Impact of workflow-integrated corollary orders on aminoglycoside monitoring in children

Computerized provider order entry (CPOE) and clinical decision support improve medication prescribing safety in adults. However, effective therapy for children requires dosing based on circulating medication levels. We examined the introduction of a computerized corollary order for aminoglycoside blood level monitoring. The study was divided into baseline (BP) and corollary order (CP) periods. In the CP, we implemented a workflow-integrated reminder to order blood levels and presented this to the clinician during each aminoglycoside ordering session. Appropriate laboratory monitoring was 128/159 (80.5%) courses in the BP and 146/177 (82.5%) courses in the CP. Thus introduction of the order did not significantly improve laboratory monitoring rates, nor did it result in a reduction in the rate of either toxic or subtherapeutic levels. However, aminoglycoside corollary orders may have an important role in institutions where pharmacists are not actively involved in monitoring therapy.

Determination of neomycin sulfate and impurities using high-performance anion-exchange chromatography with integrated pulsed amperometric detection

Neomycin B is one of a class of aminoglycoside antibiotics that lack a good chromophore, and is therefore difficult to determine using reversed-phase HPLC with absorbance detection. This is especially true for determining the quantity of each impurity. We show that neomycin sulfate and its major impurities, including neamine (neomycin A), can be separated on a strong anion-exchange column using a weak potassium hydroxide eluent (2.40 mM) at a column temperature of 30 degrees C, and directly detected by integrated pulsed amperometric detection (IPAD). The resolution (United States Pharmacopeia (USP) definition) between neomycin B and the closest major impurity ranged from 6.56 and 7.45 over 10 days of consecutive analysis (7.24+/-0.10, n=836 injections). Due to the difficulty of producing weak hydroxide eluents of the required purity (i.e. carbonate-free), this method depends on automatic eluent generation to ensure method ruggedness. This method exhibited good long-term (10 days, 822 injections) retention time stability with a R.S.D. of 0.6%. Peak area R.S.D. (10 microM) was 1.3%. Method robustness was evaluated by intentionally varying the flow rate, eluent concentration, column temperature, and column. The spike recoveries of neomycin B from extractions of three different topical ointments and cream formulations ranged from 95 to 100%. The measured concentration of neomycin B in these formulations ranged from 119 to 154% of the label concentration. The R.S.D. for the measured concentration of one of the formulations tested over three separate days, n=11 extracts, was 3.2%. Based on the results of these evaluations, we believe this method can be used for neomycin sulfate identity, assay, and purity.

Electrochemical detection of tobramycin or gentamicin according to the European Pharmacopoeia analytical method

Tobramycin and gentamicin are two aminoglycosidic antibiotics used in lung infection, ophthalmic treatments as well as in skin infections. Pharmaceutical companies which produce remedies containing tobramycin and gentamicin need an analytical method for their internal quality control. For several years a simple chromatographic method based on anion exchange separation coupled with amperometric detection was proposed for aminoglycosides. This analytical approach was partially used in the last edition of the European Pharmacopoeia (EP) for tobramycin and gentamicin analysis. In fact they use integrated pulsed amperometric detection (IPAD) on a gold electrode while the separation is obtained on a polymeric wide pore reversed phase instead of anion exchange in alkaline conditions. Such coupling seems to be cumbersome and not so easy to realize and to reproduce from one laboratory to another. Besides, the described method lacks some of the details as important as the waveform steps duration. Unfortunately the quality control (QC) laboratories have to use exactly the method described in the EP, so they complained about the troubles. Therefore, the EP authors published recently a paper regarding the guidelines for good practice in the method application, but the suggestion was not yet resolutive. In our work we evaluated the eluent composition and the kind of amperometric cell, work electrode diameter and cell volume. Mainly we optimized the amperometric waveform. In addition, for tobramycin analysis another chromatographic phase was explored in order to achieve better efficiency and to separate all the impurities confirming the effectiveness of the detection. The conditions described in the paper seem to allow the analyst to operate in conformity with the EP method.

Trace analysis of aminoglycoside antibiotics in bovine milk by MEKC with LIF detection

This work describes a straightforward and sensitive method for the multi-residue analysis of aminoglycoside antibiotics (kanamycin B, amikacin, neomycin B and paromomycin I) in bovine milk samples. The method involves the pre-capillary derivatization of antibiotics with sulfoindocyanine succinimidyl ester (Cy5) and their separation and determination by MEKC with LIF detection. The optimum procedure includes a derivatization step of the antibiotics at 25 degrees C for 30 min and direct injection for MEKC analysis, which is performed in about 20 min by using borate buffer (35 mM; pH 9.2) with 55 mM SDS as an anionic surfactant and 20% ACN as the organic modifier. Under these conditions, dynamic ranges of 10-500 microg/L and RSDs (within-day precision) from 3.8 to 5.3% were obtained. These results indicate that the proposed MEKC-LIF method is useful as a selective and sensitive tool for the determination of these antibiotics and surpasses other reported electrophoretic alternatives. Finally, the method was successfully applied to bovine milk samples after a simple solid-phase extraction clean-up and preconcentration procedure. The aminoglycosides were readily detected at 0.5-1.5 microg/kg levels with average recoveries ranging from 89.4 to 93.3%.

Determination of vertilmicin sulfate and its related substances by HPLC-ELSD and HPLC-MS2

A new and simple high-performance liquid chromatography (HPLC)-evaporative light scattering detection (ELSD) method for the determination of vertilmicin sulfate and its related substances is developed. The column is an Agilent SB-C(18) (250 x 4.6 mm, 5 microm). The mobile phase is 0.05 mol/L trifluoroacetic acid-methanol (85:15). Good separation of vertilmicin from the main related substances is achieved. The standard curve is rectilinear in the range of 270-1350 microg/mL (r = 0.9998). The average recovery is 99.8%. The limit of detection is 10 microg/mL. The HPLC-mass spectrometry-mass spectrometry (MS(2)) method is used to characterize the structures of vertilmicin sulfate and its related substances. In positive mode, vertilmicin sulfate and its related substances are elucidated by use of electrospray ion trap MS in the multi-stage MS full scan mode. The possible structure of an unknown impurity in vertilmicin is deduced based on the HPLC-MS(2) data.

On-line concentration of neomycin and screening aminoglycosides in milk by short capillary column and tandem mass spectrometry

An MS-MS method was established for the trace analysis of neomycin and screening aminoglycoside antibiotics (such as amikacin, gentamicin, kanamycin, and tobramycin) in a milk sample. The extraction and purification are based on ion-pair SPE technology on a short fused-silica capillary RP C18 column. The capillary SPE column provided the stationary phase to retain aminoglycoside antibiotics and MS-MS compatible organic acid heptafluorobutyric acid (HFBA) was used as protein precipitation and ion-pair reagent. Aminoglycosides were extracted in this short column and directly eluted to MS-MS without evaporating to dryness and reconstituted with MS-MS compatible solvent after SPE. The LOQ was 0.1 microg/mL and the calibration curve was linear up to 6.4 microg/mL. A small amount of milk product, 10 microL, is sufficient for the analysis and application of this method as the trace analysis of neomycin in the biological matrix proved simple and workable.

Evaporative light scattering detection (ELSD): a tool for improved quality control of drug substances

Thanks to the recent technological advancements, evaporative light-scattering detection (ELSD) is regarded as a valuable alternative to UV detection for liquid chromatographic analysis of substances that do not contain a chromophore. In the field of substances for pharmaceutical use, LC-ELSD appears to be suitable for aminoglycosides, most of which (for ex. gentamicin) are presently controlled in the Ph. Eur. by pulsed amperometric detection. Other substances (ex sugars, triglycerides) presently employing refractometrric detection, could be conveniently analysed by LC-ELSD. ELS detection is regarded as robust and relatively simple, although not particularly sensitive. A key feature of ELSD is that - unlike refractometry - it can operate in gradient mode, thus allowing application of more selective liquid chromatographic methods. ELSD can also be used to set up MS-compatible methods, as the mobile phase constraints are essentially the same. Due to all the above, ELSD is becoming increasingly used in pharmacopoeial methods.

Cp*Rh-Based Indicator-Displacement Assays for the Identification of Amino Sugars and Aminoglycosides

Indicator-displacement assays based on the organometallic complex [{Cp*RhCl2}2] (Cp*=pentamethylcyclopentadienyl) and the dye gallocyanine were used to sense amino sugars and aminoglycosides in buffered aqueous solution by conducting UV-visible spectroscopy. The data of three assays at pH 7.0, 8.0, and 9.0 were sufficient to distinguish between the amino sugars galactosamine, glucosamine, mannosamine and the aminoglycosides kanamycin A, kanamycin B, amikacin, apramycin, paromomycin, and streptomycin. Furthermore, the assays were used to characterize mixtures of aminoglycosides and obtain quantitative information about the respective analytes.

Analysis of etimicin sulfate by liquid chromatography with pulsed amperometric detection

A new method for determination of etimicin's (ETM) purity and content is developed by liquid chromatography (LC) and pulsed amperometric detection (PAD). A reversed-phase ion-pair LC method with pulsed amperometric detection on a gold electrode after post-added NaOH is described. The mobile phase consisted of an aqueous solution containing 0.033 mol L(-1) oxalic acid, 0.012 mol L(-1) heptafluorobutyric acid, and 210 mL L(-1) acetonitrile with pH 3.40 adjusting by dilute NaOH solution. The total analysis time was not more than 30 min. The effects of the different chromatographic parameters on the separation were also investigated. A number of commercial samples of etimicin sulfate were analyzed using this method.

Rapid and sensitive determination of aminoglycoside antibiotics in water samples using a strong cation-exchange chromatography non-derivatisation method with chemiluminescence detection

A simple and sensitive chemiluminescence (CL) detection approach was developed for the direct analysis of aminoglycoside antibiotics in water samples following strong cation-exchange chromatographic (SCX-HPLC) separation. This detection system, which eliminates the need for sample derivatisation, is based on the inhibitory effect of aminoglycosides on the CL reaction between luminol and hydrogen peroxide catalysed by copper(II). As the operational and chemical variables that affect the CL signal were optimised, ionic strength and the Triton X-100 micelles turned out to be the keys to obtain maximum CL efficiency. Aminoglycosides were successfully separated in 10 min on a SCX column using a mobile phase consisting of an aqueous solution containing 5.0 x 10(-3)mol/l sodium acetate and 0.65 mol/l sodium chloride at pH 6.1. Sample volumes of 50 ml were preconcentrated by passage through a weakly acidic IRC-50 exchange column. Limits of detection from 0.7 to 10 microg/l and relative standard deviations from 2.7 to 5.4% were thus obtained. The proposed method surpasses other chromatographic alternatives in terms of the limit of detection, sample requirements for analysis and cost.

1H and 13C NMR data for indolo[2,3-b]quinoline-aminoglycoside hybrids, a novel potent anticancer drug family

The complete NMR signal assignment of title compounds were carried out by extensive use of 1D and 2D NMR techniques (1H, 13C, GCOSY, GHSQC and GHMBC).

Comparative study on the analytical performance of three waveforms for the determination of several aminoglycoside antibiotics with high performance liquid chromatography using amperometric detection

A preliminary comparative study was carried out on the analytical performances of a new six-potential waveform and other two detection waveforms, triple-potential waveform and quadruple-potential waveform. The analytical performances compared included signal response, background noise, signal/noise ratio and signal stability. Compared with triple-potential waveform and quadruple-potential waveform, the new six-potential waveform had higher signal response, signal/noise ratio, and sensitivity. As for determination reproducibility, the six-potential waveform also exhibited a slightly better performance than the other two waveforms. Under the selected experimental conditions based on the six-potential waveform, there is a linear correlation between peak area and concentration over two to three orders of magnitude for nine aminoglycoside antibiotics with a correlation coefficients better than 0.998 and the detection limits measured as three times the peak height signal-to-noise ratio for the nine aminoglycoside antibiotics were in the range of 0.0198-0.889 microg/mL. The proposed method had been used to analyze real gentamicin sulphate drug sample.

Determination of 11 aminoglycosides in meat and liver by liquid chromatography with tandem mass spectrometry

A method using liquid chromatography with tandem mass spectrometry was developed for the determination of 11 commonly used aminoglycoside antibiotics in meat. The proposed method is sufficiently sensitive (detection limits of 15 to 40 ppb for the various antibiotics) and highly selective. It is suitable for the quantitation and confirmation of aminoglycosides in a variety of matrixes (pork muscle, fish, and veal liver). Any multiresidue method for aminoglycosides must take into account their high affinity toward sample proteins and the significantly different pK values of the various analytes. The developed method uses a low-pH extraction with trichloracetic acid to ensure complete extraction of the analytes from the matrix. An anion-exchange step is used to remove the acid from the centrifuged extract. Aminoglycosides in this solution of low ionic strength can be quantitatively retained and afterwards eluted from a weak cation-exchanger solid-phase extraction (SPE) cartridge. The highly selective SPE steps produce clean extracts, which minimize possible suppression of the mass spectrometer signal.

Stability indicating reversed-phase ion-pairing liquid chromatographic determination of vertilmicin sulfate as bulk drug and in injections

A simple reversed-phase high performance liquid chromatographic method was developed for the analysis of vertilmicin sulfate, a novel aminoglycoside (AG). UV detection was used to determine vertilmicin sulfate and its related compounds in drug substance and products without sample derivatization. The method was used to determine the content of vertilmicin and its related compounds and test the stability of vertilmicin sulfate as drug substance and in injections, which was required for registration of new drug.

Simple confirmatory assay for analyzing residues of aminoglycoside antibiotics in bovine milk: hot water extraction followed by liquid chromatography–tandem mass spectrometry

A simple, selective and sensitive procedure for determining nine widely used aminoglycoside antibiotics (AGs) in bovine whole milk is presented. It is based on matrix solid-phase dispersion with heated water, at 70 degrees C, as extractant followed by liquid chromatography (LC)-tandem mass spectrometry (MS) using an electrospray ion source. After acidification and filtration, 0.2 ml of the aqueous extract was injected into the LC column. MS data acquisition was performed in the multi reaction monitoring mode, selecting two (three, when possible) precursor ion > product ion transitions for each target compound. Analyte recoveries ranged between 70 and 92%. Using aminosidine (an AG not used in veterinary medicine) as surrogate internal standard, the accuracy of the method at three spike levels varied between 80 and 107% with R.S.D. not larger than 11%. The limits of quantification were between 2 ng/ml (apramycin) and 13 ng/ml (streptomycin). They are well below the tolerance levels set by both the European Union and the U.S. Food and Drug Administration.

Mass spectrometric study to characterize thioisoindole derivatives of aminoglycoside antibiotics

Aminoglycoside antibiotics are widely used to treat serious Gram-negative and Gram-positive bacterial infections. The lack of a UV chromophore presents a problem in the analysis of aminoglycosides. Derivatization with 1,2-phthalic dicarboxaldehyde (OPA) in the presence of a thiol made it possible to introduce a UV chromophoric thioisoindole moiety. A qualitative mass spectrometry study was carried out to confirm the molecular identity of the products formed. The conditions described earlier to derivatize gentamicin and kanamycin yielded products in which all primary amino groups are fully derivatized. On the other hand, with tobramycin and amikacin, there was also formation of incompletely derivatized products that contained one thioisoindole group less than the fully derivatized product. This study has therefore brought an additional insight into the nature of the OPA-aminoglycoside derivatives studied.

Preparation of macrocyclic 15N-labelled oligoaminodeoxysaccharides as probes for RNA-binding

Two macrocyclic aminoglycosides were prepared from a 1,4-butanediol linked 2-deoxy-L-rhamnal which was O-allylated at the 4- and 4'-positions via the precursor allyl 3,4-di-O-acetyl-2,6-dideoxy-alpha-L-arabino-hexoside employing olefin metathesis and ring closing metathesis in a sequential manner. The macrocycles were 15N-labelled at all four amino groups in order to study interactions with regulatory RNA structures in solution by NMR spectroscopy. A key step for the introduction of the 15N-label was a reductive amination step using commercially available 15NH4OAc. The reductive amination proceeds with excellent stereocontrol. As a by-product the unusual acyclic amino nitrile was isolated which originated from intramolecular imine formation followed by cyanide addition to the intermediate C=N double bond.

[Electrospray ion trap mass spectrometry of eight aminoglycoside antibiotics]

AIM

To study the dissociation pathways of aminoglycoside antibiotics.

METHODS

In positive mode, eight aminoglycoside antibiotics were elucidated by use of electrospray ion trap mass spectrometry in the multi-stage MS full scan mode.

RESULTS

It was demonstrated that the eight aminoglycoside antibiotics gave abundant product ions at m/z 322 (gentamicin, micronomicin and sisomicin), m/z 350 (etimicin, netilmicin and vetilmicin) and m/z 324 (kanamycin and tobramycin) by loss of the C-ring (amino-alpha-D-glucopyranose) in MS2 full scan mode. In MS3 full scan mode, the prominent fragmentation ions at m/z 163 as well as m/z 191 were formed from the fragmentation ions at m/z 322, m/z 350 and m/z 324 by loss of the A-ring (amino-alpha-D-glucopyranose), separately, while the characteristic fragmentation ions at m/z 160 as well as m/z 162 were formed from m/z 322, m/z 350 and m/z 324 by loss of the B-ring (2-deoxy-D-streptamine), separately.

CONCLUSION

The structural information was obtained via collision-activated dissociation and these characteristics are applicable to the structural elucidation and quantitative analysis of aminoglycoside compounds.

Determination of Aminoglycosides and Quinolones in Food Using Tandem Mass Spectrometry: A Review

The widespread use of antibiotics in dairy cattle management may result in the presence of antibiotic residues in food. While rapid screening tests are commonly used to detect the presence of antibiotics in food, more accurate chromatographic-mass spectrometric methods combined with tandem mass spectrometry (MS/MS) are required to determine the identity and quantity of the antibiotic present. These methods (HPLC/MS/MS) may have the greatest potential for accomplishing direct multi-residue identifications in complex biological matrices, such as food. This study reviews recent applications of tandem mass spectrometry in the determination of antibiotic residues, such as aminoglycosides and quinolones in food.

Cloning and characterization of sanO, a gene involved in nikkomycin biosynthesis in Streptomyces ansochromogenes

AIMS

To clone and characterize sanO, a gene involved in the biosynthesis of nikkomycins in Streptomyces ansochromogenes.

METHODS AND RESULTS

A 4.5-kb BamHI-KpnI fragment was cloned and sequenced. Sequence analysis revealed that this fragment contains three complete open reading frames. The largest one with 2034 bp was designated sanO, which encodes a protein consisting of 667 amino acids with high similarity to module of peptide synthetase. sanO disruption mutants produced no nikkomycin X, but formed nikkomycin Z at almost the same level of the wild-type strain. The production of nikkomycin X can be recovered by genetic complementation of sanO disruption mutants. Primer extension also revealed that transcription start point(tsp) of sanO was localized 87 bp upstream of the potential start codon (GTG).

CONCLUSIONS

sanO was essential for the biosynthesis of nikkomycin X.

SIGNIFICANCE AND IMPACT OF THE STUDY

Nikkomycins have received increased interest of study because of their prospective application in agriculture and medicine. Cloning and characterization of genes involved in the nikkomycin biosynthesis will help to elucidate the whole biosynthetic pathway of nikkomycins.

A new micellar electrokinetic capillary chromatography method for separation of the components of the aminoglycoside antibiotics

Aminoglycoside antibiotics are always a mixture of structurally related amino sugars, which do not have a chromophore or fluorophore. The aim of the study was to find one method for evaluation of the components and impurities of the antibiotics. Derivatization with o-phthaldialdehyde and thioglycolic acid is found to be appropriate for all antibiotics. The components of gentamicin (GM), sisomicin, netilmicin, kanamycin, amikacin, and tobramycin were tried to separate by means of micellar electrokinetic chromatography. The background electrolyte was composed of sodium tetraborate (100 mM, pH 10.0), sodium deoxycholate (20 mM), and beta-cyclodextrin (15 mM). This method is valid for evaluation of GM, kanamycin, and tobramycin. It has to be improved for amikacin and netilmicin. In addition, 46 bulk samples of GM of different manufacturer or pharmaceutical companies were investigated. Many samples were found to contain many minor products and different amounts. Beside different patterns of the main compounds GM C1, GM C1a, GM C2a, and GM C2, many lots were found consisting of a substantial number of minor products. The appearance of a high number of minor products is always associated with the existence of sisomicin, which is not found in "pure" samples. However, almost all samples met the requirements of the European Pharmacopoeia (EP) and United States Pharmacopoeia (USP).

Resonance Rayleigh scattering spectra for studying the interaction of aminoglycoside antibiotics with pontamine sky blue and their analytical applications

In a weakly acid medium, some aminoglycoside antibiotics, such as kanamycin (KANA), gentamicin (GEN), tobramycin (TOB), and neomycin (NEO), or acid bisazo dye pontamine sky blue (PSB) can only produce very weak resonance Rayleigh scattering (RRS) signals. However, when the two agents react with each other to form the ion association complexes, the RRS intensity can be enhanced greatly and a new RRS spectrum and a significant enhancement of the RRS intensity in the wavelength range 350-600 nm can be observed. The maximum scattering peak is at 580 nm. There is a linear relationship between the RRS intensity and the antibiotic concentration in the range 0.01-6.0 microg mL(-1) at 580 nm. This RRS method has therefore been developed for the determination of trace levels of aminoglycoside antibiotics. The detection limits (3 sigma) of the four antibiotics, whose order of sensitivity is KANA>NEO>TOB>GEN, are 5.8-6.9 ng mL(-1). This method has a good selectivity and has been successfully applied to the quick determination of antibiotics not only for injections and ear drops, but clinic serum samples as well. In addition, quantum chemistry-based analysis of the reaction mechanism, the factors influencing the RRS spectra, and the reasons for the enhancement of RRS are discussed.

Reversed-phase liquid chromatographic method for the analysis of aminoglycoside antibiotics using pre-column derivatization with phenylisocyanate

A pre-column derivatization liquid chromatographic method has been developed for the analysis of aminoglycoside antibiotics using phenylisocyanate as a derivatization reagent. Derivatives including kanamycin, neomycin and gentamicin were formed by reaction of the analytes with phenylisocyanate in the presence of triethylamine. Phenylisocyanato groups were attached to corresponding amino groups of aminoglycoside and their molecular mass was confirmed by liquid chromatography-electrospray ionization-mass spectrometry (LC-ESI-MS). The experimental conditions for derivatization and separation of aminoglycoside derivatives were optimized and validated. A simple liquid chromatographic method for the determination of aminoglycoside antibiotics was demonstrated.