Hospital, Guangxi, China
| | - Zhuoxin Liang
- Department of Critical Care Medicine, Liuzhou Maternity and Child Care Hospital, Guangxi, China
| | - Min Zheng
- Department of Pediatric, Liuzhou Maternity and Child Care Hospital, Guangxi, China
| | - Yuling Huang
- Department of Pharmacy, Liuzhou Maternity and Child Care Hospital, Guangxi, China
| | - Haihong Tang
- Department of Neonatology, Liuzhou Maternity and Child Care Hospital, Guangxi, China
| | - Renhao Ou
- Department of Pharmacy, Liuzhou Maternity and Child Care Hospital, Guangxi, China
| | - Ni Yang
- Department of Pharmacy, Liuzhou Maternity and Child Care Hospital, Guangxi, China
| | - Xi Ling
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhigang Zhao
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Precision Medicine Research Center for Neurological Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Tannert A, Ramoji A, Neugebauer U, Popp J. Photonic monitoring of treatment during infection and sepsis: development of new detection strategies and potential clinical applications. Anal Bioanal Chem 2017; 410:773-790. [PMID: 29214536 DOI: 10.1007/s00216-017-0713-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 10/06/2017] [Accepted: 10/17/2017] [Indexed: 01/02/2023]
Abstract
Despite the strong decline in the infection-associated mortality since the development of the first antibiotics, infectious diseases are still a major cause of death in the world. With the rising number of antibiotic-resistant pathogens, the incidence of deaths caused by infections may increase strongly in the future. Survival rates in sepsis, which occurs when body response to infections becomes uncontrolled, are still very poor if an adequate therapy is not initiated immediately. Therefore, approaches to monitor the treatment efficacy are crucially needed to adapt therapeutic strategies according to the patient's response. An increasing number of photonic technologies are being considered for diagnostic purpose and monitoring of therapeutic response; however many of these strategies have not been introduced into clinical routine, yet. Here, we review photonic strategies to monitor response to treatment in patients with infectious disease, sepsis, and septic shock. We also include some selected approaches for the development of new drugs in animal models as well as new monitoring strategies which might be applicable to evaluate treatment response in humans in the future. Figure Label-free probing of blood properties using photonics.
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Affiliation(s)
- Astrid Tannert
- Leibniz Institute of Photonic Technology, Albert-Einstein-Str. 9, 07745, Jena, Germany
- Jena Biophotonics and Imaging Laboratory, 07745, Jena, Germany
| | - Anuradha Ramoji
- Leibniz Institute of Photonic Technology, Albert-Einstein-Str. 9, 07745, Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Ute Neugebauer
- Leibniz Institute of Photonic Technology, Albert-Einstein-Str. 9, 07745, Jena, Germany.
- Jena Biophotonics and Imaging Laboratory, 07745, Jena, Germany.
- Center for Sepsis Control and Care, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
- Institute of Physical Chemistry, Friedrich Schiller University Jena, Helmholtzweg 4, 07743, Jena, Germany.
- InfectoGnostics Research Campus Jena, Philosophenweg 7, Jena, Germany.
| | - Jürgen Popp
- Leibniz Institute of Photonic Technology, Albert-Einstein-Str. 9, 07745, Jena, Germany
- Jena Biophotonics and Imaging Laboratory, 07745, Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
- Institute of Physical Chemistry, Friedrich Schiller University Jena, Helmholtzweg 4, 07743, Jena, Germany
- InfectoGnostics Research Campus Jena, Philosophenweg 7, Jena, Germany
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Liu S, Zhao G, Zhao H, Zhai G, Chen J, Zhao H. Antibiotics in a general population: Relations with gender, body mass index (BMI) and age and their human health risks. Sci Total Environ 2017; 599-600:298-304. [PMID: 28477487 DOI: 10.1016/j.scitotenv.2017.04.216] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 04/26/2017] [Accepted: 04/27/2017] [Indexed: 06/07/2023]
Abstract
Recently, increasing regulatory and public attention has been paid to the exposure risks of antibiotics due to their occurrence and antibiotic resistance worldwide. However, limited information on antibiotic levels in general populations is available. Forty antibiotics, including 9 sulfonamides, 5 fluoroquinolones, 4 macrolides, 4 tetracyclines, 3 chloramphenicols, 12 β-lactams and 3 others, were analyzed in 107 serum samples of normal adults collected from a hospital in Dalian, North China, between 2015 and 2016 using solid-phase extraction (SPE) coupled with HPLC-MS/MS. The results clearly showed that antibiotics were present in the serum of these adults. Specifically, 28 antibiotics were detected in the samples, with detection frequencies ranging from 0.9% to 17.8%. The total antibiotic concentrations in 26.2% of the serum samples were between the LOD and 20.0ng/mL. Importantly, the maximum concentrations of 5 antibiotics (trimethoprim, ciprofloxacin, cefaclor, lincomycin and erythromycin) were above 1000ng/mL in 3.7% of the samples. Furthermore, the detection frequencies of 5 veterinary antibiotics, 7 human antibiotics and 16 human/veterinary antibiotics in the serum samples were 23.4%, 17.8% and 29.0%, respectively. Significant differences of the veterinary antibiotics between female and male adults and of the sulfonamides between different BMI (body mass index) groups were observed (p<0.05). The concentrations of sulfonamides in elderly individuals were significantly higher (p<0.05) than those in young people. Finally, our results showed that almost all of the adults had no health risks related to exposure to antibiotics at such levels despite the high effect ratio (ER=1.74) for azithromycin in one sample. This study is the first to report the current status of antibiotics in human blood, which can help in better understanding the long-term effects of antibiotics on general populations and in identifying susceptible populations that are at high risk to antibiotic exposure.
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Affiliation(s)
- Sisi Liu
- Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education), School of Environmental Science and Technology, Dalian University of Technology, Linggong Road 2, Dalian 116023, China
| | - Guodong Zhao
- Gland surgery, The Second Affiliated Hospital of Dalian Medical University, Zhongshan Road 467, Dalian 116020, China
| | - Hongxia Zhao
- Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education), School of Environmental Science and Technology, Dalian University of Technology, Linggong Road 2, Dalian 116023, China.
| | - Guangshu Zhai
- 3M Environment, Health, Safety and Sustainability, 3M Center, Building 026-05-N-17, St. Paul, MN 55144-1000, USA
| | - Jingwen Chen
- Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education), School of Environmental Science and Technology, Dalian University of Technology, Linggong Road 2, Dalian 116023, China
| | - Haidong Zhao
- Gland surgery, The Second Affiliated Hospital of Dalian Medical University, Zhongshan Road 467, Dalian 116020, China.
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81
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Zareba-Szczudlik J, Romejko-Wolniewicz E, Lewandowski Z, Rozanska H, Malinowska-Polubiec A, Dobrowolska-Redo A, Wilczynski J, Czajkowski K. Evaluation of the amoxicillin concentrations in amniotic fluid, placenta, umbilical cord blood and maternal serum two hours after oral administration. Neuro Endocrinol Lett 2017; 38:502-508. [PMID: 29369602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/21/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Amoxicillin is a broad-spectrum beta-lactam antibiotic. Due to its low toxicity, it is commonly used in obstetrics. The objective of this study was to assess amoxicillin concentrations in amniotic fluid, umbilical blood, placenta and maternal serum two hours following oral administration among pregnant women at term and to assess obstetric and non-obstetric factors that might affect amoxicillin's penetration of these tissues. MATERIALS AND METHODS A total of 30 full-term pregnant women who qualified for elective Caesarean delivery were included in the study. Amoxicillin at a dose of 500 mg was administered prior to surgery. Amoxicillin levels were determined by diffusion microbial assay. RESULTS The maternal serum, placental, umbilical blood and amniotic fluid levels of amoxicillin two hours after oral administration were 2.18±1.30 µg/g, 1.00±0.71 µg/g, 1.00±0.73 µg/g, and 0.67±0.59 µg/g, respectively (Table 2). Maternal serum levels of amoxicillin were significantly higher compared to other tissues (p<0.05). CONCLUSION If the target tissues for the use of antibiotic drugs in pregnant patients are the fetus and/or the placenta, the drug should be administered in a higher-than-standard dose than that used to treat infections in non-pregnant patients. Considering that there is a maximum absorbable dose following oral administration, intravenous administration should be considered to prevent failure of antibiotic treatment. A higher dose of amoxicillin should be considered in obese mothers.
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Affiliation(s)
| | | | | | - Hanna Rozanska
- National Veterinary Research Institute in Pulawy, Poland
| | | | | | - Jan Wilczynski
- 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw , Poland
| | - Krzysztof Czajkowski
- 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw , Poland
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Salerno SN, Edginton A, Cohen‐Wolkowiez M, Hornik CP, Watt KM, Jamieson BD, Gonzalez D. Development of an Adult Physiologically Based Pharmacokinetic Model of Solithromycin in Plasma and Epithelial Lining Fluid. CPT Pharmacometrics Syst Pharmacol 2017; 6:814-822. [PMID: 29068158 PMCID: PMC5744174 DOI: 10.1002/psp4.12252] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 08/16/2017] [Accepted: 09/04/2017] [Indexed: 12/27/2022]
Abstract
Solithromycin is a fluoroketolide antibiotic under investigation for community-acquired bacterial pneumonia (CABP). We developed a whole-body physiologically based pharmacokinetic (PBPK) model for solithromycin in adults using PK-Sim and MoBi version 6.2, which incorporated time-dependent CYP3A4 auto-inhibition. The model was developed and evaluated using plasma and epithelial lining fluid (ELF) concentration data from 100 healthy subjects and 22 patients with CABP (1,966 plasma, 30 ELF samples). We performed population simulations and calculated the number of observations falling outside the 90% prediction interval. For the oral regimen (800 mg on day 1 and 400 mg daily on days 2-5) that was evaluated in phase III studies, 11% and 23% of observations from healthy adults fell outside the 90% prediction interval for plasma and ELF, respectively. This regimen should be effective because ≥97% of simulated adults achieved area under the concentration vs. time curve (AUC) to minimum inhibitory concentration ratios associated with a log10 colony forming unit reduction in ELF.
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Affiliation(s)
- Sara N. Salerno
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of PharmacyThe University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Andrea Edginton
- School of PharmacyUniversity of WaterlooKitchenerOntarioCanada
| | - Michael Cohen‐Wolkowiez
- Department of PediatricsDuke University Medical CenterDurhamNorth CarolinaUSA
- Duke Clinical Research Institute, Duke University Medical CenterDurhamNorth CarolinaUSA
| | - Christoph P. Hornik
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of PharmacyThe University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Department of PediatricsDuke University Medical CenterDurhamNorth CarolinaUSA
- Duke Clinical Research Institute, Duke University Medical CenterDurhamNorth CarolinaUSA
| | - Kevin M. Watt
- Department of PediatricsDuke University Medical CenterDurhamNorth CarolinaUSA
- Duke Clinical Research Institute, Duke University Medical CenterDurhamNorth CarolinaUSA
| | | | - Daniel Gonzalez
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of PharmacyThe University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
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83
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Sanders KL, Bas E, Cox SK, Rothen DE. Pharmacokinetics of Single-bolus Subcutaneous Cefovecin in C57BL/6 Mice. J Am Assoc Lab Anim Sci 2017; 56:558-561. [PMID: 28903828 PMCID: PMC5605181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 03/22/2017] [Accepted: 06/08/2017] [Indexed: 06/07/2023]
Abstract
Because of its extended half-life, cefovecin is a broad-spectrum cephalosporin antibiotic commonly used to treat dermatitis in dogs and cats. A single injection in dogs can yield an effective plasma concentration for as long as 14 d, depending on the strain of Staphylococcus and for as long as 7 d in cats for the treatment of Pasteurella multocida. In the laboratory animal setting, C57BL/6 mice are commonly affected with dermatologic conditions that make these animals unsuitable for experiments. Therefore, we performed this pharmacokinetic study to determine whether cefovecin would be of benefit in mice. Plasma levels of the drug were determined by HPLC. For this study, single-bolus subcutaneous dosages of 8 and 40 mg/kg were assessed. The results showed that the dosage of 40 mg/kg achieved a maximal plasma concentration of 411.54 μg/mL with a half-life of 0.84 h, whereas 8 mg/kg yielded 78.18 μg/mL and 1.07 h respectively. The pharmacokinetic results suggest that cefovecin is not suitable as a long-acting antibiotic after a single subcutaneous bolus injection in mice for the treatment of dermatitis or any other bacteria sensitive to this medication.
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Affiliation(s)
| | - Esperanza Bas
- The Ear Institute, University of Miami, Miami, Florida
| | - Sherry K Cox
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Tennessee
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84
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Bashir L, Shoaib MH, Naz S, Yousuf RI, Jabeen S, Israr F, Siddiqui F. Development and validation of HPLC method for the determination of Cefpodoxime Proxetil in human plasma. Pak J Pharm Sci 2017; 30:1603-1607. [PMID: 29084679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A new, simple, accurate, precise and specific method has been developed for the analysis of Cefpodoxime Proxetil in human plasma. The proposed method was developed and validated with the aim to be used in Bioavailability/Bioequivalence studies for quantification of drug in human plasma. The mobile phase components were acetonitrile, methanol, and water in the ratio of 20:50:30. Ortho phosphoric acid was used to adjust at pH5.0. Flow rate and wavelength were kept 1ml/min and 247nm respectively. The column was C-18 HPLC column 5um particle size, L x 1.d. 25cm x4.6mm. (Supelcosil). Retention time of Cefpodoxime Proxetil was found to be 10.967min. The developed method was validated for selectivity, recovery, accuracy, precision, repeatability, reproducibility, stability and linearity in the range of 0.195mcg/ml to 50mcg/ml. The accuracy and Precision of the proposed method were well within the predefined limits i.e. ±15% for all the calibration standards other than LLOQ (Lower Limit of Quantification) where it was well within ±20% of the nominal value. The analytical recovery was always above 89% showing satisfactory recovery. The coefficient of correlation (R2 ) was 0.999. The developed method was found suitable for the estimation of Cefpodoxime Proxetil in plasma.
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Affiliation(s)
- Lubna Bashir
- Department of Pharmaceutics, Faculty of Pharmacy, University of Karachi, Karachi, Pakistan
| | - Muhammad Harris Shoaib
- Department of Pharmaceutics, Faculty of Pharmacy, University of Karachi, Karachi, Pakistan
| | - Shazia Naz
- Department of Pharmaceutics, Faculty of Pharmacy, University of Karachi, Karachi, Pakistan
| | - Rabia Ismail Yousuf
- Department of Pharmaceutics, Faculty of Pharmacy, University of Karachi, Karachi, Pakistan
| | - Sabahat Jabeen
- Department of Pharmaceutics, Faculty of Pharmacy, University of Karachi, Karachi, Pakistan
| | - Fozia Israr
- Department of Pharmaceutics, Faculty of Pharmacy, University of Karachi, Karachi, Pakistan
| | - Fahad Siddiqui
- Department of Pharmaceutics, Faculty of Pharmacy, University of Karachi, Karachi, Pakistan
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85
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Naz S, Shoaib MH, Bashir L, Yousuf RI, Anjum F, Siddiqui F, Yaseen S. HPLC method development and validation for the determination of Cefaclor in human plasma. Pak J Pharm Sci 2017; 30:1645-1649. [PMID: 29084685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Cefaclor was analyzed in the human plasma by developing a simple, precise and accurate assay method which was then validated for its accuracy, specificity and precision. The mobile phase comprised of a mixture of sodium 1-pentanesulfonate, water, triethylamine and methanol. Phosphoric acid was used to adjust the pH to 2.5±0.1. The flow rate was maintained at 1.5ml/min and the wavelength was set at 265 nm. A C-18 HPLC, column 5um particle size, L x 1.D. 25cm x 4.6mm (Supelcosil) was utilized for chromatographic separation. The retention time of Cefaclor was found to be 17min. This method was validated for selectivity, accuracy, precision, repeatability, reproducibility, recovery, linearity, and stability. Calibration curves were found linear were in the range of 0.39µg/ml to50µg/mland the coefficient of correlation (R2) was found to be 0.999. Hence, this method has been found useful for the determination of Cefaclor in plasma.
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Affiliation(s)
- Shazia Naz
- Department of Pharmaceutics, Faculty of Pharmacy, Federal Urdu University of Arts, Science and Technology, Karachi, Pakistan
| | - Muhammad Harris Shoaib
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, Pakistan
| | - Lubna Bashir
- Department of Pharmaceutics, Faculty of Pharmacy, Federal Urdu University of Arts, Science and Technology, Karachi, Pakistan
| | - Rabia Ismail Yousuf
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, Pakistan
| | - Fakhsheena Anjum
- Dow College of Pharmacy, Dow University of Health Sciences, Karachi, Pakistan
| | - Fahad Siddiqui
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, Pakistan
| | - Saima Yaseen
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Federal Urdu University of Arts, Science and Technology, Karachi, Pakistan
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Matsumoto S, Singley CM, Hoover J, Nakamura R, Echols R, Rittenhouse S, Tsuji M, Yamano Y. Efficacy of Cefiderocol against Carbapenem-Resistant Gram-Negative Bacilli in Immunocompetent-Rat Respiratory Tract Infection Models Recreating Human Plasma Pharmacokinetics. Antimicrob Agents Chemother 2017; 61:e00700-17. [PMID: 28630178 PMCID: PMC5571323 DOI: 10.1128/aac.00700-17] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 06/07/2017] [Indexed: 11/20/2022] Open
Abstract
Cefiderocol (S-649266), a novel siderophore cephalosporin, shows potent activity against carbapenem-resistant Gram-negative bacilli. In this study, we evaluated the efficacy of cefiderocol against carbapenem-resistant Gram-negative bacilli (Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae) in immunocompetent-rat respiratory tract infection models recreating plasma pharmacokinetics (PK) profiles in healthy human subjects. A total of 6 clinical isolates (1 cephalosporin-susceptible P. aeruginosa isolate, 1 multidrug-resistant P. aeruginosa isolate, 2 multidrug-resistant A. baumannii isolates, and 2 carbapenem-resistant K. pneumoniae isolates) were evaluated. Four-day treatment with a human exposure of 1 g ceftazidime every 8 h as a 0.5-h infusion showed potent efficacy only against a ceftazidime-susceptible isolate, not against five ceftazidime-resistant isolates harboring carbapenemase. With cefiderocol, a human exposure of 2 g every 8 h as a 3-h infusion for 4 days produced a >3 log10 reduction in the number of viable cells of these carbapenem-resistant isolates in the lungs. When the infusion time was 1 h, bactericidal activity was also observed against all isolates tested, although for 2 of 5 carbapenem-resistant isolates, a 3 log10 reduction was not achieved. The difference in efficacy achieved by changing the infusion period from 1 h to 3 h was considered to be due to the higher percentage of the dosing interval during which free-drug concentrations were above the MIC (%fTMIC), as observed for β-lactam antibiotics. These results suggest the potential utility of cefiderocol for the treatment of lung infections caused by carbapenem-resistant P. aeruginosa, A. baumannii, and K. pneumoniae strains.
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Affiliation(s)
- Shuhei Matsumoto
- Drug Discovery & Disease Research Laboratory, Shionogi & Co., Ltd., Toyonaka, Osaka, Japan
| | - Christine M Singley
- Antibacterial Discovery Performance Unit, GlaxoSmithKline Pharmaceuticals, Upper Providence, Pennsylvania, USA
| | - Jennifer Hoover
- Antibacterial Discovery Performance Unit, GlaxoSmithKline Pharmaceuticals, Upper Providence, Pennsylvania, USA
| | - Rio Nakamura
- Drug Discovery & Disease Research Laboratory, Shionogi & Co., Ltd., Toyonaka, Osaka, Japan
| | - Roger Echols
- Infectious Disease Drug Development Consulting, LLC, Easton, Connecticut, USA
| | - Stephen Rittenhouse
- Antibacterial Discovery Performance Unit, GlaxoSmithKline Pharmaceuticals, Upper Providence, Pennsylvania, USA
| | - Masakatsu Tsuji
- Drug Discovery & Disease Research Laboratory, Shionogi & Co., Ltd., Toyonaka, Osaka, Japan
| | - Yoshinori Yamano
- Drug Discovery & Disease Research Laboratory, Shionogi & Co., Ltd., Toyonaka, Osaka, Japan
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Abstract
Vancomycin is a glycopeptide antibiotic that is active against Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus. Nephrotoxicity, which is usually reversible, is the most serious common adverse effect of vancomycin. Vancomycin-associated nephrotoxicity prolongs hospital stays, imposes a need for additional antibiotics and, in rare circumstances, dialysis treatment, and increases medical costs and mortality. Risk factors for nephrotoxicity include the dose and duration of vancomycin treatment, serum trough concentration, patient characteristics, and concomitant receipt of nephrotoxins. Contemporary guidelines recommend targeting vancomycin trough concentrations of ≥10 mg/L to prevent resistance and trough concentrations of 15-20 mg/L to optimize outcomes. There is significant correlation between vancomycin trough serum concentrations and the incidence of vancomycin-associated nephrotoxicity; however, evidence of an association between trough concentrations and efficacy is less convincing. Routine monitoring of serum vancomycin concentrations consumes time and limited healthcare resources and may not be cost effective. The use of alternative antibacterial agents that do not require monitoring would free up pharmacy resources. This time could then be devoted to initiatives such as pharmacist-led antibiotic stewardship programs that are known to reduce antibiotic use and promote improved patient outcomes.
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Affiliation(s)
- Meghan N Jeffres
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, 12850 E. Montview Blvd. V20-1212, Aurora, CO, 80045, USA.
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Van Toi P, Pouplin T, Tho NDK, Phuong PN, Chau TTH, Thuong Thuong NT, Heemskerk D, Hien TT, Thwaites GE. High-performance liquid chromatography with time-programmed fluorescence detection for the quantification of Levofloxacin in human plasma and cerebrospinal fluid in adults with tuberculous meningitis. J Chromatogr B Analyt Technol Biomed Life Sci 2017; 1061-1062:256-262. [PMID: 28756357 DOI: 10.1016/j.jchromb.2017.07.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 07/17/2017] [Accepted: 07/18/2017] [Indexed: 11/19/2022]
Abstract
An accurate and reliable high-performance liquid chromatography with time-programmed fluorescence detection was developed and validated to measure levofloxacin in human plasma and cerebrospinal fluid (CSF). After solid phase extraction process using Evolute® ABN 96 fixed well plate; levofloxacin and internal standard-enoxacin were separated using a mobile phase consisting of phosphate buffer 10mM with 0.025% triethylamine pH 3.0 - acetonitrile (88:12, v/v) on a Purosphere RP-8e column (5μm, 125×4.0mm) at a flow rate of 1.2mL/min at 35°C. The excitation/emission wavelengths were set to 269/400nm and 294/500nm, for enoxacin and levofloxacin, respectively. The method was linear over the concentration range of 0.02 to 20.0μg/mL with a limit of detection of 0.01μg/mL. The relative standard deviation of intra-assay and inter-assay precision for levofloxacin at four quality controls concentrations (0.02, 0.06, 3.0 and 15.0μg/mL) were less than 7% and the accuracies ranged from 96.75% to 101.9% in plasma, and from 93.00% to 98.67% in CSF. The validated method was successfully applied to quantify levofloxacin in a considerable quantity of plasma (826) and CSF (477) samples collected from 232 tuberculous meningitis patients, and the preliminary intensive pharmacokinetics analysis from 14 tuberculous meningitis patients in Vietnam is described in this paper.
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Affiliation(s)
- Pham Van Toi
- Oxford University Clinical Research Unit, Wellcome Trust Major Oversea Programme, Ho Chi Minh City- In Partnership with Hospital for Tropical Diseases Ho Chi Minh City, Viet Nam.
| | - Thomas Pouplin
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | - Nguyen Duc Khanh Tho
- Oxford University Clinical Research Unit, Wellcome Trust Major Oversea Programme, Ho Chi Minh City- In Partnership with Hospital for Tropical Diseases Ho Chi Minh City, Viet Nam.
| | - Pham Nguyen Phuong
- Oxford University Clinical Research Unit, Wellcome Trust Major Oversea Programme, Ho Chi Minh City- In Partnership with Hospital for Tropical Diseases Ho Chi Minh City, Viet Nam.
| | | | - Nguyen Thuy Thuong Thuong
- Oxford University Clinical Research Unit, Wellcome Trust Major Oversea Programme, Ho Chi Minh City- In Partnership with Hospital for Tropical Diseases Ho Chi Minh City, Viet Nam.
| | - Dorothee Heemskerk
- Oxford University Clinical Research Unit, Wellcome Trust Major Oversea Programme, Ho Chi Minh City- In Partnership with Hospital for Tropical Diseases Ho Chi Minh City, Viet Nam.
| | - Tran Tinh Hien
- Oxford University Clinical Research Unit, Wellcome Trust Major Oversea Programme, Ho Chi Minh City- In Partnership with Hospital for Tropical Diseases Ho Chi Minh City, Viet Nam; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom.
| | - Guy E Thwaites
- Oxford University Clinical Research Unit, Wellcome Trust Major Oversea Programme, Ho Chi Minh City- In Partnership with Hospital for Tropical Diseases Ho Chi Minh City, Viet Nam; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom.
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Shah K, Hassan E, Ahmed F, Anis I, Rabnawaz M, Shah MR. Novel fluorene-based supramolecular sensor for selective detection of amoxicillin in water and blood. Ecotoxicol Environ Saf 2017; 141:25-29. [PMID: 28288309 DOI: 10.1016/j.ecoenv.2017.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 02/28/2017] [Accepted: 03/06/2017] [Indexed: 06/06/2023]
Abstract
Synthesis, characterization and molecular recognition properties of fluorene based supramolecular cleft 1 is reported. The cleft molecule 1 was prepared in a single-step with good yield (85% yield), by linking Fluorene with 1-ethyl piperazine. The cleft molecule 1 was carefully characterized using various spectroscopic techniques such as NMR and mass spectrometry. The supramolecular interaction of cleft 1 with amoxicillin, 6APA, aspirin, captopril, cefotaxime, ceftriaxone, cefuroxime, diclofenac, penicillin, and cephradine was evaluated by fluorescent spectroscopy. The molecular recognition studies showed that amoxicillin selectively binds with cleft 1 in the presence of other drugs. The analytical method developed for the supramolecular interaction of molecular cleft 1 and amoxicillin was validated at varying pH, concentration and temperature during recognition process. Job's plots indicated that the stochiometry of the interactions between the cleft 1 and the amoxicillin was 1:1.
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Affiliation(s)
- Kiramat Shah
- International Center for Chemical and Biological Sciences, H.E.J. Research Institute of Chemistry, University of Karachi, Karachi 75270, Pakistan.
| | - Erum Hassan
- Department of Chemistry, University of Karachi, Karachi 75270, Pakistan
| | - Farid Ahmed
- International Center for Chemical and Biological Sciences, H.E.J. Research Institute of Chemistry, University of Karachi, Karachi 75270, Pakistan
| | - Itrat Anis
- Department of Chemistry, University of Karachi, Karachi 75270, Pakistan
| | - Muhammad Rabnawaz
- School of Packaging, Michigan State University, 448 Wilson Road, East Lansing, MI 48824-1223, United States of America (USA)
| | - Muhammad Raza Shah
- International Center for Chemical and Biological Sciences, H.E.J. Research Institute of Chemistry, University of Karachi, Karachi 75270, Pakistan.
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Gonzalez D, Bradley JS, Blumer J, Yogev R, Watt KM, James LP, Palazzi DL, Bhatt-Mehta V, Sullivan JE, Zhang L, Murphy J, Ussery XT, Puttagunta S, Dunne MW, Cohen-Wolkowiez M. Dalbavancin Pharmacokinetics and Safety in Children 3 Months to 11 Years of Age. Pediatr Infect Dis J 2017; 36:645-653. [PMID: 28060045 PMCID: PMC5468484 DOI: 10.1097/inf.0000000000001538] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Dalbavancin is a novel lipoglycopeptide antibiotic that has potent in vitro activity against Gram-positive microorganisms. METHODS We performed a phase 1, open-label, multicenter study to investigate the pharmacokinetics (PK) and safety of a single dose of intravenous dalbavancin in hospitalized pediatric subjects 3 months to 11 years of age. We combined these data with previously collected adolescent PK data and performed a population PK analysis. RESULTS Model development was performed using 311 dalbavancin plasma concentrations from 43 subjects. The median age was 5.9 years (range: 0.3-16.9). A 3-compartment, linear PK model was developed. Based on simulations, the following age-dependent dosing regimen was found to achieve similar dalbavancin exposure to that in adults administered a 2-dose regimen: children 6 to <18 years of age, 12 mg/kg (1000 mg maximum) on day 1 and 6 mg/kg (500 mg maximum) on day 8 and children 3 months to <6 years of age, 15 mg/kg (1000 mg maximum) on day 1 and 7.5 mg/kg (500 mg maximum) on day 8. Similarly, the following age-dependent regimen was found to match adult exposure after a single-dose (1500 mg): 6 to <18 years of age, 18 mg/kg (1500 mg maximum) on day 1 and 3 months to <6 years of age, 22.5 mg/kg (1500 mg maximum) on day 1. Nineteen subjects experienced 36 treatment-emergent adverse events. Five of 36 adverse events were assessed as possibly or probably related to treatment. CONCLUSIONS Dalbavancin pediatric dosing that matched adult exposure was identified. Overall, dalbavancin was well tolerated in our study population.
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Affiliation(s)
- Daniel Gonzalez
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - John S. Bradley
- University of California San Diego School of Medicine and Rady Children’s Hospital, San Diego, CA
| | | | - Ram Yogev
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Kevin M. Watt
- Department of Pediatrics, Duke University Medical Center, Durham, NC
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Laura P. James
- Arkansas Children’s Hospital Research Institute and University of Arkansas for Medical Sciences, Little Rock, AR
| | - Debra L. Palazzi
- Infectious Diseases Section, Baylor College of Medicine, Houston, TX
| | - Varsha Bhatt-Mehta
- College of Pharmacy and Department of Pediatrics, University of Michigan, Ann Arbor, MI
| | - Janice E. Sullivan
- Kosair Charities Pediatric Clinical Research Unit, Department of Pediatrics, University of Louisville, and Kosair Children’s Hospital, Louisville, KY
| | - Li Zhang
- Institute for Clinical Pharmacodynamics, Latham, NY
| | - Jennifer Murphy
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Xilla T. Ussery
- Durata Therapeutics, a subsidiary of Actavis plc, Branford, Connecticut
| | | | - Michael W. Dunne
- Durata Therapeutics, a subsidiary of Actavis plc, Branford, Connecticut
| | - Michael Cohen-Wolkowiez
- Department of Pediatrics, Duke University Medical Center, Durham, NC
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
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91
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Diene SM, Abat C, Rolain JM, Raoult D. How artificial is the antibiotic resistance definition? Lancet Infect Dis 2017; 17:690. [PMID: 28653629 DOI: 10.1016/s1473-3099(17)30338-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 05/16/2017] [Accepted: 05/16/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Seydina M Diene
- URMITE (Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes), Aix Marseille Université, UM63, CNRS 7278, IRD 198, INSERM 1095, IHU-Méditerranée Infection, Marseille Cedex 05, France
| | - Cédric Abat
- URMITE (Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes), Aix Marseille Université, UM63, CNRS 7278, IRD 198, INSERM 1095, IHU-Méditerranée Infection, Marseille Cedex 05, France
| | - Jean-Marc Rolain
- URMITE (Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes), Aix Marseille Université, UM63, CNRS 7278, IRD 198, INSERM 1095, IHU-Méditerranée Infection, Marseille Cedex 05, France
| | - Didier Raoult
- URMITE (Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes), Aix Marseille Université, UM63, CNRS 7278, IRD 198, INSERM 1095, IHU-Méditerranée Infection, Marseille Cedex 05, France.
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92
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Pondel J, Krajewski P, Królikowska N, Tobiasz A, Augustyniak-Bartosik H, Hurkacz M. [Measurements of vancomycin concentrations in the blood - a method of personalization the antibiotic therapy in patients with chronic kidney disease]. Pol Merkur Lekarski 2017; 42:145-150. [PMID: 28530212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
UNLABELLED Therapeutic Drug Monitoring is a recognized method of personalizing treatment, having particular application in patients with chronic kidney disease who have frequent infections, requiring administration of vancomycin. International guidelines indicate the need to adjust the dose of the drug to the state of renal function. The recommended therapeutic ranges of minimum and maximum levels should be achieved in order to increase the effectiveness and safety of treatment. AIM The aim of this study was to evaluate the usefulness of measuring the concentration of vancomycin in patients with chronic kidney disease due to bacterial infection. MATERIALS AND METHODS The study included 96 adult patients with chronic kidney disease of varying severity treated with vancomycin Patients were divided into 3 groups: treated by haemodialysis (hd), after renal transplantations (ktx), do not require renal replacement therapy (nef). In subjects were examined the minimum and maximum concentrations of vancomycin in steady-state and were compared with recommended therapeutic ranges. RESULTS Statistically significant decrease of inflammatory markers was observed only in patients treated with dialysis. In the other groups not significant changes in values of inflammatory parameters were confirmed. Trough concentrations of vancomycin marked in patients were consistent with the recommendation of EUCAST, but exceeded the value recommended by the manufacturers of the drug. Considering absolute values of the minimum concentrations, only about 50% of patients achieved the therapeutic range (58% for recommendation EUCAST and 36% for the manufacturer's instructions). Peak concentration values indicated in dialyzed patients were below the prescribed range of 20-50 mg/l and averaged 17.7 mg / l. In the other subgroups they were correct. The rating of the absolute values of the peak concentrations of vancomycin also showed that only 46% (64% in the ktx, 30% - hd and 53% - nef) was within the recommended range, while 50% were classified as concentrations of sub-therapeutic (36% in the ktx, 42% of the nef group and 65% in hd). CONCLUSIONS Vancomycin concentrations measured in patients with chronic kidney disease, both minimum and maximum, were not fully comply with the recommended therapeutic ranges, despite the use of doses determined based on a calculation of glomerular filtration rate. This points to the need for particularly careful monitoring of therapy and analysis of antibiotic concentrations to improve the effectiveness and reduce the incidence of undesirable consequences of treatment.
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Affiliation(s)
- Joanna Pondel
- Medical University of Wrocław, Poland: 1Department of Nephrology and Transplant Medicine
| | - Piotr Krajewski
- Medical University of Wrocław, Poland: Department of Nephrology and Transplant Medicine
| | - Natalia Królikowska
- Medical University of Wrocław, Poland: Department of Nephrology and Transplant Medicine
| | - Aleksandra Tobiasz
- Medical University of Wrocław, Poland: Chair and Department of Clinical Pharmacology
| | | | - Magdalena Hurkacz
- Medical University of Wrocław, Poland: Chair and Department of Clinical Pharmacology
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93
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Goto K, Sato Y, Yasuda N, Hidaka S, Suzuki Y, Tanaka R, Kaneko T, Nonoshita K, Itoh H. Pharmacokinetics of ceftriaxone in patients undergoing continuous renal replacement therapy. J Basic Clin Physiol Pharmacol 2017; 27:625-631. [PMID: 27497425 DOI: 10.1515/jbcpp-2016-0022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 07/02/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND The duration of time for which the serum levels exceed the minimum inhibitory concentration (MIC) is an important pharmacokinetics (PK)/pharmacodynamics (PD) parameter correlating with efficacy for the antibiotic, ceftriaxone (CTRX). However, no reports exist regarding the PK or PD in patients undergoing continuous renal replacement therapy (CRRT). The purpose of this study was to examine the PK and safety of CTRX in patients undergoing CRRT in order to establish safer and more effective regimens. METHODS CTRX (1 g once a day) was intravenously administered four or more times to nine patients undergoing CRRT. Blood was collected after administration to measure CTRX concentrations in serum and the filtration fraction of CRRT by high-performance liquid chromatography. In addition to calculating PK parameters from serum CTRX, we (a) estimated by simulation CTRX concentrations when the dose interval was extended to once every 2 or 3 days, (b) calculated CTRX clearance via CRRT from CTRX concentrations in the filtration fraction, and (c) assessed the safety of CTRX use. RESULTS Total body clearance and the half-life of CTRX were 7.46 mL/min (mean) and 26.5 h, respectively, in patients undergoing CRRT. CTRX was found in the filtration fraction, and the estimated clearance by CRRT was about 70% of total body clearance. Simulations revealed that even when the dose interval is increased to 2 or 3 days, CTRX would retain its efficacy. CONCLUSIONS Our findings suggest that, depending on the condition of patients undergoing CRRT, CTRX could be used safely against pathogens with a CTRX MIC ≤2 µg/mL, even when extending the dose interval.
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94
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Smith MJ, Gonzalez D, Goldman JL, Yogev R, Sullivan JE, Reed MD, Anand R, Martz K, Berezny K, Benjamin DK, Smith PB, Cohen-Wolkowiez M, Watt K. Pharmacokinetics of Clindamycin in Obese and Nonobese Children. Antimicrob Agents Chemother 2017; 61:e02014-16. [PMID: 28137820 PMCID: PMC5365720 DOI: 10.1128/aac.02014-16] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 01/12/2017] [Indexed: 12/12/2022] Open
Abstract
Although obesity is prevalent among children in the United States, pharmacokinetic (PK) data for obese children are limited. Clindamycin is a commonly used antibiotic that may require dose adjustment in obese children due to its lipophilic properties. We performed a clindamycin population PK analysis using data from three separate trials. A total of 420 samples from 220 children, 76 of whom had a body mass index greater than or equal to the 95th percentile for age, were included in the analysis. Compared to other metrics, total body weight (TBW) was the most robust measure of body size. The final model included TBW and a sigmoidal maturation relationship between postmenstrual age (PMA) and clearance (CL): CL (liters/hour) = 13.8 × (TBW/70)0.75 × [PMA2.83/(39.52.83+PMA2.83)]; volume of distribution (V) was associated with TBW, albumin (ALB), and alpha-1 acid glycoprotein (AAG): V (liters) = 63.6 × (TBW/70) × (ALB/3.3)-0.83 × (AAG/2.4)-0.25 After accounting for differences in TBW, obesity status did not explain additional interindividual variability in model parameters. Our findings support TBW-based dosing for obese and nonobese children.
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Affiliation(s)
- Michael J Smith
- Division of Pediatric Infectious Diseases, University of Louisville, Louisville, Kentucky, USA
- Kosair Charities Pediatric Clinical Research Unit, University of Louisville, Louisville, Kentucky, USA
| | - Daniel Gonzalez
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Ram Yogev
- Northwestern University, Chicago, Illinois, USA
| | - Janice E Sullivan
- Kosair Charities Pediatric Clinical Research Unit, University of Louisville, Louisville, Kentucky, USA
| | | | | | | | - Katherine Berezny
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Daniel K Benjamin
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - P Brian Smith
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Michael Cohen-Wolkowiez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
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95
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Suchánková H, Matušková Z, Vanduchová A. [Therapeutic drug monitoring of beta-lactam antibiotics]. Klin Mikrobiol Infekc Lek 2017; 23:4-9. [PMID: 28467590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Therapeutic drug monitoring (TDM) is a dosage individualization strategy that helps to minimize toxicity whilst maximizing the efficacy of an agent. For many years, beta-lactam antibiotics were not considered ideal candidates for TDM due to their wide therapeutic range. Profound and difficult to predict beta-lactam pharmacokinetic variability in specific patient populations and increasing bacterial resistance suggest that reaching optimal exposures can be challenging in some clinical settings. The aims are to review the role of beta-lactam TDM, identify patients that would most likely benefit from it, summarize methods used to measure beta-lactam concentrations and outline their limitations, discuss the concentration-effect relationship and therapeutic targets and finally describe dosage adjustment strategies.
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Affiliation(s)
- Hana Suchánková
- Department of Pharmacology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic, e-mail:
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96
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Nie H, Feng X, Peng J, Liang L, Lu C, Tiwari RV, Tang S, He J. Comparative pharmacokinetics of ceftiofur hydrochloride and ceftiofur sodium after administration to water buffalo (Bubalus bubalis). Am J Vet Res 2017; 77:646-52. [PMID: 27227504 DOI: 10.2460/ajvr.77.6.646] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate pharmacokinetics and bioavailability after administration of ceftiofur hydrochloride and ceftiofur sodium to water buffalo (Bubalus bubalis). ANIMALS 5 healthy adult water buffalo (3 males and 2 nonlactating females). PROCEDURES All animals received a dose (2.2 mg/kg) of 3 ceftiofur products (2 commercially available suspensions of ceftiofur hydrochloride [CEF1 and CEF2, IM] and ceftiofur sodium [CEF3, IV]). Blood samples were collected for up to 196 hours. Concentrations of ceftiofur in plasma were determined by use of high-performance liquid chromatography, and pharmacokinetic parameters were calculated on the basis of noncompartmental methods. RESULTS Most of the pharmacokinetic parameters, except for bioavailability and the area under the concentration-time curve extrapolated to infinity, were significantly different between the 2 products administered IM. Mean ± SD bioavailability of CEF1 and CEF2 was 89.57 ± 32.84% and 86.28 ± 11.49%, respectively, which indicated good absorption of both products. In addition, there was a longer drug residence time for CEF1 than for CEF2. Data analysis for CEF1 revealed a flip-flop phenomenon. CONCLUSIONS AND CLINICAL RELEVANCE In this study, there was good absorption of CEF1, and CEF1 had a longer drug residence time in vivo than did CEF2. On the basis of pharmacokinetic parameters and the in vitro antimicrobial susceptibility, a dosage regimen of 2.2 mg/kg administered at 48- and 36-hour intervals for CEF1 and CEF2, respectively, could be an appropriate choice for the treatment of buffalo with infectious diseases.
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97
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Yoshida S, Suzuki A, Ohmori T, Niwa T, Okada H, Suzuki K, Kobayashi R, Doi T, Kitaichi K, Matsuura K, Murakami N, Ogura S, Itoh Y. A simplified chart for determining the initial loading dose of teicoplanin in critically ill patients. Pharmazie 2017; 72:53-57. [PMID: 29441898 DOI: 10.1691/ph.2017.6811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIM OF THE STUDY A simplified chart to determine the initial loading dose of teicoplanin (TEIC chart) for achieving the target trough concentration was developed. The aim of the present study was to evaluate the usefulness of this chart in critically ill patients. PATIENTS AND METHODS The initial loading dose and maintenance dose to achieve a target trough concentration ≥10 μg/mL on day 4 was determined using the teicoplanin TDM software and presented in a TEIC chart. The dosage of teicoplanin, including the loading dose for the first 2 days and the maintenance dose thereafter, was selected from the chart (chart method, N = 41) or calculated using TDM software (software method, N = 39). RESULTS The performance rate of initial loading of teicoplanin increased from 83.0% to 100% after the TEIC chart was introduced (P = 0.016). The TEIC chart significantly reduced the time required for determining the initial loading dose compared with the use of software (1.9±0.6 min vs. 29.7±13.8 min, P < 0.001). No significant differences were observed in the rates of achieving a target level ≥10 μg/mL (P = 0.766). CONCLUSION The TEIC chart enables a simple, rapid, and reliable determination of teicoplanin dosage.
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98
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Sorlí L, Luque S, Segura C, Campillo N, Montero M, Esteve E, Herrera S, Benito N, Alvarez-Lerma F, Grau S, Horcajada JP. Impact of colistin plasma levels on the clinical outcome of patients with infections caused by extremely drug-resistant Pseudomonas aeruginosa. BMC Infect Dis 2017; 17:11. [PMID: 28056821 PMCID: PMC5217330 DOI: 10.1186/s12879-016-2117-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 12/14/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Colistin has a narrow therapeutic window with nephrotoxicity being the major dose-limiting adverse effect. Currently, the optimal doses and therapeutic plasma levels are unknown. METHODS Prospective observational cohort study, including patients infected by colistin-susceptible P. aeruginosa treated with intravenous colistimethate sodium (CMS). Clinical data and colistin plasma levels at steady-state (Css) were recorded. The primary and secondary end points were clinical cure and 30-day all-cause mortality. RESULTS Ninety-one patients were included. Clinical cure was observed in 72 (79%) patients. The mean (SD) Css was 1.49 (1.4) mg/L and 2.42 (1.5) mg/L (p = 0.01) in patients who achieved clinical cure and those who not, respectively. Independent risk factors for clinical failure were male sex (OR 5.88; 95% CI 1.09-31.63), APACHE II score (OR 1.15; 95% CI 1.03-1.27) and nephrotoxicity at the EOT (OR 9.13; 95% CI 95% 2.06-40.5). The 30-day mortality rate was 30.8%. Risk factors for 30-day mortality included the APACHE II score (OR 1.98; 95% CI 1-1.20), the McCabe score (OR 2.49; 95% CI 1.14-5.43) and the presence of nephrotoxicity at the end of treatment (EOT) (OR 3.8; 95% CI 1.26-11.47). CONCLUSION In this series of patients with infections caused by XDR P. aeruginosa infections, Css is not observed to be related to clinical outcome.
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Affiliation(s)
- Luisa Sorlí
- Infectious Disease Service, Hospital del Mar, Barcelona, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- CEXS-Universitat Pompeu Fabra, Barcelona, Spain
| | - Sonia Luque
- Pharmacy Service, Hospital del Mar, Barcelona, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Concepción Segura
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
- Laboratori de Referència de Catalunya, Prat de Llobregat, Spain
| | - Nuria Campillo
- Pharmacy Service, Hospital del Mar, Barcelona, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Milagro Montero
- Infectious Disease Service, Hospital del Mar, Barcelona, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
- CIBERES, Madrid, Spain
| | - Erika Esteve
- Infectious Disease Service, Hospital del Mar, Barcelona, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Sabina Herrera
- Infectious Disease Service, Hospital del Mar, Barcelona, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Natividad Benito
- InfectiousDiseaseUnit, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d’Investigació Biomèdica Sant Pau, Barcelona, Spain
- CIBERES, Madrid, Spain
| | - Francisco Alvarez-Lerma
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
- Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain
- CIBERES, Madrid, Spain
| | - Santiago Grau
- Pharmacy Service, Hospital del Mar, Barcelona, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
- CIBERES, Madrid, Spain
| | - Juan Pablo Horcajada
- Infectious Disease Service, Hospital del Mar, Barcelona, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
- Intensive Care Unit, Hospital del Mar, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- CEXS-Universitat Pompeu Fabra, Barcelona, Spain
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Del Bono V, Giacobbe DR, Marchese A, Parisini A, Fucile C, Coppo E, Marini V, Arena A, Molin A, Martelli A, Gratarola A, Viscoli C, Pelosi P, Mattioli F. Meropenem for treating KPC-producing Klebsiella pneumoniae bloodstream infections: Should we get to the PK/PD root of the paradox? Virulence 2017; 8:66-73. [PMID: 27430122 PMCID: PMC5963200 DOI: 10.1080/21505594.2016.1213476] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/14/2016] [Accepted: 07/11/2016] [Indexed: 10/21/2022] Open
Abstract
The objective of this study was to assess the achievement of pharmacokinetic/pharmacodynamic (PK/PD) targets of meropenem (MEM) in critically-ill patients with bloodstream infections (BSI) due to Klebsiella pneumoniae-carbapenemase-producing Klebsiella pneumoniae (KPC-Kp) with MEM minimum inhibitory concentrations (MICs) ≥16 mg/L. Nineteen critically-ill patients with KPC-Kp BSI were given combination therapy including MEM, tigecycline, plus colistin or gentamicin (according to susceptibility testing). MEM was administered as an extended 3-hour infusion of 2 g every 8 hours, or adjusted according to renal function. MEM plasma concentrations were determined by high-performance liquid chromatography. PK/PD targets for MEM were defined as T > 40% 1×MIC and T > 40% 4×MIC. Possible synergisms between MEM and coadministered agents were assessed by time-kill assays based on plasma levels for MEM and on fixed plasma concentrations for the other agents. In none of 19 patients MEM reached any PK/PD target. The actual MEM MICs were 256, 512, and 1024 mg/L in 1, 3, and 15 isolates, respectively. However, theoretically, the PK/PD target of T > 40% 1×MIC could have been achieved in 95%, 68%, 32% and 0% of the isolates for MIC equal to 8, 16, 32, and 64 mg/L, respectively. No synergisms were observed between MEM and coadministered agents. In conclusion, high-dose MEM failed to reach PK/PD targets in 19 patients with BSI due to KPC-Kp with very high MEM MICs. On a theoretical basis, our results suggest a possible usefulness of MEM against resistant blood isolates with MICs up to 32 mg/L.
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Affiliation(s)
- Valerio Del Bono
- Clinica Malattie Infettive, DIPMI, DISSAL, IRCCS AOU San Martino-IST, Università di Genova, Genova, Italy
| | - Daniele Roberto Giacobbe
- Clinica Malattie Infettive, DIPMI, DISSAL, IRCCS AOU San Martino-IST, Università di Genova, Genova, Italy
| | - Anna Marchese
- Unità di Microbiologia, DIPSE, DISC, IRCCS AOU San Martino-IST, Università di Genova, Genova, Italy
| | - Andrea Parisini
- Centro ortopedico di Quadrante, Ospedale Madonna del Popolo, Omegna, Italy
| | - Carmen Fucile
- Unità di Farmacologia Clinica e Tossicologia, DIMI, Università di Genova, Genova, Italy
| | - Erika Coppo
- Unità di Microbiologia, DIPSE, DISC, IRCCS AOU San Martino-IST, Università di Genova, Genova, Italy
| | - Valeria Marini
- Unità di Farmacologia Clinica e Tossicologia, DIMI, Università di Genova, Genova, Italy
| | - Antonio Arena
- U.O. Anestesia e Rianimazione, DIPEA, IRCCS AOU San Martino-IST, Genova, Italy
| | - Alexandre Molin
- U.O. Anestesia e Terapia Intensiva, DIPEA, IRCCS AOU San Martino-IST, Genova, Italy
| | - Antonietta Martelli
- Unità di Farmacologia Clinica e Tossicologia, DIMI, Università di Genova, Genova, Italy
| | - Angelo Gratarola
- U.O. Anestesia e Rianimazione, DIPEA, IRCCS AOU San Martino-IST, Genova, Italy
| | - Claudio Viscoli
- Clinica Malattie Infettive, DIPMI, DISSAL, IRCCS AOU San Martino-IST, Università di Genova, Genova, Italy
| | - Paolo Pelosi
- U.O. Anestesia e Terapia Intensiva, DIPEA, IRCCS AOU San Martino-IST, Genova, Italy
- Anestesia e Terapia Intensiva, DISC, Università di Genova, Genova, Italy
| | - Francesca Mattioli
- Unità di Farmacologia Clinica e Tossicologia, DIMI, Università di Genova, Genova, Italy
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van Dam DGHA, Burgers DMT, Foudraine N, Janssen PKC, Neef C, le Noble JLML. Treatment of cefuroxime-induced neurotoxicity with continuous venovenous haemofiltration. Neth J Med 2017; 75:32-34. [PMID: 28124668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A 61-year-old woman with decreased consciousness, myoclonus, tremors, nystagmus and bradypnoea, due to cefuroxime-induced neurotoxicity, was admitted to the intensive care unit. Continuous venovenous haemofiltration (CVVH) rapidly reduced plasma cefuroxime concentrations and improved neurological manifestations within the next few hours. Retrospective pharmacokinetic assessment showed a total cefuroxime clearance of 166 ml/min during the CVVH.
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Affiliation(s)
- D G H A van Dam
- Department of Intensive Care, VieCuri Medical Centre, the Netherlands
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