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Cotia A, Oliveira Junior HA, Matuoka JY, Boszczowski Í. Clinical Equivalence between Generic Versus Branded Antibiotics: Systematic Review and Meta-Analysis. Antibiotics (Basel) 2023; 12:antibiotics12050935. [PMID: 37237838 DOI: 10.3390/antibiotics12050935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/05/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Regulatory authorities authorize the clinical use of generic drugs (GD) based on bioequivalence studies, which consist of the evaluation of pharmacokinetics after a single dose in vitro or in healthy individuals. There are few data on clinical equivalence between generic and branded antibiotics. Our aim was to synthesize and analyze the available evidence on the clinical efficacy and safety of generic antibiotics compared to their original formulations. A systematic review was performed on Medline (PubMed) and Embase and validated through Epistemonikos and Google Scholar. The last search was conducted on 30 June 2022. Meta-analyses of clinical cure and mortality outcomes were performed. One randomized clinical trial (RCT) and 10 non-randomized intervention studies were included. No differences in clinical cure were observed between groups in the meta-analysis (OR = 0.89, 95% CI [0.61-1.28]; I2 = 70%, p = 0.005). No difference was observed between groups when considering the use of carbapenems for overall mortality (OR = 0.99, 95% CI [0.63-1.55]; I2 = 78%) or death associated with infections (OR = 0.79, 95% CI [0.48-1.29], I2 = 67%). Most of the studies were observational, and the duration of follow-up, the characteristics of the participants, and the sites of infections were heterogeneous. Due to the uncertainty of the evidence, it is not possible to contraindicate the use of generics, which is an important strategy to expand access.
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Affiliation(s)
- André Cotia
- MBA Program in Prevention of Healthcare Acquired Infections, Infectious Diseases Department, Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil
| | | | - Jessica Y Matuoka
- Health Technology Assessment Unit, Hospital Alemão Oswaldo Cruz, São Paulo 01323-903, Brazil
| | - Ícaro Boszczowski
- Infection Control Department, Hospital Alemão Oswaldo Cruz, São Paulo 01323-020, Brazil
- Infection Control Department, Central Institute, Clinics Hospital, Medicine Faculty, Universidade de São Paulo, São Paulo 05403-010, Brazil
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Amábile-Cuevas CF. Myths and Misconceptions around Antibiotic Resistance: Time to Get Rid of Them. Infect Chemother 2022; 54:393-408. [PMID: 36047302 PMCID: PMC9533159 DOI: 10.3947/ic.2022.0060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/20/2022] [Indexed: 12/02/2022] Open
Abstract
The antibiotic resistance arena is fraught with myths and misconceptions, leading to wrong strategies to combat it. It is crucial to identify them, discuss them in light of current evidence, and dispel those that are unequivocally wrong. This article proposes some concepts that may qualify as misconceptions around antibiotic resistance: the susceptible-resistant dichotomy; that incomplete antibiotic courses cause resistance; that resistance "emerges" in patients and hospitals; that antibiotics are mostly abused clinically; that resistance is higher in countries that use more antibiotics; that reducing antibiotic usage would reduce resistance; that financial incentives would "jumpstart" research and development of antibiotics; that generic and "original" antibiotics are the same; and that new anti-infective therapies are just around the corner. While some of these issues are still controversial, it is important to recognize their controversial status, instead of repeating them in specialized literature and lectures and, especially, in the planning of strategies to cope with resistance.
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Li X, Xu W, Li R, Guo Q, Li X, Sun J, Sun S, Li J. Prediction of Unbound Vancomycin Levels in Intensive Care Unit and Nonintensive Care Unit Patients: Total Bilirubin May Play an Important Role. Infect Drug Resist 2021; 14:2543-2554. [PMID: 34239310 PMCID: PMC8259942 DOI: 10.2147/idr.s311231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/11/2021] [Indexed: 11/23/2022] Open
Abstract
Background The mean unbound vancomycin fraction and whether the unbound vancomycin level could be predicted from the total vancomycin level are still controversial, especially for patients in different groups, such as intensive care unit (ICU) versus non-ICU patients. Other relevant potential patient characteristics that may predict unbound vancomycin levels have yet to be clearly determined. Methods We enrolled a relatively large study population and included widely comprehensive potential covariates to evaluate the unbound vancomycin fractions in a cohort of ICU (n=117 samples) and non-ICU patients (n=73 samples) by using a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method. Results The mean unbound vancomycin fraction was 45.80% ± 18.69% (median, 46.01%; range: 2.13–99.45%) in the samples from the total population. No significant differences in the unbound vancomycin fraction were found between the ICU patients and the non-ICU patients (P=0.359). A significant correlation was established between the unbound and total vancomycin levels. The unbound vancomycin level can be predicted with the following equations: unbound vancomycin level=0.395×total vancomycin level+0.019×total bilirubin level+0.468 (R2=0.771) for the ICU patients and unbound vancomycin level=0.526×total vancomycin level-0.527 (R2=0.749) for the non-ICU patients. Overall, the observed-versus-predicted plots were acceptable. Conclusion A significant correlation between the total and unbound vancomycin levels was found, and measurement of the unbound vancomycin level seems to have no added value over measurement of the total vancomycin level. The study developed parsimonious equations for predicting the unbound vancomycin level and provides a reference for clinicians to predict the unbound vancomycin level in adult populations.
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Affiliation(s)
- Xiao Li
- Department of Clinical Pharmacy, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266003, People's Republic of China
| | - Wen Xu
- Department of Clinical Pharmacy, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266003, People's Republic of China
| | - Ran Li
- Department of Infectious Diseases, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266003, People's Republic of China
| | - Qie Guo
- Department of Clinical Pharmacy, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266003, People's Republic of China
| | - Xiangpeng Li
- Department of Clinical Pharmacy, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266003, People's Republic of China
| | - Jialin Sun
- Department of Clinical Pharmacy, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266003, People's Republic of China
| | - Shuhong Sun
- Department of Clinical Pharmacy, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266003, People's Republic of China
| | - Jing Li
- Department of Clinical Pharmacy, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266003, People's Republic of China
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Zhang SH, Wei SS, Zhu ZY, Chen Y, Cai HL, Zhang BK. Physicochemical Assessment of Branded and Generic Linezolid Injection from Different Pharmaceutical Manufacturers. CURR PHARM ANAL 2021. [DOI: 10.2174/1573412916666200224104617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Up to date, generic linezolid injections produced by Chinese manufacturers
were not widely used in clinics in China. Quality evaluation of linezolid injections produced in China
is a prerequisite, which has rarely been performed.
Objective:
This study aimed to evaluate the quality of branded and generic injections from different
manufacturers and to provide a basis for quality control.
Methods:
In this study, the content of linezolid, related impurities and enantiomer of linezolid were
determined by high-performance liquid chromatography. The content of glucose was determined by the
iodine method. The insoluble particles and visible and sub-visible particles were determined by light
blockage and lamp test, respectively. Osmotic pressure was determined by the freezing point depression
method. The standard solution control method was used to check the color of the injection. Linezolid
injections from different manufacturers were evaluated uniformly.
Results:
No significant difference was found in the content of linezolid, glucose, related impurities,
visible particles, insoluble particles, pH value, and solution color between branded and generic drugs
from different manufacturers in China.
Conclusion:
The quality of samples from different manufacturers is consistent. Although the physicochemical
similarity does not guarantee the bioequivalence of studied branded and generic linezolid injections,
the results provide references for further bioequivalence study. Generic injections offer more
affordable treatment options for patients with infections than expensive branded drugs.
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Affiliation(s)
- Su-hua Zhang
- Department of Pharmacy, Second Xiangya Hospital, Central South University, Changsha 410011,China
| | - Shan-shan Wei
- Department of Pharmacy, Second Xiangya Hospital, Central South University, Changsha 410011,China
| | - Zhen-yu Zhu
- Department of Pharmacy, Second Xiangya Hospital, Central South University, Changsha 410011,China
| | - Ying Chen
- Department of Pharmacy, Second Xiangya Hospital, Central South University, Changsha 410011,China
| | - Hua-lin Cai
- Department of Pharmacy, Second Xiangya Hospital, Central South University, Changsha 410011,China
| | - Bi-kui Zhang
- Department of Pharmacy, Second Xiangya Hospital, Central South University, Changsha 410011,China
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Antibiotic resistance and drug modification: Synthesis, characterization and bioactivity of newly modified potent ciprofloxacin derivatives. Bioorg Chem 2021; 108:104658. [PMID: 33517003 DOI: 10.1016/j.bioorg.2021.104658] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 01/08/2021] [Accepted: 01/12/2021] [Indexed: 11/23/2022]
Abstract
Development of new derivatives of commercial antibiotics using different organic reagents and testing these derivatives against different microorganisms are the main goals of this article. Thus, the antibiotic ciprofloxacin, CF, was acylated via reaction with ethyl cyanoacetate and ethyl acetoacetate in basic medium to give the cyanoacetylpiprazinyl dihydroquinoline derivative 3, and oxobutanoylpiprazinyl dihydroquinoline derivative 5, respectively. On the other hand, N-alkylated derivatives 8-10, were prepared through the reaction of CF with chloroacetonitrile, chloroacetyl acetone and chloroacetone in the presence of carbonate salt. In basic medium, both 3 and 10 were coupled with benzenediazonium chloride to afford hydrazono derivatives, which were then cyclized to give 4-(dihydropyridazinecarbonyl)piperazinyl-1,4-dihydroquinoline. Furthermore, compounds 3 and 10 were reacted with benylidenemalononitrile to produce 4H-pyan and pyrido[1,2-a]pyrazine derivatives, respectively. Both 3 and 10 were reacted with DMFDMA to give enaminone derivatives. These enaminones were cyclized to aminopyrimidine derivatives by reacting with urea or thiourea. X-ray, elemental analysis and spectral data were used to illustrate and confirm the structures of the isolated compounds. The bioactivities of the novel compounds were investigated against different gram-positive and gram-negative bacteria. In addition, these novel antibiotic derivatives were tested against ciprofloxacin-resistant bacteria isolated from patients aged 65-74 years. This study reveals that most of the modified drugs show high to moderate antibacterial activity. Additionally, these drugs show good effects against ciprofloxacin-resistant bacteria.
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Real-World Use of Generic Meropenem: Results of an Observational Study. Antibiotics (Basel) 2021; 10:antibiotics10010062. [PMID: 33440602 PMCID: PMC7827234 DOI: 10.3390/antibiotics10010062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/24/2020] [Accepted: 01/04/2021] [Indexed: 11/17/2022] Open
Abstract
Background: To determine the therapeutic effect and tolerability of meropenem in routine clinical practice, in terms of clinical and microbiological response. Methods: A real-world, observational, descriptive, longitudinal study with daily monitoring of clinical history records was conducted on all patients who were medically prescribed meropenem during a period between October 2015 and March 2016 at a university hospital in Bucaramanga (Colombia). Results: The study evaluated 84 patients with an average age of 63.2 years, mostly older adults with multiple comorbidities, of whom 54.8% were men. A positive clinical or microbiological response was obtained in 98.8% of the patients. At the end of the treatments, significant improvements in dysthermia (0% vs. 29% at the beginning, p = 0.000), tachycardia (13% vs. 47%, p = 0.049), and leukocytosis (39% vs. 15% at the beginning, p = 0.008) were evidenced. The improvement in the indicator that combines all the Systemic Inflammatory Response Syndrome (SIRS) criteria was also significant (p = 0.000). The treatment was well tolerated, although we identified some non-serious and expected adverse reactions. Conclusions: Generic meropenem proved to be effective and well tolerated for different types of infection in routine clinical practice. The results are consistent with the findings of the clinical studies with the innovator drug.
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Nabbe P, Le Reste JY, Guillou-Landreat M, Assenova R, Kasuba Lazic D, Czachowski S, Stojanović-Špehar S, Hasanagic M, Lingner H, Clavería A, Rodríguez-Barragán M, Sowinska A, Argyriadou S, Lygidakis C, Le Floch B, Montier T, Van Marwijk H, Van Royen P. Nine Forward-Backward Translations of the Hopkins Symptom Checklist-25 With Cultural Checks. Front Psychiatry 2021; 12:688154. [PMID: 34475830 PMCID: PMC8406698 DOI: 10.3389/fpsyt.2021.688154] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/07/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: The Hopkins Symptom Checklist-25 (HSCL-25) is an effective, reliable, and ergonomic tool that can be used for depression diagnosis and monitoring in daily practice. To allow its broad use by family practice physicians (FPs), it was translated from English into nine European languages (Greek, Polish, Bulgarian, Croatian, Catalan, Galician, Spanish, Italian, and French) and the translation homogeneity was confirmed. This study describes this process. Methods: First, two translators (an academic translator and an FP researcher) were recruited for the forward translation (FT). A panel of English-speaking FPs that included at least 15 experts (researchers, teachers, and practitioners) was organized in each country to finalize the FT using a Delphi procedure. Results: One or two Delphi procedure rounds were sufficient for each translation. Then, a different translator, who did not know the original version of the HSCL-25, performed a backward translation in English. An expert panel of linguists compared the two English versions. Differences were listed and a multicultural consensus group determined whether they were due to linguistic problems or to cultural differences. All versions underwent cultural check. Conclusion: All nine translations were finalized without altering the original meaning.
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Affiliation(s)
- Patrice Nabbe
- Department of General Practice, EA 7479 Soins primaires, Santé publique, Registre des cancers de Bretagne Occidentale, Université de Bretagne Occidentale, Brest, France
| | - Jean Yves Le Reste
- Department of General Practice, EA 7479 Soins primaires, Santé publique, Registre des cancers de Bretagne Occidentale, Université de Bretagne Occidentale, Brest, France
| | - Morgane Guillou-Landreat
- Department of Addictology, EA 7479 Soins primaires, Santé publique, Registre des cancers de Bretagne Occidentale, Université de Bretagne Occidentale, Brest, France
| | - Radost Assenova
- Department of Urology and General Medicine, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Djurdjica Kasuba Lazic
- Department of Family Medicine "Andrija Stampar, " School of Public Health, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Slawomir Czachowski
- Department of Clinical Psychology and Neuropsychology, Nicolaus Copernicus University, Torun, Poland
| | - Stanislava Stojanović-Špehar
- Department of Family Medicine "Andrija Stampar, " School of Public Health, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Melida Hasanagic
- Health Care Studies, University "Djemal Bijedic, " Mostar, Bosnia and Herzegovina
| | - Heidrun Lingner
- Centre for Public Health and Healthcare, Hannover Medical School, Hanover, Germany
| | - Ana Clavería
- Xerencia Xestión Integrada de Vigo, Servizo Galego de Saúde, Instituto de Investigación Sanitaria Galicia-Sur, Red de Investigación en Actividades Preventivas y de Promoción de la Salud, Vigo, Spain
| | - María Rodríguez-Barragán
- Centro de Atención Primaria La Mina, Gerencia Territorial de Atención Primaria de Barcelona, Instituto Catalán de la Salud, Sant Adrià de Besòs, Barcelona, Spain.,Fundación Instituto Universitario de Investigación en Atención Primaria de Salud Jordi Gol i Gurina (IDIAP Jordi Gol), Barcelona, Spain.,Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Agnieszka Sowinska
- Department of Experimental Linguistics, Nicolaus Copernicus University, Torun, Poland.,Escuela de Inglés, Universidad Catolica del Norte, Antofagasta, Chile
| | - Stella Argyriadou
- The Greek Association of General Practitioners (ELEGEIA), Thessaloniki, Greece
| | - Charileos Lygidakis
- Department of Behavioral and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Bernard Le Floch
- Department of General Practice, EA 7479 Soins primaires, Santé publique, Registre des cancers de Bretagne Occidentale, Université de Bretagne Occidentale, Brest, France
| | - Tristan Montier
- INSERM, Etablissement Français du Sang, UMR 1078, Génétique, Génomique Fonctionnelle et biotechnologies, Univ Brest, Brest, France.,Service de Génétique Médicale et Biologie de la Reproduction, CHRU de Brest, Brest, France
| | - Harm Van Marwijk
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Brighton, Brighton, United Kingdom
| | - Paul Van Royen
- INSERM, Etablissement Français du Sang, UMR 1078, Génétique, Génomique Fonctionnelle et biotechnologies, Univ Brest, Brest, France.,Department of Family Medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Murage JK, Amugune BK, Njogu P, Ndwigah S. Development and application of a spectrophotometric method in quality evaluation of benzimidazole anthelminthics in Nairobi city county. FUTURE JOURNAL OF PHARMACEUTICAL SCIENCES 2020. [DOI: 10.1186/s43094-020-00103-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Neglected tropical diseases (NTDs) are a group of communicable diseases which are prevalent in the tropics affecting more than one billion people. Treatment and prevention of these infections is very costly to developing economies. Helminthiases are classified among NTDs. The communities afflicted are poor and have limited access to essential resources for their livelihood. Poor-quality drugs for NTDs may lead to death or prolonged treatment without achieving the desired results. The limited resources used in purchasing poor-quality drugs will therefore be wasted instead of being put to good use.
Most of the methods available for the analysis of benzimidazole anthelminthics utilize high-performance liquid chromatography. They are therefore time consuming, require sophisticated and expensive equipment, utilize rare and expensive reagents and solvents, and call for skilled personnel. A simple, rapid, and inexpensive ultraviolet spectrophotometric method of analysis would therefore come in handy especially in the analysis of many samples as occurs during post-authorization market surveillance for quality.
Results
The suitable solvent for the spectroscopic analysis was established as 0.1 M methanolic HCl. The wavelength of analysis was set at 294 nm. Upon validation, the method was found to have good linearity. The range over which linearity was established was way beyond the 80 to 120% of the working concentration specified by the ICH. The method exhibited good precision.
Out of 32 commercial samples analyzed, five (15.6%) did not comply with compendial specifications. Intra-brand batch variation was also observed. Out of three batches of product A002T analyzed, one did not comply with compendial specifications.
Conclusion
A major limitation in the analysis of benzimidazole anthelminthics is the lack of reliable, simple, rapid, and low-cost methods of analysis with high throughput. The developed method serves to fill this gap. It can be used in the analysis of raw materials and finished products. It can also be used in the establishment of the quality of products prior to registration. The method will prove very useful in post-market surveillance of quality of benzimidazole anthelminthics.
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Successful response of primary sclerosing cholangitis and associated ulcerative colitis to oral vancomycin may depend on brand and personalized dose: report in an adolescent. Clin J Gastroenterol 2020; 14:684-689. [PMID: 33231850 DOI: 10.1007/s12328-020-01296-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/05/2020] [Indexed: 01/16/2023]
Abstract
Primary sclerosing cholangitis (PSC) is a rare, progressive liver disease characterized by cholestasis and bile duct fibrosis that has no accepted therapy known to delay or arrest its progression. We report a 23-year-old female patient who at age 14 was diagnosed with moderate pancolonic ulcerative colitis (UC) and at age 15 with small-duct PSC unresponsive to conventional therapy. The patient began single drug therapy with the antibiotic oral vancomycin (OVT) and achieved normalization of liver enzymes and resolution of UC symptoms with colonic mucosal healing. These improvements have persisted over 8 years. There has been no colon dysplasia, liver fibrosis or failure, bile duct stricture, or cancer. Of note, the patient's response was dependent on the brand of oral vancomycin capsule, as well as dose. This raised the questions of possible differences in bioequivalence of different commercial versions of the drug and whether this factor might play into the variability of efficacy seen in published trials. Evidence suggests that oral vancomycin both alters the intestinal microbiome and has immunomodulatory effects. Its striking effectiveness in this and other patients supports further investigation in randomized trials, with careful attention to its bioavailability profile in the gut.
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Nettles R, Ricks KD, Koide RT. The Dynamics of Interacting Bacterial and Fungal Communities of the Mouse Colon Following Antibiotics. MICROBIAL ECOLOGY 2020; 80:573-592. [PMID: 32451559 DOI: 10.1007/s00248-020-01525-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/05/2020] [Indexed: 05/25/2023]
Abstract
We tested two hypotheses concerning the dynamics of intestinal microbial communities of young mice following antibiotic-induced disturbance. The first is that disturbance of the bacterial community causes disturbance of the fungal community. Our results were consistent with that hypothesis. Antibiotics significantly altered bacterial community structure. Antibiotics also altered fungal community structure, significantly increasing the relative abundance of Candida lusitaniae, a known pathogen, while simultaneously significantly decreasing the relative abundances of several other common fungal species. The result was a temporary decrease in fungal diversity. Moreover, bacterial load was negatively correlated with the relative abundances of Candida lusitaniae and Candida parapsilosis, while it was positively correlated with the relative abundances of many other fungal species. Our second hypothesis is that control mice serve as a source of probiotics capable of invading intestines of mice with disturbed microbial communities and restoring pre-antibiotic bacterial and fungal communities. However, we found that control mice did not restore disturbed microbial communities. Instead, mice with disturbed microbial communities induced disturbance in control mice, consistent with the hypothesis that antibiotic-induced disturbance represents an alternate stable state that is easier to achieve than to correct. Our results indicate the occurrence of significant interactions among intestinal bacteria and fungi and suggest that the stimulation of certain bacterial groups may potentially be useful in countering the dominance of fungal pathogens such as Candida spp. However, the stability of disturbed microbial communities could complicate recovery.
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Affiliation(s)
- Rachel Nettles
- Department of Biology, Brigham Young University, Provo, UT, 84602, USA
- Currently: Kintai Therapeutics, 26 Landsdowne Street, Boston, MA, 02139, USA
| | - Kevin D Ricks
- Department of Biology, Brigham Young University, Provo, UT, 84602, USA
- Currently: Program in Ecology, Evolution and Conservation Biology, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
| | - Roger T Koide
- Department of Biology, Brigham Young University, Provo, UT, 84602, USA.
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Kim HK, Choi SM, Kang G, Park KH, Lee DG, Park WB, Rhee SJ, Lee S, Jung SI, Jang HC. Comparison of In Vivo Pharmacokinetics and Pharmacodynamics of Vancomycin Products Available in Korea. Yonsei Med J 2020; 61:301-309. [PMID: 32233172 PMCID: PMC7105400 DOI: 10.3349/ymj.2020.61.4.301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 03/10/2020] [Accepted: 03/10/2020] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Few studies have been investigated the in vivo efficacy of generic vancomycin products available outside of the United States. In this study, we aimed to compare the in vivo pharmacokinetics (PK) and pharmacodynamics (PD) of five generic vancomycin products available in Korea with those of the innovator. MATERIALS AND METHODS The in vitro vancomycin purity of each product was examined using high-pressure liquid chromatography. Single-dose PK analyses were performed using neutropenic mice. The in vivo efficacy of vancomycin products was compared with that of the innovator in dose-effect experiments (25 to 400 mg/kg per day) using a thigh-infection model with neutropenic mice. RESULTS Generic products had a lower proportion of vancomycin B (range: 90.3-93.8%) and a higher proportion of impurities (range: 6.2-9.7%) than the innovator (94.5% and 5.5%, respectively). In an in vivo single-dose PK study, the maximum concentration (Cmax) values of each generic were lower than that of the innovator, and the geographic mean area under the curve ratios of four generics were significantly lower than that of the innovator (all p<0.1). In the thigh-infection model, the maximum efficacies of generic products reflected in maximal effect (Emax) values were not significantly different from the innovator. However, the PD profile curves of some generic products differed significantly from that of the innovator in mice injected with a high level of Mu3 (all p≤0.05). CONCLUSION Some generic vancomycin products available in Korea showed inferior PK and PD profiles, especially in mice infected with hetero-vancomycin-resistant Staphylococcus aureus.
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Affiliation(s)
- Hee Kyung Kim
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Korea
| | - Su-Mi Choi
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Korea
| | - Gaeun Kang
- Division of Clinical Pharmacology, Department of Pharmacology, Chonnam National University Medical School, Gwangju, Korea
| | - Kyung-Hwa Park
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Korea
| | - Dong-Gun Lee
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Wan-Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Su-jin Rhee
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - SeungHwan Lee
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Sook-In Jung
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Korea
| | - Hee-Chang Jang
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Korea
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12
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Clinical and economic impact of generic versus brand name meropenem use in an intensive care unit in Colombia. Braz J Infect Dis 2019; 23:237-245. [PMID: 31344357 PMCID: PMC9427813 DOI: 10.1016/j.bjid.2019.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 06/13/2019] [Accepted: 06/16/2019] [Indexed: 01/08/2023] Open
Abstract
Background Recent studies suggest that sustained use of generic antibiotics may be associated with clinical failure and emergence of antibacterial resistance. The present study was designed to determine the clinical outcome between the use of generic meropenem (GM) and brand-name meropenem (BNM). Additionally, this study evaluated the economic impact of GM and BNM to determine if the former represents a cost-effective alternative to the latter. Methods Patients treated between January 2011 and May 2014 received GM while patients treated between June 2014 and March 2017 received BNM. Mortality was compared between groups. Total infection cost was defined by the cost of antimicrobial consumption, length of stay, and laboratory and imaging exams until infection resolution. Findings A total of 168 patients were included; survival rate for the 68 patients treated with GM was 38% compared to 59% in the patients treated with BNM. Multivariate analysis showed that the variables most strongly-associated with mortality were cardiovascular disease (OR 18.18, 95% CI 1.25–262.3, p = 0.033) and treatment with generic meropenem (OR 18.45, 95% CI 1.45–232.32, p = 0.024). On the other hand, total infection cost did not show a significant difference between groups (BNM $10,771 vs. GM $11,343; p = 0.91). Interpretation The present study suggests that patients treated with GM have a risk of death 18 times higher compared to those treated with BNM. Furthermore, economic analysis shows that GM is not more cost effective than BNM. Summary More studies measuring clinical outcomes are needed to confirm the clinical equivalence of brand-name versus generic antibiotics, not only for meropenem but also for other molecules.
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Secco G, Sachetti C, Rossato-Grando LG, Regina Hahn S, Pagnussat LR, da Cruz Fresco PMF, Dallazem Bertol C. Quality of Vancomycin for Injection Formulations in Brazil. CURR PHARM ANAL 2019. [DOI: 10.2174/1573412914666180116143232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
The presence of impurities in vancomycin compromised the safety and contributed
to decrease of its use for years. In Brazil, vancomycin generic drug represents an option to reduce
hospital costs. However, the controversy over the quality of these formulations and their relationship
to effectiveness and safety raised concerns.
Objective and Methods:
To assess in vitro quality of vancomycin injections through uniformity of
weight, pH, clarity of solution, microbiological assay and impurities determination by High Performance
Liquid Chromatography (HPLC).
Results:
The samples were approved in the tests.
Conclusion:
The injectable formulations of vancomycin proved to be safe for use in hospital environment.
This work contributes to increase health professionals’ confidence on generic vancomycin.
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Affiliation(s)
- Gabriela Secco
- Curso de Farmacia, Instituto de Ciencias Biologicas, Universidade de Passo Fundo, Passo Fundo, RS, Brazil
| | - Cristiane Sachetti
- Curso de Farmacia, Instituto de Ciencias Biologicas, Universidade de Passo Fundo, Passo Fundo, RS, Brazil
| | | | - Siomara Regina Hahn
- Curso de Farmacia, Instituto de Ciencias Biologicas, Universidade de Passo Fundo, Passo Fundo, RS, Brazil
| | - Lidiane Riva Pagnussat
- Servico de Controle de Infeccao Hospitalar, Hospital Sao Vicente de Paulo, Passo Fundo, RS, Brazil
| | | | - Charise Dallazem Bertol
- Curso de Farmacia, Instituto de Ciencias Biologicas, Universidade de Passo Fundo, Passo Fundo, RS, Brazil
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Agudelo M, Rodriguez CA, Zuluaga AF, Vesga O. Nontherapeutic equivalence of a generic product of imipenem-cilastatin is caused more by chemical instability of the active pharmaceutical ingredient (imipenem) than by its substandard amount of cilastatin. PLoS One 2019; 14:e0211096. [PMID: 30726248 PMCID: PMC6364906 DOI: 10.1371/journal.pone.0211096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 01/02/2019] [Indexed: 11/25/2022] Open
Abstract
Background We demonstrated therapeutic nonequivalence of “bioequivalent” generics for meropenem, but there is no data with generics of other carbapenems. Methods One generic product of imipenem-cilastatin was compared with the innovator in terms of in vitro susceptibility testing, pharmaceutical equivalence, pharmacokinetic (PK) and pharmacodynamic (PD) equivalence in the neutropenic mouse thigh, lung and brain infection models. Both pharmaceutical forms were then subjected to analytical chemistry assays (LC/MS). Results and conclusion The generic product had 30% lower concentration of cilastatin compared with the innovator of imipenem-cilastatin. Regarding the active pharmaceutical ingredient (imipenem), we found no differences in MIC, MBC, concentration or potency or AUC, confirming equivalence in terms of in vitro activity. However, the generic failed therapeutic equivalence in all three animal models. Its Emax against S. aureus in the thigh model was consistently lower, killing from 0.1 to 7.3 million less microorganisms per gram in 24 hours than the innovator (P = 0.003). Against K. pneumoniae in the lung model, the generic exhibited a conspicuous Eagle effect fitting a Gaussian equation instead of the expected sigmoid curve of the Hill model. In the brain infection model with P. aeruginosa, the generic failed when bacterial growth was >4 log10 CFU/g in 24 hours, but not if it was less than 2.5 log10 CFU/g. These large differences in the PD profile cannot be explained by the lower concentration of cilastatin, and rather suggested a failure attributable to the imipenem constituent of the generic product. Analytical chemistry assays confirmed that, besides having 30% less cilastatin, the generic imipenem was more acidic, less stable, and exhibited four different degradation masses that were absent in the innovator.
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Affiliation(s)
- Maria Agudelo
- GRIPE: Grupo Investigador de Problemas en Enfermedades Infecciosas, University of Antioquia (UdeA) Medical School, Medellín, Colombia
- Infectious Diseases Unit, Hospital Universitario San Vicente Fundación, Medellín, Colombia
| | - Carlos A. Rodriguez
- GRIPE: Grupo Investigador de Problemas en Enfermedades Infecciosas, University of Antioquia (UdeA) Medical School, Medellín, Colombia
- CIEMTO: Centro de Información de Medicamentos y Tóxicos, University of Antioquia (UdeA) Medical School, Medellín, Colombia
| | - Andres F. Zuluaga
- GRIPE: Grupo Investigador de Problemas en Enfermedades Infecciosas, University of Antioquia (UdeA) Medical School, Medellín, Colombia
- CIEMTO: Centro de Información de Medicamentos y Tóxicos, University of Antioquia (UdeA) Medical School, Medellín, Colombia
| | - Omar Vesga
- GRIPE: Grupo Investigador de Problemas en Enfermedades Infecciosas, University of Antioquia (UdeA) Medical School, Medellín, Colombia
- Infectious Diseases Unit, Hospital Universitario San Vicente Fundación, Medellín, Colombia
- * E-mail:
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15
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Drug utilization study of two generic antibiotics in a tertiary hospital in Bogotá. BIOMEDICA 2018; 38:398-406. [PMID: 30335245 DOI: 10.7705/biomedica.v38i4.3831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 10/24/2017] [Indexed: 11/21/2022]
Abstract
Introduction: The Colombian national pharmaceutical policy establishes as a strategy the generation of greater pharmaco-epidemiological research at the national level, especially in the case of antibiotic drugs.
Objective: To provide local pharmaco-epidemiological evidence regarding the effectiveness, conditions of use and safety of generic meropenem and cefepime in a tertiary hospital in Bogotá.
Materials and methods: We conducted a descriptive, longitudinal and retrospective drug utilization study. The data were collected from the medical histories of all the patients who had cefepime or meropenem prescribed.
Results: We included 82 patients treated with cefepime and 91 treated with meropenem in the study. Most of the patients were in services different from the intensive care unit (taking cefepime: 59.8%, and meropenem: 52.7%). Only 21.9% of the patients treated with cefepime and 49% of those treated with meropenem were seen by an infectious disease specialist. The antibiogram was performed for 47% and 60% of the patients treated with cefepime and meropenem, respectively. The most frequent
indication for cefepime were respiratory infections and for meropenem, genitourinary ones. Therapeutic success rates were 61.7% for cefepime and 63.0% for meropenem.
Conclusions: This study contributes evidence regarding the therapeutic performance of two generic antibiotics used in tertiary hospitals. There were no reports of therapeutic failure during the study period. In the cases of non-response, pharmacokinetic alterations, unfavorable clinical conditions, and inappropriate choice of antimicrobial treatment were identified as frequent factors.
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16
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Fabri FV, Lolis MA, Gimenes M, Tognim MCB, Caparroz-Assef SM. Different formulations of vancomycin: In vitro antimicrobial activity against clinical isolates of methicillin-resistant Staphylococcus aureus. Diagn Microbiol Infect Dis 2018; 92:332-337. [PMID: 30033164 DOI: 10.1016/j.diagmicrobio.2018.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 02/18/2018] [Accepted: 06/21/2018] [Indexed: 11/16/2022]
Abstract
We compared in vitro antimicrobial activity of four vancomycin formulations used clinically against clinical isolates of Staphylococcus aureus, including methicillin-resistant and -susceptible (MRSA and MSSA, respectively), using different susceptibility assays. The minimal inhibitory concentrations (MICs) against MRSA clinical isolates were significantly different for some vancomycin formulations by the broth microdilution and agar dilution methods. However, these variations would not compromise their clinical use, since the MICs were within the range recommended by the Clinical and Laboratory Standards Institute. Furthermore, 26.9% of MRSA clinical isolates showed a vancomycin MIC ≥1.5 μg/mL according to the Etest® method but none by broth microdilution. Regarding quality, all formulations were in accordance with United States Pharmacopeia criteria. Our results showed that all vancomycin formulations tested showed similar in vitro antimicrobial activity, making them suitable for clinical use, and that the evaluation method chosen to determine sensitivity to this antimicrobial should be carefully performed, particularly for MRSA.
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Affiliation(s)
- Franciele Viana Fabri
- Post Graduate Program in Biociências e Fisiopatologia, Universidade Estadual de Maringá, Maringá, PR, Brazil.
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17
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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. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 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] [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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18
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Sharma D, Patel RP, Zaidi STR, Sarker MMR, Lean QY, Ming LC. Interplay of the Quality of Ciprofloxacin and Antibiotic Resistance in Developing Countries. Front Pharmacol 2017; 8:546. [PMID: 28871228 PMCID: PMC5566961 DOI: 10.3389/fphar.2017.00546] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 08/04/2017] [Indexed: 12/01/2022] Open
Abstract
Ciprofloxacin, a second generation broad spectrum fluoroquinolone, is active against both Gram-positive and Gram-negative bacteria. Ciprofloxacin has a high oral bioavailability and a large volume of distribution. It is used for the treatment of a wide range of infections including urinary tract infections caused by susceptible bacteria. However, the availability and use of substandard and spurious quality of oral ciprofloxacin formulations in the developing countries has been thought to have contributed toward increased risk of treatment failure and bacterial resistance. Therefore, quality control and bioequivalence studies of the commercially available oral ciprofloxacin formulations should be monitored. Appropriate actions should be taken against offending manufacturers in order to prevent the sale of substandard and spurious quality of ciprofloxacin formulations.
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Affiliation(s)
- Deepali Sharma
- Pharmacy, School of Medicine, University of Tasmania, HobartTAS, Australia
| | - Rahul P Patel
- Pharmacy, School of Medicine, University of Tasmania, HobartTAS, Australia
| | | | | | - Qi Ying Lean
- Vector borne Diseases Research Group, Pharmaceutical and Life Sciences CoRe, Universiti Teknologi MARAShah Alam, Malaysia.,Faculty of Pharmacy, Universiti Teknologi MARABertam, Malaysia
| | - Long C Ming
- Pharmacy, School of Medicine, University of Tasmania, HobartTAS, Australia.,School of Pharmacy, KPJ Healthcare University CollegeNegeri Sembilan, Malaysia
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19
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Mer M, Snyman JR, van Rensburg CEJ, van Tonder JJ, Laurens I. A prospective, observational study comparing the PK/PD relationships of generic Meropenem (Mercide ®) to the innovator brand in critically ill patients. Clin Pharmacol 2016; 8:191-198. [PMID: 27895516 PMCID: PMC5117905 DOI: 10.2147/cpaa.s106676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Clinicians’ skepticism, fueled by evidence of inferiority of some multisource generic antimicrobial products, results in the underutilization of more cost-effective generics, especially in critically ill patients. The aim of this observational study was to demonstrate equivalence between the generic or comparator brand of meropenem (Mercide®) and the leading innovator brand (Meronem®) by means of an ex vivo technique whereby antimicrobial activity is used to estimate plasma concentration of the active moiety. Methods Patients from different high care and intensive care units were recruited for observation when prescribed either of the meropenem brands under investigation. Blood samples were collected over 6 hours after a 30 minute infusion of the different brands. Meropenem concentration curves were established against United States Pharmacopeia standard meropenem (Sigma-Aldrich) by using standard laboratory techniques for culture of Klebsiella pneumoniae. Patients’ plasma samples were tested ex vivo, using a disc diffusion assay, to confirm antimicrobial activity and estimate plasma concentrations of the two brands. Results Both brands of meropenem demonstrated similar curves in donor plasma when concentrations in vials were confirmed. Patient-specific serum concentrations were determined from zones of inhibition against a standard laboratory Klebsiella strain ex vivo, confirming at least similar in vivo concentrations as the concentration curves (90% confidence interval) overlapped; however, the upper limit of the area under the curve for the ratio comparator/innovator exceeded the 1.25-point estimate, i.e., 4% higher for comparator meropenem. Conclusion This observational, in-practice study demonstrates similar ex vivo activity and in vivo plasma concentration time curves for the products under observation. Assay sensitivity is also confirmed. Current registration status of generic small molecules is in place. The products are therefore clinically interchangeable based on registration status as well as bioassay results, demonstrating sufficient overlap for clinical comfort. The slightly higher observed comparator meropenem concentration (4%) is still clinically acceptable due to the large therapeutic index and should ally fears of inferiority.
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Affiliation(s)
- Mervyn Mer
- Department of Medicine, Divisions of Critical Care and Pulmonology, University of the Witwatersrand, Johannesburg, South Africa
| | - Jacques Rene Snyman
- Office of the Dean, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | | | - Jacob John van Tonder
- Scientific Affairs Department, Triclinium Clinical Development (Pty) Ltd, Centurion, South Africa
| | - Ilze Laurens
- Office of the Dean, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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20
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Lee SH, Tai CL, Chen SY, Chang CH, Chang YH, Hsieh PH. Elution and Mechanical Strength of Vancomycin-Loaded Bone Cement: In Vitro Study of the Influence of Brand Combination. PLoS One 2016; 11:e0166545. [PMID: 27855203 PMCID: PMC5113949 DOI: 10.1371/journal.pone.0166545] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 10/31/2016] [Indexed: 01/19/2023] Open
Abstract
Antibiotic-loaded bone cement (ALBC) is widely used in orthopaedic surgery for both prevention and treatment of infection. Little is known about the effect of different brand combinations of antibiotic and bone cement on the elution profile and mechanical strength of ALBC. Standardized specimens that consisted of one of the 4 brands of bone cement and one of the 3 brands of vancomycin were fashioned, producing 12 combinations of ALBC. Two dosages of vancomycin in 40g bone cement were used to represent the high (4g vancomycin) and low (1g vancomycin) dose groups. Concentrations of vancomycin elution from ALBC was measured for up to 336 hours. The ultimate compression strength was tested at axial compression using a material testing machine before and after elution. In both high-dose and low-dose groups, Lyo-Vancin in PALACOS bone cement resulted in the highest cumulative elution and Vanco in Simplex P bone cement resulted in the lowest elution (458% and 65% higher in high- and low-dose groups, respectively). The mechanical strength was not significantly compromised in all groups with low dose vancomycin (range: 70.31 ± 2.74 MPa to 87.28 ± 8.26MPa after elution). However, with the addition of high dose vancomycin, there was a mixed amount of reduction in the ultimate compression strength after cement aging, ranging from 5% (Vanco in Simplex P, 81.10 ± 0.48 MPa after elution) to 38% (Sterile vancomycin in CMW, 60.94 ± 5.74 MPa after elution). We concluded that the selection of brands of vancomycin and bone cement has a great impact on the release efficacy and mechanical strength of ALBC.
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Affiliation(s)
- Sheng-Hsun Lee
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, R.O.C.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, R.O.C
| | - Ching-Lung Tai
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, R.O.C.,Graduate Institute of Medical Mechatronics, Chang Gung University, No. 259, Wenhua 1st Rd., Guidshan Dist., Taoyuan City, 333, Taiwan, R.O.C
| | - Szu-Yuan Chen
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, R.O.C.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, R.O.C
| | - Chih-Hsiang Chang
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, R.O.C.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, R.O.C
| | - Yu-Han Chang
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, R.O.C.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, R.O.C
| | - Pang-Hsin Hsieh
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, R.O.C.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, R.O.C
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Aguirre TAS, Teijeiro-Osorio D, Rosa M, Coulter IS, Alonso MJ, Brayden DJ. Current status of selected oral peptide technologies in advanced preclinical development and in clinical trials. Adv Drug Deliv Rev 2016; 106:223-241. [PMID: 26921819 DOI: 10.1016/j.addr.2016.02.004] [Citation(s) in RCA: 211] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 02/15/2016] [Accepted: 02/18/2016] [Indexed: 01/12/2023]
Abstract
The development of oral dosage forms that allows absorption of therapeutic peptides to the systemic circulation is one of the greatest challenges for the pharmaceutical industry. Currently, a number of technologies including either mixtures of penetration enhancers or protease inhibitors and/or nanotechnology-based products are under clinical development. Typically, these formulations are presented in the form of enteric-coated tablets or capsules. Systems undergoing preclinical investigation include further advances in nanotechnology, including intestinal microneedle patches, as well as their combination with regional delivery to the colon. This review critically examines four selected promising oral peptide technologies at preclinical stage and the twelve that have progressed to clinical trials, as indicated in www.clinicaltrials.gov. We examined these technologies under the criteria of peptide selection, formulation design, system components and excipients, intestinal mechanism of action, efficacy in man, and safety issues. The conclusion is that most of the technologies in clinical trials are incremental rather than paradigm-shifting and that even the more clinically advanced oral peptide drugs examples of oral bioavailability appear to yield oral bioavailability values of only 1-2% and are, therefore, only currently suitable for a limited range of peptides.
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Affiliation(s)
- T A S Aguirre
- Centro de Ciências Exatas e Tecnologia, Universidade de Caxias do Sul (UCS), Caxias do Sul, Brazil
| | - D Teijeiro-Osorio
- CIMUS Research Institute, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - M Rosa
- Sigmoid Pharma, Dublin City University, Invent Centre, Dublin 9, Ireland
| | - I S Coulter
- Sigmoid Pharma, Dublin City University, Invent Centre, Dublin 9, Ireland
| | - M J Alonso
- CIMUS Research Institute, University of Santiago de Compostela, Santiago de Compostela, Spain.
| | - D J Brayden
- UCD School of Veterinary Medicine and UCD Conway Institute, University College Dublin, Belfield, Dublin 4, Ireland.
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Boix-Montañes A, Garcia-Arieta A. About the equivalence between different batches of a glycopeptide drug. Pharm Dev Technol 2016; 21:642-5. [DOI: 10.3109/10837450.2015.1035726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Antonio Boix-Montañes
- Departamento de Farmacia y Tecnologia Farmacéutica, Facultad de Farmacia/Universidad de Barcelona, Barcelona, Spain and
| | - Alfredo Garcia-Arieta
- División de Farmacología y Evaluación Clínica, Departamento de Medicamentos de Uso Humano, Agencia Española de Medicamentos y Productos Sanitarios, Madrid, Spain
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Impact on Bacterial Resistance of Therapeutically Nonequivalent Generics: The Case of Piperacillin-Tazobactam. PLoS One 2016; 11:e0155806. [PMID: 27191163 PMCID: PMC4871539 DOI: 10.1371/journal.pone.0155806] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 05/04/2016] [Indexed: 11/19/2022] Open
Abstract
Previous studies have demonstrated that pharmaceutical equivalence and pharmacokinetic equivalence of generic antibiotics are necessary but not sufficient conditions to guarantee therapeutic equivalence (better called pharmacodynamic equivalence). In addition, there is scientific evidence suggesting a direct link between pharmacodynamic nonequivalence of generic vancomycin and promotion of resistance in Staphylococcus aureus. To find out if even subtle deviations from the expected pharmacodynamic behavior with respect to the innovator could favor resistance, we studied a generic product of piperacillin-tazobactam characterized by pharmaceutical and pharmacokinetic equivalence but a faulty fit of Hill's Emax sigmoid model that could be interpreted as pharmacodynamic nonequivalence. We determined the impact in vivo of this generic product on the resistance of a mixed Escherichia coli population composed of ∼99% susceptible cells (ATCC 35218 strain) and a ∼1% isogenic resistant subpopulation that overproduces TEM-1 β-lactamase. After only 24 hours of treatment in the neutropenic murine thigh infection model, the generic amplified the resistant subpopulation up to 20-times compared with the innovator, following an inverted-U dose-response relationship. These findings highlight the critical role of therapeutic nonequivalence of generic antibiotics as a key factor contributing to the global problem of bacterial resistance.
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Sun HY, Liao HW, Sheng MH, Tai HM, Kuo CH, Sheng WH. Bioequivalence and in vitro antimicrobial activity between generic and brand-name levofloxacin. Diagn Microbiol Infect Dis 2016; 85:347-351. [PMID: 27181716 DOI: 10.1016/j.diagmicrobio.2016.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 03/18/2016] [Accepted: 04/23/2016] [Indexed: 01/07/2023]
Abstract
Generic agents play a crucial role in reducing the cost of medical care in many countries. However, the therapeutic equivalence remains a great concern. Our study aims to assess the in vitro antimicrobial activity and bioequivalence between generic and brand-name levofloxacin. Enantiomeric purity test, dissolution test, and in vitro antimicrobial susceptibility against seven clinically important pathogens by the agar dilution method were employed to assess the similarity between four generic products and brand-name levofloxacin (Daiichi Sankyo). All the generic and brand-name levofloxacin passed enantiomeric purity test. The results of dissolution tests were not similar among the generic products and the brand-name levofloxacin. Compared with the generic products, the brand-name levofloxacin had the smallest mean variations (-25% to 13%) with reference standard (United States Pharmacopeia levofloxacin Reference Standards). Variations were observed particularly in dissolution profiles and in vitro activity between generic products and brand-name levofloxacin.
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Affiliation(s)
- Hsin-Yun Sun
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiao-Wei Liao
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | | | - Hui-Min Tai
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Hua Kuo
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Wang-Huei Sheng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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Demonstration of Therapeutic Equivalence of Fluconazole Generic Products in the Neutropenic Mouse Model of Disseminated Candidiasis. PLoS One 2015; 10:e0141872. [PMID: 26536105 PMCID: PMC4633286 DOI: 10.1371/journal.pone.0141872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 10/14/2015] [Indexed: 11/25/2022] Open
Abstract
Some generics of antibacterials fail therapeutic equivalence despite being pharmaceutical equivalents of their innovators, but data are scarce with antifungals. We used the neutropenic mice model of disseminated candidiasis to challenge the therapeutic equivalence of three generic products of fluconazole compared with the innovator in terms of concentration of the active pharmaceutical ingredient, analytical chemistry (liquid chromatography/mass spectrometry), in vitro susceptibility testing, single-dose serum pharmacokinetics in infected mice, and in vivo pharmacodynamics. Neutropenic, five week-old, murine pathogen free male mice of the strain Udea:ICR(CD-2) were injected in the tail vein with Candida albicans GRP-0144 (MIC = 0.25 mg/L) or Candida albicans CIB-19177 (MIC = 4 mg/L). Subcutaneous therapy with fluconazole (generics or innovator) and sterile saline (untreated controls) started 2 h after infection and ended 24 h later, with doses ranging from no effect to maximal effect (1 to 128 mg/kg per day) divided every 3 or 6 hours. The Hill’s model was fitted to the data by nonlinear regression, and results from each group compared by curve fitting analysis. All products were identical in terms of concentration, chromatographic and spectrographic profiles, MICs, mouse pharmacokinetics, and in vivo pharmacodynamic parameters. In conclusion, the generic products studied were pharmaceutically and therapeutically equivalent to the innovator of fluconazole.
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Pharmacodynamics of nine generic products of amikacin compared with the innovator in the neutropenic mouse thigh infection model. BMC Res Notes 2015; 8:546. [PMID: 26445936 PMCID: PMC4596513 DOI: 10.1186/s13104-015-1507-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 09/21/2015] [Indexed: 11/21/2022] Open
Abstract
Background Previously, we validated the mouse thigh infection model to test the therapeutic equivalence of generic antibiotic products. Here, our aim was to compare the in vivo efficacy of amikacin products in clinical use in Colombia using this animal model. Results All except one generic product had the same in vitro potency, judging by the lack of differences on MIC and MBC compared with the innovator. However, eight of nine generic products failed in the neutropenic mouse thigh infection model to achieve the innovator’s maximum effect (Emax ≤ 5.65 for the generics vs. 6.58 log10 CFU/g for the innovator) against Escherichia coli SIG-1, after subcutaneous treatment every 6 h with doses ranging from 1.5 to 3072 mg/kg per day. Conclusion As we demonstrated previously with other antibiotics such as vancomycin, gentamicin and oxacillin, the generic products of amikacin failed the in vivo efficacy testing. The therapeutic equivalence should be assessed in vivo before clinical approval of generic products.
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Nephrotoxicity comparison of two commercially available generic vancomycin products. Antimicrob Agents Chemother 2015; 59:5470-4. [PMID: 26124161 DOI: 10.1128/aac.00388-15] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 06/15/2015] [Indexed: 01/15/2023] Open
Abstract
To date, no comparative clinical studies have investigated the effects of different vancomycin products on nephrotoxicity. The objective of this single-center, retrospective, matched-cohort study was to investigate the impact of two different vancomycin products on the development of nephrotoxicity. The study population included adults receiving a single vancomycin product, from either Pfizer or Hospira, for their entire course of therapy. Patients were matched based on underlying nephrotoxicity risk factors. Secondary outcomes included the need for renal replacement therapy, length of hospital stay, and in-hospital mortality. One-hundred forty-six matched pairs (n = 292) were included, and they had no significant differences in demographics, comorbid conditions, severity of illness, or vancomycin-associated nephrotoxicity risk factors. The frequency of nephrotoxicity was 8.9% in the Pfizer group and 11.0% in the Hospira group as defined by the 2009 consensus vancomycin guidelines (P = 0.56), 17.1% in the Pfizer group and 13.0% in the Hospira group as defined by the Acute Kidney Injury Network (AKIN) (P = 0.33), and 10.3% in the Pfizer group and 11.6% in the Hospira group as defined by RIFLE (risk, injury, failure, loss, and end-stage renal disease) criteria (P = 0.71). There were no differences between groups in regard to nephrotoxicity by any definition or in secondary outcomes. In multivariate analysis of overall nephrotoxicity risk factors, the type of vancomycin product was not independently associated with increased odds of developing nephrotoxicity according to the RIFLE criteria. Based on our results, there are no discernible differences between Pfizer and Hospira vancomycin products in the frequency of nephrotoxicity. Confirmation of these results with other types of vancomycin and different patient populations is warranted.
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Choe H, Inaba Y, Kobayashi N, Miyamae Y, Ike H, Saito T. Clinical utility of antibiotic-loaded hydroxyapatite block for treatment of intractable periprosthetic joint infection and septic arthritis of the hip. Mod Rheumatol 2015; 25:937-42. [PMID: 25800641 DOI: 10.3109/14397595.2015.1031360] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Antibiotic-loaded hydroxyapatite block (AHAB) allows gradual release of antibiotics for long duration without thermal damage and, therefore, is potentially a more effective antibacterial spacer than antibiotic-loaded polymethylmethacrylate cement (ALAC). The purposes of this study are to assess the utility of AHAB for the treatment of periprosthetic joint infection (PJI) or septic arthritis (SA) of the hip and to assess the potency of AHAB and ALAC in vitro. METHODS AHAB was utilized in two-stage reconstruction surgery for 20 PJI and 7 SA patients. Clinical success was confirmed if the patients did not show any sign of recurrence of infection during the follow-up period. Duration and amount of active vancomycin (VCM) released from AHAB and ALAC spacer were investigated in vitro. RESULTS Two-stage reconstruction using AHAB significantly improved hip function and showed 100% clinical success with mean follow-up of 37 months. The in vitro duration of the active effect of VCM released from AHAB (21 days) was longer than that from ALAC (7 days) and the amount of active VCM released from AHAB was higher than that from ALAC. CONCLUSIONS AHAB promises to release higher amounts of active VCM for longer durations than ALAC; therefore, it is a promising treatment for intractable PJI or SA.
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Affiliation(s)
- Hyonmin Choe
- a Department of Orthopaedic Surgery , Yokohama City University , Yokohama , Japan
| | - Yutaka Inaba
- a Department of Orthopaedic Surgery , Yokohama City University , Yokohama , Japan
| | - Naomi Kobayashi
- a Department of Orthopaedic Surgery , Yokohama City University , Yokohama , Japan
| | - Yushi Miyamae
- a Department of Orthopaedic Surgery , Yokohama City University , Yokohama , Japan
| | - Hiroyuki Ike
- a Department of Orthopaedic Surgery , Yokohama City University , Yokohama , Japan
| | - Tomoyuki Saito
- a Department of Orthopaedic Surgery , Yokohama City University , Yokohama , Japan
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Lewis PO, Kirk LM, Brown SD. Comparison of three generic vancomycin products using liquid chromatography-mass spectrometry and an online tool. Am J Health Syst Pharm 2015; 71:1029-38. [PMID: 24865760 DOI: 10.2146/ajhp130516] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Three different generic vancomycin products were compared using liquid chromatography-mass spectrometry (LC-MS) and open-access metabolomic tools. METHODS Single-lot samples of vancomycin hydrochloride from three different manufacturers (Hospira, APP Pharmaceuticals, and Pfizer) were reconstituted and injected into a high-resolution LC-MS system. The mass spectral fingerprints were compared for similarity of nonvancomycin B components using the XCMS Online system through Scripps University. Significance was defined as a p of ≤0.01 and a fold change of ≥1.5. The concentration of vancomycin B in each product was also measured using LC-MS on days 0, 1, 2, 4, 7, 10, and 14. RESULTS Qualitative comparisons of the products using the XCMS Online interface indicated the presence of significant differences among the products at the time of reconstitution; however, these variations seemed to converge after 14 days of storage. The concentration profiles of vancomycin B during refrigerated storage did not differ significantly among the three products. XCMS Online analyses revealed that the Pfizer and Hospira products were the most similar to each other. CONCLUSION While there were no significant differences found in the concentration of vancomycin B among Pfizer, APP, and Hospira products, there were differences in their initial mass spectral analysis after reconstitution. Liquid chromatography-tandem mass spectrometry profiles of the ions or isotopes present in the three products showed significant differences in impurities such as crystalline degradation product (CDP)-1 and CDP intermediate. After 14 days of refrigerated storage, the differences among the products converged, and fewer distinct features could be detected.
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Affiliation(s)
- Paul O Lewis
- Paul O. Lewis, Pharm.D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases, Johnson City Medical Center, Johnson City, TN. Loren M. Kirk, B.S., is Pharm.D. Candidate; and Stacy D. Brown, Ph.D., is Associate Professor of Pharmaceutical Sciences, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City.
| | - Loren M Kirk
- Paul O. Lewis, Pharm.D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases, Johnson City Medical Center, Johnson City, TN. Loren M. Kirk, B.S., is Pharm.D. Candidate; and Stacy D. Brown, Ph.D., is Associate Professor of Pharmaceutical Sciences, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City
| | - Stacy D Brown
- Paul O. Lewis, Pharm.D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases, Johnson City Medical Center, Johnson City, TN. Loren M. Kirk, B.S., is Pharm.D. Candidate; and Stacy D. Brown, Ph.D., is Associate Professor of Pharmaceutical Sciences, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City
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Agudelo M, Rodriguez CA, Zuluaga AF, Vesga O. Relevance of various animal models of human infections to establish therapeutic equivalence of a generic product of piperacillin/tazobactam. Int J Antimicrob Agents 2014; 45:161-7. [PMID: 25481459 DOI: 10.1016/j.ijantimicag.2014.10.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 10/09/2014] [Accepted: 10/15/2014] [Indexed: 11/27/2022]
Abstract
After demonstrating with diverse intravenous antibacterials that pharmaceutical equivalence (PE) does not predict therapeutic equivalence, we tested a single generic product of piperacillin/tazobactam (TZP) in terms of PE, pharmacokinetics and in vitro/vivo pharmacodynamics against several pathogens in neutropenic mouse thigh, lung and brain infection models. A generic product was compared head-to-head against the innovator. PE was evaluated by microbiological assay. Single-dose serum pharmacokinetics were determined in infected mice, and the MIC/MBC were determined by broth microdilution. In vivo experiments were done in a blind fashion. Reproducibility was tested on different days using different infecting organisms and animal models. Neutropenic MPF mice were infected in the thighs with Staphylococcus aureus GRP-0057 or Pseudomonas aeruginosa PA01 and in the lungs or brain with Klebsiella pneumoniae ATCC 10031. Treatment started 2h (thigh and brain) or 14 h (lung) after infection and was administered every 3h over 24h (thigh and lung) or 48 h (brain). Both products exhibited the same MIC/MBC against each strain, yielded overlaid curves in the microbiological assay (P>0.21) and were bioequivalent (IC90 83-117% for AUC test/reference ratio). In vivo, the generic product and innovator were again undistinguishable in all models and against the different bacterial pathogens involved. The relevance of these neutropenic murine models of infection was established by demonstrating their accuracy to predict the biological response following simultaneous treatment with a generic product or the innovator of TZP. Therapeutic equivalence of the generic product was proved in every model and against different pathogens.
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Affiliation(s)
- Maria Agudelo
- Grupo Investigador de Problemas en Enfermedades Infecciosas (GRIPE), University of Antioquia Medical School, Medellín, Colombia; Department of Pharmacology & Toxicology, University of Antioquia Medical School, Medellín, Colombia; Infectious Diseases Unit, Hospital Universitario de San Vicente Fundación, Medellín, Colombia
| | - Carlos A Rodriguez
- Grupo Investigador de Problemas en Enfermedades Infecciosas (GRIPE), University of Antioquia Medical School, Medellín, Colombia; Department of Pharmacology & Toxicology, University of Antioquia Medical School, Medellín, Colombia
| | - Andres F Zuluaga
- Grupo Investigador de Problemas en Enfermedades Infecciosas (GRIPE), University of Antioquia Medical School, Medellín, Colombia; Department of Pharmacology & Toxicology, University of Antioquia Medical School, Medellín, Colombia
| | - Omar Vesga
- Grupo Investigador de Problemas en Enfermedades Infecciosas (GRIPE), University of Antioquia Medical School, Medellín, Colombia; Department of Pharmacology & Toxicology, University of Antioquia Medical School, Medellín, Colombia; Infectious Diseases Unit, Hospital Universitario de San Vicente Fundación, Medellín, Colombia; Department of Internal Medicine, University of Antioquia Medical School, Medellín, Colombia.
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Vecino E. REACTION to the review article ‘The consequences of generic marketing on antibiotic consumption and the spread of microbial resistance: the need for new antibiotics’. J Vet Pharmacol Ther 2014; 37:615-7. [DOI: 10.1111/jvp.12167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- E. Vecino
- EGGVP (European Group for Generic Veterinary Products); Brussels Belgium
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Pharmacodynamic evaluation of the activities of six parenteral vancomycin products available in the United States. Antimicrob Agents Chemother 2014; 59:622-32. [PMID: 25385113 DOI: 10.1128/aac.03710-14] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A recent report found that generic parenteral vancomycin products may not have in vivo efficacies equivalent to those of the innovator in a neutropenic murine thigh infection model despite having similar in vitro microbiological activities and murine serum pharmacokinetics. We compared the in vitro and in vivo activities of six of the parenteral vancomycin products available in the United States. The in vitro assessments for the potencies of the vancomycin products included MIC/minimal bactericidal concentration (MBC) determinations, quantifying the impact of human and murine serum on the MIC values, and time-kill studies. Also, the potencies of the vancomycin products were quantified with a biological assay, and the human and mouse serum protein binding rates for the vancomycin products were measured. The in vivo studies included dose-ranging experiments with the 6 vancomycin products for three isolates of Staphylococcus aureus in a neutropenic mouse thigh infection model. The pharmacokinetics of the vancomycin products were assessed in infected mice by population pharmacokinetic modeling. No differences were seen across the vancomycin products with regard to any in vitro evaluation. Inhibitory sigmoid maximal bacterial kill (Emax) modeling of the relationship between vancomycin dosage and the killing of the bacteria in mice in vivo yielded similar Emax and EC50 (drug exposure driving one-half Emax) values for bacterial killing. Further, there were no differences in the pharmacokinetic clearances of the 6 vancomycin products from infected mice. There were no important pharmacodynamic differences in the in vitro or in vivo activities among the six vancomycin products evaluated.
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An optimized mouse thigh infection model for enterococci and its impact on antimicrobial pharmacodynamics. Antimicrob Agents Chemother 2014; 59:233-8. [PMID: 25348523 DOI: 10.1128/aac.02352-13] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Negligible in vivo growth of enterococci and high-level dispersion of data have led to inaccurate estimations of antibiotic pharmacodynamics (PD). Here we improved an in vivo model apt for PD studies by optimizing the in vitro culture conditions for enterococci. The PD of vancomycin (VAN), ampicillin-sulbactam (SAM), and piperacillin-tazobactam (TZP) against enterococci were determined in vivo, comparing the following different conditions of inoculum preparation: aerobiosis, aerobiosis plus mucin, and anaerobiosis plus mucin. Drug exposure was expressed as the ratio of the area under the concentration-time curve for the free, unbound fraction of the drug to the MIC (fAUC/MIC) (VAN) or the time in a 24-h period that the drug concentration for the free, unbound fraction exceeded the MIC under steady-state pharmacokinetic conditions (fT(>MIC)) (SAM and TZP) and linked to the change in log10 CFU/thigh. Only anaerobiosis plus mucin enhanced the in vivo growth, yielding significant PD parameters with all antibiotics. In conclusion, robust in vivo growth of enterococci was crucial for better determining the PD of tested antibacterial agents, and this was achieved by optimizing the procedure for preparing the inoculum.
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Impact on resistance of the use of therapeutically equivalent generics: the case of ciprofloxacin. Antimicrob Agents Chemother 2014; 59:53-8. [PMID: 25313208 DOI: 10.1128/aac.03633-14] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Therapeutic nonequivalence of generic antibiotics may lead to treatment failure and enrichment of resistance. However, there has been no demonstration that an equivalent generic displays the same resistance selection profile as the innovator drug. We aimed to test this hypothesis with five generic versions of ciprofloxacin by assessing their pharmaceutical equivalence with microbiological assays and their efficacy against Pseudomonas aeruginosa PAO1 in the neutropenic murine thigh infection model. One equivalent generic was selected for analysis by high-pressure liquid chromatography-tandem mass spectrometry (LC-MS/MS), to confirm chemical identity, and resistance selection experiments in a hollow-fiber (HF) system simulating two clinical dosing regimens. Total and resistant populations were measured, and the MICs of the resistant cells with and without an efflux pump inhibitor were determined. LC-MS/MS found no differences between products, and the innovator and the generic selected resistance with the same magnitude and mechanism after 7 days of treatment in the HF system, supporting the fact that a generic with demonstrated equivalence in vivo is also equivalent regarding resistance selection.
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Arnet I, Altermatt M, Roggo Y, Schnetzler G. Pharmaceutical quality of eight generics of ceftriaxone preparation for injection in Eastern Asia. J Chemother 2014; 27:337-42. [DOI: 10.1179/1973947814y.0000000208] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Glycopeptide antibiotics: Back to the future. J Antibiot (Tokyo) 2014; 67:631-44. [DOI: 10.1038/ja.2014.111] [Citation(s) in RCA: 170] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 07/17/2014] [Accepted: 07/18/2014] [Indexed: 12/22/2022]
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Edwards B, Andini R, Esposito S, Grossi P, Lew D, Mazzei T, Novelli A, Soriano A, Gould IM. Treatment options for methicillin-resistant Staphylococcus aureus (MRSA) infection: Where are we now? J Glob Antimicrob Resist 2014; 2:133-140. [PMID: 27873719 DOI: 10.1016/j.jgar.2014.03.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 03/28/2014] [Accepted: 03/31/2014] [Indexed: 01/05/2023] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) infection continues to be a substantial global problem with significant associated morbidity and mortality. This review summarises the discussions that took place at the 4th MRSA Consensus Conference in relation to the current treatment options for serious MRSA infections and how to optimise whichever therapy is embarked upon. It highlights the many challenges faced by both the laboratory and clinicians in the diagnosis and treatment of MRSA infections.
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Affiliation(s)
- B Edwards
- Medical Microbiology Department, Royal Infirmary of Edinburgh, 51 Little France Crescent, Dalkeith Road, Edinburgh EH16 4SA, UK.
| | - R Andini
- Second University of Naples, UOC Transplant and Infectious Disease Medicine, AORN Monaldi, Naples, Italy
| | - S Esposito
- Department of Medicine, University of Salerno, Salerno, Italy
| | - P Grossi
- Department of Surgical and Morphological Studies, University of Unisubria, Varese, Italy
| | - D Lew
- Chief Infectious Diseases Division, Chief Department of Specialties of Internal Medicine, Geneva University Hospital, Geneva, Switzerland
| | - T Mazzei
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Firenze, Firenze, Italy
| | - A Novelli
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Firenze, Firenze, Italy
| | - A Soriano
- Department of Infectious Diseases, IDIBAPS, Hospital Clinic of Barcelona, Spain
| | - I M Gould
- Medical Microbiology Department, Aberdeen Royal Infirmary, Aberdeen, UK
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Evaniew N, Khan M, Drew B, Peterson D, Bhandari M, Ghert M. Intrawound vancomycin to prevent infections after spine surgery: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 24:533-42. [DOI: 10.1007/s00586-014-3357-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 04/27/2014] [Accepted: 04/27/2014] [Indexed: 10/25/2022]
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Monnier A, Malbranche C, Fagnoni P, Serge Aho L, Guerard P, Sgro C, Guignard MH, Croisier-Bertin D, Chavanet P, Chrétien ML, Caillot D, Boulin M. Generic vancomycin products: Analysis of serum concentrations in patients with acute myeloid leukemia. ANNALES PHARMACEUTIQUES FRANÇAISES 2014; 72:178-83. [PMID: 24780833 DOI: 10.1016/j.pharma.2013.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 12/13/2013] [Accepted: 12/19/2013] [Indexed: 11/26/2022]
Abstract
UNLABELLED Concerns have recently emerged about the quality of generic vancomycin products. Our aim is to analyze serum vancomycin concentrations measured 48 hours after the start of an empirical treatment regimen in patients with acute myeloid leukemia (AML) who received one of the two generic vancomycin products available in France. PATIENTS AND METHODS Seventy-nine AML patients treated with vancomycin during two study periods were included in the study. Our vancomycin dosing regimen was based on the patients' total body weight adjusted for renal clearance. RESULTS A total of 93 serum vancomycin concentrations were collected: 31 in period 1 and 62 in period 2. In bivariate analysis, the mean serum vancomycin concentrations were not significantly different (19.9 ± 11.2 mg/L in period 1 vs 18.9 ± 6.0 mg/L in period 2, P=0.64). In the final generalized estimating equations model, serum vancomycin concentrations correlated statistically with a positive coefficient for age (P<0.001) and with negative coefficients for male sex (P=0.001) and hemoglobin level (P=0.021). CONCLUSION Serum vancomycin concentrations measured 48 hours after the start of an empirical treatment were not influenced by the nature of the generic product but correlated with age, sex and hemoglobin level in AML patients.
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Affiliation(s)
- A Monnier
- Department of Pharmacy, University Hospital, 14, rue Gaffarel, 21000 Dijon, France
| | - C Malbranche
- Department of Pharmacy, University Hospital, 14, rue Gaffarel, 21000 Dijon, France
| | - P Fagnoni
- Department of Pharmacy, University Hospital, 14, rue Gaffarel, 21000 Dijon, France; University of Burgundy, EA4184, BP 87900, 21079 Dijon, France
| | - L Serge Aho
- Department of Epidemiology, University Hospital, 14, rue Gaffarel, 21000 Dijon, France
| | - P Guerard
- Department of Pharmacology-Toxicology, University Hospital, 2, rue Angélique-Ducoudray, 21000 Dijon, France
| | - C Sgro
- Department of Pharmacovigilance, University Hospital, 14, rue Gaffarel, 21000 Dijon, France
| | - M-H Guignard
- Department of Pharmacy, University Hospital, 14, rue Gaffarel, 21000 Dijon, France
| | - D Croisier-Bertin
- Department of Infectious Diseases and Vivexia, University Hospital, 14, rue Gaffarel, 21000 Dijon, France
| | - P Chavanet
- Department of Infectious Diseases and Vivexia, University Hospital, 14, rue Gaffarel, 21000 Dijon, France
| | - M-L Chrétien
- Department of Hematology, University Hospital, 14, rue Gaffarel, 21000 Dijon, France
| | - D Caillot
- Department of Hematology, University Hospital, 14, rue Gaffarel, 21000 Dijon, France
| | - M Boulin
- Department of Pharmacy, University Hospital, 14, rue Gaffarel, 21000 Dijon, France; University of Burgundy, EA4184, BP 87900, 21079 Dijon, France.
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Encore des évidences en faveur des génériques ! ANNALES PHARMACEUTIQUES FRANÇAISES 2014; 72:141-2. [DOI: 10.1016/j.pharma.2014.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Zuluaga AF, Rodriguez CA, Agudelo M, Vesga O. About the validation of animal models to study the pharmacodynamics of generic antimicrobials. Clin Infect Dis 2014; 59:459-61. [PMID: 24785234 DOI: 10.1093/cid/ciu306] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Andres F Zuluaga
- Grupo Investigador de Problemas en Enfermedades Infecciosas (GRIPE) Department of Pharmacology and Toxicology
| | - Carlos A Rodriguez
- Grupo Investigador de Problemas en Enfermedades Infecciosas (GRIPE) Department of Pharmacology and Toxicology
| | - Maria Agudelo
- Grupo Investigador de Problemas en Enfermedades Infecciosas (GRIPE) Department of Pharmacology and Toxicology
| | - Omar Vesga
- Grupo Investigador de Problemas en Enfermedades Infecciosas (GRIPE) Department of Pharmacology and Toxicology Department of Internal Medicine, School of Medicine, Universidad de Antioquia Department of Infectious Diseases Unit, Hospital Universitario San Vicente Fundación, Medellín, Colombia
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Tattevin P, Cremieux AC, Rabaud C, Gauzit R. Reply to Zuluaga et al. Clin Infect Dis 2014; 59:461-2. [DOI: 10.1093/cid/ciu310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Boix-Montañes A, Garcia-Arieta A. Composition specification of teicoplanin based on its estimated relative bioavailability. Drug Dev Ind Pharm 2014; 41:218-23. [DOI: 10.3109/03639045.2013.858733] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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44
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Lomaestro BM. Vancomycin dosing and monitoring 2 years after the guidelines. Expert Rev Anti Infect Ther 2014; 9:657-67. [DOI: 10.1586/eri.11.46] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Even apparently insignificant chemical deviations among bioequivalent generic antibiotics can lead to therapeutic nonequivalence: the case of meropenem. Antimicrob Agents Chemother 2013; 58:1005-18. [PMID: 24277034 DOI: 10.1128/aac.00350-13] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Several studies with animal models have demonstrated that bioequivalence of generic products of antibiotics like vancomycin, as currently defined, do not guarantee therapeutic equivalence. However, the amounts and characteristics of impurities and degradation products in these formulations do not violate the requirements of the U.S. Pharmacopeia (USP). Here, we provide experimental data with three generic products of meropenem that help in understanding how these apparently insignificant chemical differences affect the in vivo efficacy. Meropenem generics were compared with the innovator in vitro by microbiological assay, susceptibility testing, and liquid chromatography/mass spectrometry (LC/MS) analysis and in vivo with the neutropenic guinea pig soleus infection model (Pseudomonas aeruginosa) and the neutropenic mouse thigh (P. aeruginosa), brain (P. aeruginosa), and lung (Klebisella pneumoniae) infection models, adding the dihydropeptidase I (DHP-I) inhibitor cilastatin in different proportions to the carbapenem. We found that the concentration and potency of the active pharmaceutical ingredient, in vitro susceptibility testing, and mouse pharmacokinetics were identical for all products; however, two generics differed significantly from the innovator in the guinea pig and mouse models, while the third generic was therapeutically equivalent under all conditions. Trisodium adducts in a bioequivalent generic made it more susceptible to DHP-I hydrolysis and less stable at room temperature, explaining its therapeutic nonequivalence. We conclude that the therapeutic nonequivalence of generic products of meropenem is due to greater susceptibility to DHP-I hydrolysis. These failing generics are compliant with USP requirements and would remain undetectable under current regulations.
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Tattevin P, Cremieux AC, Rabaud C, Gauzit R. Efficacy and Quality of Antibacterial Generic Products Approved for Human Use: A Systematic Review. Clin Infect Dis 2013; 58:458-69. [DOI: 10.1093/cid/cit769] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Nakamura A, Miura SI, Sugihara M, Miyase Y, Norimatsu K, Shiga Y, Nishikawa H, Saku K. Contrast between innovator drug- and generic drug-induced renal dysfunction on coronary angiography (CONTRAST study). Heart Vessels 2013; 29:603-10. [PMID: 24072136 DOI: 10.1007/s00380-013-0410-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 08/29/2013] [Indexed: 12/26/2022]
Abstract
Contrast-induced nephropathy (CIN) has gained increasing attention in clinical practice, particularly during coronary angiography (CAG). However, some "bioequivalent" generic (GE) drugs are less effective than the innovator (IN) drug. Therefore, the aim of this study was to compare contrast media (IN drug)-induced renal dysfunction with contrast media (GE drug)-induced dysfunction. We enrolled 44 patients who underwent elective CAG or percutaneous coronary intervention (PCI) and randomly divided them into two groups that received contrast media (Iohexol, nonionic and low-osmolality contrast agent) containing either IN drug (Omnipaque) or GE drug (Iopaque). Blood and urine sampling were performed before and after (24 and 48 h) CAG or PCI. Biochemical parameters in blood (serum creatinine, cystatin C, high-sensitivity C-reactive protein, and pentraxin-3) and urine (urinary albumin/Cr and liver-type fatty acid binding protein/Cr) were measured. There were no significant differences in the biochemical parameters at baseline between the groups. In addition, there were no differences in changes in biochemical parameters in blood and urine before and after CAG or PCI between the groups, although one patient in the GE group had CIN. The degree of contrast in Iopaque-induced renal dysfunction was comparable with that in Omnipaque-induced dysfunction.
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Affiliation(s)
- Ayumi Nakamura
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
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Comparative plasma exposure and lung distribution of two human use commercial azithromycin formulations assessed in murine model: a preclinical study. BIOMED RESEARCH INTERNATIONAL 2013; 2013:392010. [PMID: 24073402 PMCID: PMC3773390 DOI: 10.1155/2013/392010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 07/03/2013] [Accepted: 07/24/2013] [Indexed: 12/02/2022]
Abstract
Azithromycin (AZM) therapeutic failure and relapses of patients treated with generic formulations have been observed in clinical practice. The main goal of this research was to compare in a preclinical study the serum exposure and lung tissue concentration of two commercial formulations AZM-based in murine model. The current study involved 264 healthy Balb-C. Mice were divided into two groups (n = 44): animals of Group A (reference formulation -R-) were orally treated with AZM suspension at 10 mg/kg of b.w. Experimental animals of Group B (generic formulation -G-) received identical treatment than Group A with a generic formulation AZM-based. The study was repeated twice as Phase II and III. Serum and lung tissue samples were taken 24 h post treatment. Validated microbiological assay was used to determine the serum pharmacokinetic and lung distribution of AZM. After the pharmacokinetic analysis was observed, a similar serum exposure for both formulations of AZM assayed. In contrast, statistical differences (P < 0.001) were obtained after comparing the concentrations of both formulations in lung tissue, being the values obtained for AUC and Cmax (AZM-R-) +1586 and 122%, respectively, than those obtained for AZM-G- in lung. These differences may indicate large differences on the distribution process of both formulations, which may explain the lack of efficacy/therapeutic failure observed on clinical practice.
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Crandon JL, MacVane SH, Nicolau DP. Clinical Laboratory-Based Assay Methodologies May Underestimate and Increase Variability of Vancomycin Protein Binding in Hospitalized Patients. Pharmacotherapy 2013; 34:203-9. [DOI: 10.1002/phar.1323] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Jared L. Crandon
- Center for Anti-Infective Research and Development; Hartford Hospital; Hartford Connecticut
| | - Shawn H. MacVane
- Center for Anti-Infective Research and Development; Hartford Hospital; Hartford Connecticut
| | - David P. Nicolau
- Center for Anti-Infective Research and Development; Hartford Hospital; Hartford Connecticut
- Division of Infectious Diseases; Hartford Hospital; Hartford Connecticut
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Toutain PL, Bousquet-Melou A. The consequences of generic marketing on antibiotic consumption and the spread of microbial resistance: the need for new antibiotics. J Vet Pharmacol Ther 2013; 36:420-4. [PMID: 23713785 DOI: 10.1111/jvp.12061] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 05/05/2013] [Indexed: 11/29/2022]
Abstract
In both human and veterinary medicine, it has been shown that flooding the market with different generics and/or 'me-too' branded drugs has increased overall antibiotic consumption correlating with the emergence and spread of bacterial resistance to antibiotics. Another possible undesirable consequence of the promotion of generics is the promotion of an economic incentive that encourages the use of old drug products with very poor oral bioavailability, marketed with historical dosage regimens and extensively excreted in the environment. What veterinary medicine rather needs is new innovative and 'ecofriendly' antibiotics to actually enforce a more prudent use of antibiotics. For a pharmaceutical company, generics are inexpensive to manufacture and on a short-term basis, the generic market is very appealing. However, on a long-term basis, this marketing orientation provides a disincentive to the development of new and innovative products that will be required to meet the therapeutic needs of the veterinary community while being consistent with public health concerns. Indeed, for veterinary medicine, the key issue surrounding antibiotics is public health. It is the opinion of the authors that veterinary antibiotics and/or veterinary drug formulations should be innovative in terms of selectivity (no or minimal impact on the commensal gut flora), biodegradable (with minimal environmental disruption), and more expensive, with a strictly regulated market rather than unselective, cheap, and freely available drugs.
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Affiliation(s)
- P-L Toutain
- UMR 1331 Toxalim INRA, INPT- Ecole Nationale Veterinaire de Toulouse, Toulouse Cedex, France
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