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Cizmarova I, Mikus P, Svidrnoch M, Piestansky J. Development and Validation of a Capillary Zone Electrophoresis-Tandem Mass Spectrometry Method for Simultaneous Quantification of Eight β-Lactam Antibiotics and Two β-Lactamase Inhibitors in Plasma Samples. Pharmaceuticals (Basel) 2024; 17:526. [PMID: 38675486 PMCID: PMC11054939 DOI: 10.3390/ph17040526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/09/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Monitoring plasma concentrations of β-lactam antibiotics is crucial, particularly in critically ill patients, where variations in concentrations can lead to treatment failure or adverse events. Standardized antimicrobial regimens may not be effective for all patients, especially in special groups with altered physiological parameters. Pharmacokinetic/pharmacodynamic (PK/PD) studies highlight the time-dependent antibacterial activity of these antibiotics, emphasizing the need for personalized dosing. Therapeutic drug monitoring (TDM) is essential, requiring rapid and accurate analytical methods for precise determination of drugs in biological material (typically plasma or serum). This study presents a novel capillary zone electrophoresis-tandem mass spectrometry (CZE-MS/MS) method designed for the simultaneous quantification of five penicillin antibiotics, two cephalosporins, one carbapenem, and two β-lactamase inhibitors in a single run. The method involves a simple sample pretreatment-precipitation with organic solvent-and has a run time of 20 min. Optimization of CZE separation conditions revealed that 20 mM ammonium hydrogen carbonate (NH4HCO3) serves as the optimal background electrolyte (BGE). Positive electrospray ionization (ESI) mode, with isopropyl alcohol (IP)/10 mM ammonium formate water solution (50/50, v/v) as the sheath liquid, was identified as the optimal condition for MS detection. Method validation according to the Food and Drug Administration (FDA) guideline for development of bioanalytical methods demonstrated satisfactory selectivity, linearity, recovery, robustness, and stability. The method's practicality was evaluated using the Blue Applicability Grade Index (BAGI), yielding a score of 77.5. Moreover, the greenness of the proposed method was evaluated by two commonly used metric tools-Analytical GREEnness (AGREE) and Green Analytical Procedure Index (GAPI). The developed CZE-MS/MS method offers a practical and reliable approach for quantifying a broad spectrum of β-lactam antibiotics in plasma. Its ability to simultaneously quantify multiple analytes in a single run, coupled with a straightforward sample pretreatment, positions it as a valuable and prospective tool for TDM in critically ill patients.
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Affiliation(s)
- Ivana Cizmarova
- Department of Pharmaceutical Analysis and Nuclear Pharmacy, Faculty of Pharmacy, Comenius University in Bratislava, Odbojarov 10, SK-832 32 Bratislava, Slovakia; (I.C.); (P.M.)
- Toxicological and Antidoping Center, Faculty of Pharmacy, Comenius University in Bratislava, Odbojarov 10, SK-832 32 Bratislava, Slovakia
| | - Peter Mikus
- Department of Pharmaceutical Analysis and Nuclear Pharmacy, Faculty of Pharmacy, Comenius University in Bratislava, Odbojarov 10, SK-832 32 Bratislava, Slovakia; (I.C.); (P.M.)
- Toxicological and Antidoping Center, Faculty of Pharmacy, Comenius University in Bratislava, Odbojarov 10, SK-832 32 Bratislava, Slovakia
| | - Martin Svidrnoch
- AGEL Lab, Revolucni 2214/35, CZ-741 01 Novy Jicin, Czech Republic;
| | - Juraj Piestansky
- Toxicological and Antidoping Center, Faculty of Pharmacy, Comenius University in Bratislava, Odbojarov 10, SK-832 32 Bratislava, Slovakia
- Department of Galenic Pharmacy, Faculty of Pharmacy, Comenius University in Bratislava, Odbojarov 10, SK-832 32 Bratislava, Slovakia
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Tůma P, Jaček M, Fejfarová V, Polák J. Electrophoretic stacking for sensitive determination of antibiotic ceftazidime in human blood and microdialysates from diabetic foot. Anal Chim Acta 2016; 942:139-145. [PMID: 27720117 DOI: 10.1016/j.aca.2016.09.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 08/29/2016] [Accepted: 09/10/2016] [Indexed: 12/30/2022]
Abstract
An electrophoretic stacking method has been developed for monitoring the therapeutic level of the antibiotic ceftazidime in blood plasma and microdialysates taken from peripheral soft tissues of the lower limbs of patients with diabetic foot syndrome. The biological samples are treated by addition of acetonitrile in an amount of 75% v/v and injected into a capillary in a large volume; after turning on the separation voltage, the residual acetonitrile is forced out of the capillary by the application of hydrodynamic pressure. The clinical samples were separated in an optimised background electrolyte composed of 50 mM chloroacetic acid +20% v/v methanol +0.5% v/v INST coating solution. The attained LOD for ceftazidime equalled 0.42 μg mL-1 (0.8 μM) and the migration time equalled 3.75 min when using a 25 μm capillary with minimum length of 31.5 cm. The separation was controlled by a maximum voltage of +30 kV and the movement of the analyte was accelerated by a pressure of 50 mbar. The RSD values for intra-day repeatability of the migration time and peak area are 0.14% and 3.8%, respectively; the inter-day values equalled 0.25% for the migration time and 7.3% for peak area, respectively. Pharmacological studies revealed that ceftazidime passes from the blood circulation to the peripheral tissues of the lower limbs with an efficiency of 20%. The introduction of CE control of ceftazidime level in diabetic foot represents a very important improvement in achieving the targeted therapeutic effect.
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Affiliation(s)
- Petr Tůma
- Charles University in Prague, Third Faculty of Medicine, Department of Biochemistry, Cell and Molecular Biology, Ruská 87, 100 00 Prague 10, Czech Republic.
| | - Martin Jaček
- Charles University in Prague, Third Faculty of Medicine, Department of Biochemistry, Cell and Molecular Biology, Ruská 87, 100 00 Prague 10, Czech Republic
| | - Vladimíra Fejfarová
- Institute for Clinical and Experimental Medicine, Diabetes Center, Vídeňská 1958, 140 21 Prague 4, Czech Republic
| | - Jan Polák
- Charles University in Prague, Third Faculty of Medicine, Center for Research on Diabetes, Metabolism and Nutrition, Ruská 87, Prague 10000, Czech Republic; 2nd Internal Medicine Department, Vinohrady Teaching Hospital, Šrobárova 50, Prague 10034, Czech Republic
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Streit F, Perl T, Schulze MH, Binder L. Personalised beta-lactam therapy: basic principles and practical approach. ACTA ACUST UNITED AC 2016. [DOI: 10.1515/labmed-2016-0050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Abstract:Bacterial infections are potentially life-threatening diseases requiring effective antibiotic treatment right from the outset to achieve a favourable prognosis. Therapeutic success depends on the susceptibility of the bacterial pathogen, determined by the minimum inhibitory concentration (MIC), and the concentration of the antibiotic at the focus of infection, which is influenced by drug metabolism and pharmacokinetic (PK) factors. Beta-lactams are time-dependent antibiotics. Bacterial killing correlates with the duration of the drug concentration above the MIC of the pathogen. Critical illness is associated with major PK changes. This may lead to unexpected drug concentrations and unpredictable dose requirements differing significantly from standard dosages. Emerging dosing strategies are therefore based on PK/pharmacodynamic (PD) principles. Therapeutic drug monitoring (TDM) is increasingly playing a key role in antibiotic treatment optimisation in general and in beta-lactam therapy, in particular, notably in severely ill patients. Furthermore, evidence of the superiority of continuous beta-lactam infusions over shorter administration regimens is growing. Target drug concentrations have to be defined, considering MIC values especially in pathogens with limited susceptibility. For reliable TDM results, correct pre-analytical sample handling is indispensable. Personalised, TDM-guided therapy currently offers the most promising approach to assuring that beta-lactam treatment is effective, especially in critically ill patients.
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Chen Z, Bi X, Li J, Tang Y, Fan G, Sun D. Application and optimization of organic-inorganic hybrid monolithic capillary electrochromatography for in vivo cefdinir determination with microdialysis. J Sep Sci 2015; 39:440-9. [DOI: 10.1002/jssc.201500817] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 10/27/2015] [Accepted: 10/27/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Zhao Chen
- Department of TCM analysis; Guangdong Province Engineering Technology Research Institute of TCM; Guangzhou PR China
| | - Xiaoli Bi
- Department of TCM analysis; Guangdong Province Engineering Technology Research Institute of TCM; Guangzhou PR China
| | - Ji Li
- Department of Pharmaceutical Analysis, School of Pharmacy; Second Military Medical University; Shanghai PR China
- Shanghai Key Laboratory for Pharmaceutical Metabolite Research; Shanghai PR China
| | - Yuanjun Tang
- Department of Pharmaceutical Analysis, School of Pharmacy; Second Military Medical University; Shanghai PR China
- Shanghai Key Laboratory for Pharmaceutical Metabolite Research; Shanghai PR China
| | - Guorong Fan
- Department of Pharmaceutical Analysis, School of Pharmacy; Second Military Medical University; Shanghai PR China
- Shanghai Key Laboratory for Pharmaceutical Metabolite Research; Shanghai PR China
| | - Dongmei Sun
- Department of TCM analysis; Guangdong Province Engineering Technology Research Institute of TCM; Guangzhou PR China
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Andrási M, Zékány L, Gáspár A. Study on repeatability of the determination of temozolomide by micellar electrokinetic capillary chromatography using internal standards. JOURNAL OF ANALYTICAL CHEMISTRY 2015. [DOI: 10.1134/s1061934815110118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Elghobashy MR, Bebawy LI, Abbas SS, Shokry RF. Stability-Indicating HPLC and RP-TLC Determination of Cefpirome Sulfate with Kinetic Study. Chromatographia 2013. [DOI: 10.1007/s10337-013-2516-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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El-Shaboury SR, Saleh GA, Mohamed FA, Rageh AH. Analysis of cephalosporin antibiotics. J Pharm Biomed Anal 2007; 45:1-19. [PMID: 17689910 DOI: 10.1016/j.jpba.2007.06.002] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2007] [Revised: 05/06/2007] [Accepted: 06/05/2007] [Indexed: 11/21/2022]
Abstract
A comprehensive review with 276 references for the analysis of members of an important class of drugs, cephalosporin antibiotics, is presented. The review covers most of the methods described for the analysis of these drugs in pure forms, in different pharmaceutical dosage forms and in biological fluids.
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Affiliation(s)
- Salwa R El-Shaboury
- Department of Pharmaceutical Analytical Chemistry, Facutly of Pharmacy, Assiut Univeristy, 71526 Assiut, Egypt
| | - Gamal A Saleh
- Department of Pharmaceutical Analytical Chemistry, Facutly of Pharmacy, Assiut Univeristy, 71526 Assiut, Egypt.
| | - Fardous A Mohamed
- Department of Pharmaceutical Analytical Chemistry, Facutly of Pharmacy, Assiut Univeristy, 71526 Assiut, Egypt
| | - Azza H Rageh
- Department of Pharmaceutical Analytical Chemistry, Facutly of Pharmacy, Assiut Univeristy, 71526 Assiut, Egypt
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Puig P, Tempels FWA, Borrull F, Calull M, Aguilar C, Somsen GW, de Jong GJ. On-line coupling of solid-phase extraction and capillary electrophoresis for the determination of cefoperazone and ceftiofur in plasma. J Chromatogr B Analyt Technol Biomed Life Sci 2007; 856:365-70. [PMID: 17572160 DOI: 10.1016/j.jchromb.2007.05.030] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Revised: 05/18/2007] [Accepted: 05/22/2007] [Indexed: 11/25/2022]
Abstract
We present a method for determining two cephalosporins (cefoperazone and ceftiofur) in plasma by on-line solid-phase extraction (SPE)-capillary zone electrophoresis (CZE) with a T-split interface. Using this interface, a part of the SPE elution plug containing the cephalosporins is injected while the rest of the sample is flushed to waste. SPE was carried out using a C(18) micro-precolumn and the cephalosporins presented good retention properties with breakthrough volumes above 1 ml. Using a desorption volume of 426 nl of acetonitrile, recoveries were 75 and 90%, for cefoperazone and ceftiofur, respectively. The resulting elution volume was about 1.8 microl. A deproteinization step was included prior to SPE for the analysis of plasma samples with recoveries of 90 and 57% for cefoperazone and ceftiofur, respectively. With UV detection at 254 nm, linear relationships between the injected concentration and peak area was measured between 10 and 500 ng ml(-1) for standards, and 200 and 1500 ng ml(-1) for plasma samples. Intra-day (n=5) and inter-day (n=5) peak area repeatability were lower than 12% RSD. The detection limits obtained for spiked plasma (100 ng ml(-1) cefoperazone and ceftiofur) are sufficient for applying the method to pharmacokinetic studies.
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Affiliation(s)
- Patricia Puig
- Department of Biomedical Analysis, Faculty of Science, Utrecht University, Sorbonnelaan 16, NL-3584 CA Utrecht, The Netherlands.
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Wang L, Zhang Z, Yang W. Pharmacokinetic study of trimebutine maleate in rabbit blood using in vivo microdialysis coupled to capillary electrophoresis. J Pharm Biomed Anal 2005; 39:399-403. [PMID: 15939564 DOI: 10.1016/j.jpba.2005.02.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2004] [Revised: 02/22/2005] [Accepted: 02/23/2005] [Indexed: 11/15/2022]
Abstract
In vivo microdialysis was used together with capillary electrophoresis (CE) to monitor the concentration of trimebutine maleate (TM) in rabbit blood. Dialysis probe was perfused at 3 microl/min resulting in relative recovery of 26.6+/-3.1% (n=3). After a one step sample preparation the samples were injected directly into the capillary. TM was detected on-column using UV detector at 214 nm. Separation of TM from other components in the dialysate was achieved within 15 min. Evaluation was based on the relative collected peak height (TM/IS). The response for TM in the blood dialysate was linear over the range of 0.5-100 microg/ml. The detection limit of TM in the blood dialysate was 0.1 microg/ml (S/N=3). This method has been successfully applied to the pharmacokinetic study of trimebutine maleate in rabbit blood following oral administration of 200 mg/kg. It provides a fast and simple technique for the pharmacokinetic study of TM in vivo.
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Affiliation(s)
- Li Wang
- Department of Chemistry, Shaanxi Normal University, Xi'an 710062, China
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Ohyama K, Wada M, Lord GA, Ohba Y, Nakashima MN, Nakashima K, Akiyama S, Lim CK, Kuroda N. Capillary electrochromatography of caffeine and its metabolites in rat brain microdialysate. Electrophoresis 2005; 26:812-817. [PMID: 15714566 DOI: 10.1002/elps.200410292] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A capillary electrochromatography (CEC) method has been developed for the separation of caffeine and its two metabolites 1-methylxanthine (1-MX) and 1,7-dimethylxanthine (1,7-DX). The stationary phase was 3-(1,8-naphthalimido) propyl-modified silyl silica gel (NAIP) and the best separations were achieved with 4.0 mM citrate buffer (pH 5.0) containing 80% methanol at an applied voltage of 25 kV. The compounds were completely separated in less than 3.5 min with good repeatability, which was approximately 3-times less than that in high-performance liquid chromatography (HPLC) with NAIP. The proposed method coupled with microdialysis was successfully applied to the monitoring of caffeine concentration in rat brain with detection limits of 1.11 microg/mL.
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Affiliation(s)
- Kaname Ohyama
- Graduate School of Biomedical Sciences, Course of Pharmaceutical Sciences, Nagasaki University, Nagasaki, Japan
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Sauermann R, Delle-Karth G, Marsik C, Steiner I, Zeitlinger M, Mayer-Helm BX, Georgopoulos A, Müller M, Joukhadar C. Pharmacokinetics and pharmacodynamics of cefpirome in subcutaneous adipose tissue of septic patients. Antimicrob Agents Chemother 2005; 49:650-5. [PMID: 15673747 PMCID: PMC547217 DOI: 10.1128/aac.49.2.650-655.2005] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2004] [Revised: 08/01/2004] [Accepted: 10/11/2004] [Indexed: 11/20/2022] Open
Abstract
The objective of the present study was to evaluate whether cefpirome, a member of the latest class of broad-spectrum cephalosporins, sufficiently penetrates subcutaneous adipose tissue in septic patients. After the administration of the drug at 2 g, tissue cefpirome concentrations in septic patients (n = 11) and healthy controls (n = 7) were determined over a period of 4 h by means of microdialysis. To assess the antibacterial effect of cefpirome at the target site, the measured pharmacokinetic profiles were simulated in vitro with select strains of Staphylococcus aureus and Pseudomonas aeruginosa. The tissue penetration of cefpirome was significantly impaired in septic patients compared with that in healthy subjects. For subcutaneous adipose tissue, the area under the concentration-versus-time curve values from 0 to 240 min were 13.11 +/- 5.20 g . min/liter in healthy subjects and 6.90 +/- 2.56 g . min/liter in septic patients (P < 0.05). Effective bacterial growth inhibition was observed in all in vitro simulations. This was attributed to the significantly prolonged half-life in tissue (P < 0.05), which kept the tissue cefpirome levels above the MICs for relevant pathogens for extended periods in the septic group. By consideration of a dosing interval of 8 h, the values for the time above MIC (T > MIC) in tissue were greater than 60% for pathogens for which the MIC was =4 mg/liter in all septic patients. The present data indicate that cefpirome is an appropriate agent for the treatment of soft tissue infections in septic patients. However, due to the high interindividual variability of the pharmacokinetics of cefpirome in tissue, dosing intervals of not more than 8 h should be preferred to ensure that susceptible bacterial strains are killed in each patient.
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Affiliation(s)
- Robert Sauermann
- Department of Clinical Pharmacology, Division of Clinical Pharmacokinetics, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
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Abstract
Microdialysis is a probe-based sampling method, which, if linked to analytical devices, allows for the measurement of drug concentration profiles in selected tissues. During the last two decades, microdialysis has become increasingly popular for preclinical and clinical pharmacokinetic studies. The advantage of in vivo microdialysis over traditional methods relates to its ability to continuously sample the unbound drug fraction in the interstitial space fluid (ISF). This is of particular importance because the ISF may be regarded as the actual target compartment for many drugs, e.g. antimicrobial agents or other drugs mediating their action through surface receptors. In contrast, plasma concentrations are increasingly recognised as inadequately predicting tissue drug concentrations and therapeutic success in many patient populations. Thus, the minimally invasive microdialysis technique has evolved into an important tool for the direct assessment of drug concentrations at the site of drug delivery in virtually all tissues. In particular, concentrations of transdermally applied drugs, neurotransmitters, antibacterials, cytotoxic agents, hormones, large molecules such as cytokines and proteins, and many other compounds were described by means of microdialysis. The combined use of microdialysis with non-invasive imaging methods such as positron emission tomography and single photon emission tomography opened the window to exactly explore and describe the fate and pharmacokinetics of a drug in the body. Linking pharmacokinetic data from the ISF to pharmacodynamic information appears to be a straightforward approach to predicting drug action and therapeutic success, and may be used for decision making for adequate drug administration and dosing regimens. Hence, microdialysis is nowadays used in clinical studies to test new drug candidates that are in the pharmaceutical industry drug development pipeline.
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Affiliation(s)
- Christian Joukhadar
- Department of Clinical Pharmacology, Division of Clinical Pharmacokinetics, Vienna University School of Medicine, Vienna General Hospital, Vienna, Austria.
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Müller M, dela Peña A, Derendorf H. Issues in pharmacokinetics and pharmacodynamics of anti-infective agents: distribution in tissue. Antimicrob Agents Chemother 2004; 48:1441-53. [PMID: 15105091 PMCID: PMC400530 DOI: 10.1128/aac.48.5.1441-1453.2004] [Citation(s) in RCA: 190] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Markus Müller
- Health Science Center, Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, Florida 32610-0494, USA
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Mayer BX, Namiranian K, Dehghanyar P, Stroh R, Mascher H, Müller M. Comparison of UV and tandem mass spectrometric detection for the high-performance liquid chromatographic determination of diclofenac in microdialysis samples. J Pharm Biomed Anal 2003; 33:745-54. [PMID: 14623601 DOI: 10.1016/s0731-7085(03)00301-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
High-performance liquid chromatography (HPLC) was used to analyze microdialysis samples obtained in vivo from human subcutaneous adipose tissue after topical application of the nonsteroidal anti-inflammatory drug diclofenac. For the reliable determination of diclofenac two different detection principles were applied in two different laboratories. One HPLC method utilized UV-detection at 280 nm, the other one used selected reaction monitoring mass spectrometry (MS). The HPLC-UV and -MS methods offered low limits of quantification of 10 and 1 ng/ml and an accuracy between 94.0-126.7 and 89.3-110.9%, respectively. However, a comparison showed that the HPLC-UV method failed to determine diclofenac in biological matrices, as both false negative and positive values were found. HPLC-MS is clearly superior to HPLC-UV due to a much more selective detection, increased sensitivity and shorter run times.
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Affiliation(s)
- Bernhard X Mayer
- Department of Clinical Pharmacology, Division of Clinical Pharmacokinetics, Vienna University School of Medicine, Währinger Gürtel 18-20, 1090 Vienna, Austria.
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Joukhadar C, Klein N, Mayer BX, Kreischitz N, Delle-Karth G, Palkovits P, Heinz G, Müller M. Plasma and tissue pharmacokinetics of cefpirome in patients with sepsis. Crit Care Med 2002; 30:1478-82. [PMID: 12130965 DOI: 10.1097/00003246-200207000-00013] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Broad initial antibiotic treatment is crucial for patients experiencing septic shock or severe sepsis. Fourth-generation beta-lactam antibiotics, such as cefpirome, are frequently favored in these conditions because of their low toxicity and wide antimicrobial coverage. From recent data, however, there is circumstantial evidence that one reason for the high mortality rate of patients with sepsis might be an impaired penetration of antimicrobial agents from the central compartment to the infectious focus. Thus, the present study aimed at describing penetration properties of cefpirome to the target site of many bacterial infections, which is the extracellular space fluid of soft tissues. DESIGN Prospective comparative study of two groups. SETTING An intensive care unit and research ward in a university hospital. SUBJECTS The study population included 12 patients with septic shock or severe sepsis and a control group of six overall age-matched healthy volunteers. INTERVENTIONS To measure cefpirome penetration into the interstitial space fluid of skeletal muscle, we employed microdialysis after single intravenous administration of 2.0 g of cefpirome to patients and healthy volunteers. MEASUREMENTS AND MAIN RESULTS Maximum concentration and area under the concentration vs. time values in interstitium were significantly lower in patients compared with the control group (p <.004). Cefpirome area under the concentration time values for plasma were 16.0 +/- 1.1 mg.min/mL (mean +/- sem) and 18.8 +/- 1.1 mg.min/mL in patients and healthy volunteers, respectively (p =.075, not significant). In both study groups, mean cefpirome concentrations in interstitium and plasma exceeded 28 microg/mL throughout the observation period of 240 mins and covered completely minimal inhibitory concentration values for a range of clinically relevant pathogens. CONCLUSION Cefpirome concentrations reached in tissue interstitium and plasma exceeded minimal inhibitory concentrations of most clinically relevant pathogens in patients with sepsis. Thus, cefpirome exhibits a tissue pharmacokinetic profile, which seems to be particularly valuable for the empirical therapy of patients with sepsis.
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Affiliation(s)
- Christian Joukhadar
- Department of Clinical Pharmacology, Division of Clinical Pharmacokinetics, University of Vienna Medical School, Austria
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Neckel U, Joukhadar C, Frossard M, Jäger W, Müller M, Mayer BX. Simultaneous determination of levofloxacin and ciprofloxacin in microdialysates and plasma by high-performance liquid chromatography. Anal Chim Acta 2002. [DOI: 10.1016/s0003-2670(02)00429-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Herkner H, Müller MR, Kreischitz N, Mayer BX, Frossard M, Joukhadar C, Klein N, Lackner E, Müller M. Closed-chest microdialysis to measure antibiotic penetration into human lung tissue. Am J Respir Crit Care Med 2002; 165:273-6. [PMID: 11790667 DOI: 10.1164/ajrccm.165.2.2106082] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The majority of bacterial lung infections are localized to the interstitial space fluid, which is therefore an important target site for antimicrobial chemotherapy. Direct measurement of interstitial concentrations of antimicrobial agents in human lung tissue would allow for a more informed approach to appropriate dosing of antimicrobial agents, but until now this was beyond technical reach. In this exploratory pharmacokinetic study, we measured the time versus concentration profile of cefpirome after a single intravenous dose administration of 2 g in the lung interstitial fluid by flexible microdialysis catheters, which were implanted during lung surgery for pulmonary tumors in five patients. Cefpirome concentrations in lung interstitial fluid were 66% of corresponding plasma values within the first 240 min, and exceeded minimal inhibitory concentrations of most relevant bacteria. The experimental procedure was well tolerated by the patients and no adverse events were observed. The present study provides evidence for the first time that closed chest microdialysis of the human lung is a feasible and safe method to measure lung concentrations in patients in vivo. The present data also corroborate the use of cefpirome as a valuable agent in the treatment of lung infections with most extracellular bacteria.
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Affiliation(s)
- Harald Herkner
- Department of Clinical Pharmacology, Division of Clinical Pharmacokinetics, University of Vienna Medical School, Vienna, Austria
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Thormann W, Lurie IS, McCord B, Marti U, Cenni B, Malik N. Advances ofcapillary electrophoresis in clinical and forensic analysis (1999-2000). Electrophoresis 2001; 22:4216-43. [PMID: 11824639 DOI: 10.1002/1522-2683(200111)22:19<4216::aid-elps4216>3.0.co;2-w] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In this paper, capillary electrophoresis in clinical and forensic analysis is reviewed on the basis of the literature of 1999, 2000 and the first papers in 2001. An overview of progress relevant examples for each major field of application, namely (i) analysis of drug seizures, explosives residues, gunshot residues and inks, (ii) monitoring of drugs, endogenous small molecules and ions in biofluids and tissues, (iii) general screening for serum proteins and analysis of specific proteins (carbohydrate deficient transferrin, alpha1-antitrypsin, lipoproteins and hemoglobins) in biological fluids, and (iv) analysis of nucleic acids and oligonucleotides in biological samples, including oligonucleotide therapeutics, are presented.
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Affiliation(s)
- W Thormann
- Department of Clinical Pharmacology, University of Bern, Switzerland.
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Abstract
This article reviews recent developments in the characterization of antibiotics. Many capillary electrophoretic techniques have been utilized in their analyses, addressing various aspects of quantifying, profiling and monitoring. Sensitive electrochemical and laser-induced fluorescence detection systems have been utilized, demonstrating trace level determinations in clinical settings and in environmental samples. Different sample introduction methods have been explored, enhancing detection sensitivity, or reducing or eliminating sample manipulation prior to injection.
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Affiliation(s)
- C L Flurer
- Forensic Chemistry Center, U.S. Food and Drug Administration, Cincinnati, OH 45237, USA.
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21
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Abstract
This review surveys approaches on how to improve precision in capillary zone electrophoresis and micellar electrokinetic chromatography. Many different techniques have been employed successfully to improve instrument precision and to facilitate method transfer between instruments and laboratories. Operational parameters as well as theories will be discussed in detail.
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Affiliation(s)
- B X Mayer
- University of Vienna, University School of Medicine, Department of Clinical Pharmacology, Austria.
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22
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Abstract
The introduction of in vivo microdialysis (MD) to clinical pharmacological studies has opened the opportunity to obtain previously inaccessible information about the drug distribution process to the clinically relevant target site. The aim of this review is to provide a comprehensive overview of the current literature about MD in drug delivery studies from a clinical perspective. In particular the application of MD in clinical--antimicrobial, oncological and transdermal--and neurological research will be described and the scope of MD in pharmacokinetic-pharmacodynamic (PK-PD) studies will be discussed. It is concluded that MD has a great potential for both academic and industrial research, and may become the method of choice for drug distribution studies in humans.
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Affiliation(s)
- M Müller
- Department of Clinical Pharmacology, Division of Clinical Pharmacokinetics, Vienna University School of Medicine, Vienna General Hospital - AKH Wien, Währinger Gürtel 18-20, A-1090, Vienna, Austria.
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