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Beraldi-Magalhaes F, Parker SL, Sanches C, Garcia LS, Souza Carvalho BK, Costa AA, Fachi MM, de Liz MV, de Souza AB, Safe IP, Pontarolo R, Wallis S, Lipman J, Roberts JA, Cordeiro-Santos M. Is the Pharmacokinetics of First-Line Anti-TB Drugs a Cause of High Mortality Rates in TB Patients Admitted to the ICU? A Non-Compartmental Pharmacokinetic Analysis. Trop Med Infect Dis 2023; 8:312. [PMID: 37368730 DOI: 10.3390/tropicalmed8060312] [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: 02/24/2023] [Revised: 05/28/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Patients with tuberculosis (TB) may develop multi-organ failure and require admission to intensive care. In these cases, the mortality rates are as high as 78% and may be caused by suboptimal serum concentrations of first-line TB drugs. This study aims to compare the pharmacokinetics of oral rifampin, isoniazid, pyrazinamide and ethambutol patients in intensive care units (ICU) to outpatients and to evaluate drug serum concentrations as a potential cause of mortality. METHODS A prospective pharmacokinetic (PK) study was performed in Amazonas State, Brazil. The primary PK parameters of outpatients who achieved clinical and microbiological cure were used as a comparative target in a non-compartmental analysis. RESULTS Thirteen ICU and twenty outpatients were recruited. The clearance and volume of distribution were lower for rifampin, isoniazid, pyrazinamide and ethambutol. ICU thirty-day mortality was 77% versus a cure rate of 89% in outpatients. CONCLUSIONS ICU patients had a lower clearance and volume of distribution for rifampin, isoniazid, pyrazinamide and ethambutol compared to the outpatient group. These may reflect changes to organ function, impeded absorption and distribution to the site of infection in ICU patients and have the potential to impact clinical outcomes.
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Affiliation(s)
- Francisco Beraldi-Magalhaes
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-000, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus 69040-000, Brazil
- Secretaria de Estado da Saúde do Paraná, Curitiba 80010-130, Brazil
- School of Medicine, Faculdades Pequeno Príncipe, Curitiba 80230-020, Brazil
| | - Suzanne L Parker
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD 4029, Australia
| | - Cristina Sanches
- Department of Pharmacy, Campus Centro-Oeste Dona Lindu, Universidade Federal de São João del-Rei, Divinopolis 35501-296, Brazil
| | - Leandro Sousa Garcia
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-000, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus 69040-000, Brazil
| | - Brenda Karoline Souza Carvalho
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-000, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus 69040-000, Brazil
| | - Amanda Araujo Costa
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus 69040-000, Brazil
| | - Mariana Millan Fachi
- Department of Pharmacy, Campus Jardim Botânico, Universidade Federal do Paraná, Curitiba 80210-170, Brazil
| | - Marcus Vinicius de Liz
- Department of Chemistry & Biology, Campus Curitiba, Universidade Tecnológica Federal do Paraná, Curitiba 81280-340, Brazil
| | - Alexandra Brito de Souza
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-000, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus 69040-000, Brazil
| | - Izabella Picinin Safe
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus 69040-000, Brazil
| | - Roberto Pontarolo
- Department of Pharmacy, Campus Jardim Botânico, Universidade Federal do Paraná, Curitiba 80210-170, Brazil
| | - Steven Wallis
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD 4029, Australia
| | - Jeffrey Lipman
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD 4029, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD 4029, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, 30900 Nimes, France
| | - Jason A Roberts
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD 4029, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD 4029, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, 30900 Nimes, France
- Department of Pharmacy, Royal Brisbane and Women's Hospital, Brisbane, QLD 4029, Australia
| | - Marcelo Cordeiro-Santos
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-000, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus 69040-000, Brazil
- School of Medicine, Universidade Nilton Lins, Manaus 69058-040, Brazil
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Pršo K, Žideková N, Porvazník I, Solovič I, Mokrý J, Kertys M. A high-throughput LC-MS/MS method for simultaneous determination of isoniazid, ethambutol and pyrazinamide in human plasma. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2023; 37:e9425. [PMID: 36329637 PMCID: PMC9787364 DOI: 10.1002/rcm.9425] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/09/2022] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Abstract
RATIONALE Tuberculosis (TB) remains a challenging global infectious disease, mainly affecting the lungs. First-line anti-TB drugs play a crucial role in slowing down the rapid spread of TB. In addition, the patient might benefit from therapeutic drug monitoring since it has become an accepted clinical tool for optimizing TB treatment. METHODS A simple and sensitive liquid chromatography/tandem mass spectrometry method was developed to monitor the plasma level of isoniazid, ethambutol and pyrazinamide in plasma samples. A one-step extraction procedure using an Ostro™ plate was applied, and extracts were analyzed by gradient elution followed by detection on a mass spectrometer by multiple reaction monitoring mode. RESULTS The analytes were separated within 4.2 min and over the concentration range of 0.2-10 μg/ml for isoniazid and ethambutol and 1-65 μg/ml for pyrazinamide. The method was successfully validated according to the European Medicine Agency guideline for the selectivity, linearity and lower limit of detection, precision and accuracy, matrix effect, extraction recovery, carryover, dilution integrity and stability, and applied for quantification of analytes in clinical samples from TB patients. CONCLUSIONS The presented method allows sensitive and reproducible determination of selected anti-TB drugs with advantages such as low sample volume requirement, short run time of analysis, one-step sample preparation procedure with capabilities for phospholipids removal, and a low quantification limit as well as a high degree of selectivity.
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Affiliation(s)
- Kristián Pršo
- Department of Pharmacology, Jessenius Faculty of Medicine in MartinComenius UniversityBratislavaSlovakia
| | - Nela Žideková
- Department of Pharmacology, Jessenius Faculty of Medicine in MartinComenius UniversityBratislavaSlovakia
| | - Igor Porvazník
- Lung Diseases and Thoracic SurgeryNational Institute for TuberculosisVyšné HágySlovakia
- Faculty of HealthCatholic UniversityRužomberokSlovakia
| | - Ivan Solovič
- Lung Diseases and Thoracic SurgeryNational Institute for TuberculosisVyšné HágySlovakia
| | - Juraj Mokrý
- Department of Pharmacology, Jessenius Faculty of Medicine in MartinComenius UniversityBratislavaSlovakia
| | - Martin Kertys
- Department of Pharmacology, Jessenius Faculty of Medicine in MartinComenius UniversityBratislavaSlovakia
- Biomedical Center Martin, Jessenius Faculty of Medicine in MartinComenius UniversityBratislavaSlovakia
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Quantitative Analysis of Isoniazid and Its Four Primary Metabolites in Plasma of Tuberculosis Patients Using LC-MS/MS. Molecules 2022; 27:molecules27238607. [PMID: 36500699 PMCID: PMC9740544 DOI: 10.3390/molecules27238607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Isoniazid and its metabolites are potentially associated with hepatotoxicity and treatment outcomes in patients who receive antituberculosis (TB) therapy. To further understand the pharmacokinetic profiles of these molecules, a method based on LC-MS/MS was developed to determine the concentration of these compounds in human plasma. Isoniazid, acetylisoniazid, and isonicotinic acid were directly analyzed, whereas hydrazine and acetylhydrazine were determined after derivatization using p-tolualdehyde. Chromatographic separation was conducted on reversed-phase C18 columns with gradient elution, and detection was carried out in multiple reaction monitoring mode. The calibration curves were linear with correlation coefficients (r) greater than 0.9947 for all analytes. The intra- and inter-day precision was less than 13.43%, and the accuracy ranged between 91.63 and 114.00%. The recovery and matrix effect of the analytes were also consistent (coefficient of variation was less than 9.36%). The developed method successfully quantified isoniazid and its metabolites in TB patients. The method has broad applications in clinical research, including isoniazid one-point-based therapeutic drug monitoring, genotype-phenotype association studies of isoniazid metabolic profile and isoniazid-induced hepatotoxicity, and the initial dose prediction of isoniazid using population pharmacokinetic modeling.
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Brozyna-Heredia IY, Ganoza-Yupanqui ML, Moreno-Exebio L, Dos Santos JL. Chromatographic Methods for the Determination of Rifampicin, Isoniazid, Pyrazinamide, Ethambutol, and Main Metabolites in Biological Samples: A Review. Crit Rev Anal Chem 2022:1-16. [PMID: 36444713 DOI: 10.1080/10408347.2022.2150071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Bioanalytical methods are used to quantify drugs and their metabolites in biological samples in order to determine bioequivalence, perform pharmacokinetic and bioavailability studies, and complete therapeutic drug monitoring. The objective of this review paper is to describe bioanalytical methods based on Liquid Chromatography that are used to quantify antitubercular drugs and their metabolites in different biological samples, utilizing scientific literature from 1992 to 2021.
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Affiliation(s)
- Irena Y Brozyna-Heredia
- Laboratorio de Control de Calidad, Facultad de Farmacia y Bioquímica, Universidad Nacional de Trujillo, Trujillo, Perú
| | - Mayar Luis Ganoza-Yupanqui
- Laboratorio de Control de Calidad, Facultad de Farmacia y Bioquímica, Universidad Nacional de Trujillo, Trujillo, Perú
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A UHPLC-QTOF-MS/MS method with a superimposed multiple product ion strategy and esterase inhibitor improved sensitivity for the determination of xylocarpin H in rat plasma. J Pharm Biomed Anal 2022; 216:114803. [DOI: 10.1016/j.jpba.2022.114803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/11/2022] [Accepted: 04/23/2022] [Indexed: 11/23/2022]
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Study of isoniazid degradation by Fenton and photo-Fenton processes, by-products analysis and toxicity evaluation. J Photochem Photobiol A Chem 2022. [DOI: 10.1016/j.jphotochem.2021.113671] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Beraldi-Magalhaes F, Parker SL, Sanches C, Sousa Garcia L, Souza Carvalho BK, Fachi MM, de Liz MV, Pontarolo R, Lipman J, Cordeiro-Santos M, Roberts JA. Is Dosing of Ethambutol as Part of a Fixed-Dose Combination Product Optimal for Mechanically Ventilated ICU Patients with Tuberculosis? A Population Pharmacokinetic Study. Antibiotics (Basel) 2021; 10:antibiotics10121559. [PMID: 34943771 PMCID: PMC8698281 DOI: 10.3390/antibiotics10121559] [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: 11/01/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) patients admitted to intensive care units (ICU) have high mortality rates. It is uncertain whether the pharmacokinetics of first-line TB drugs in ICU patients are different from outpatients. This study aims to compare the pharmacokinetics of oral ethambutol in TB patients in ICU versus TB outpatients and to determine whether contemporary dosing regimens achieve therapeutic exposures. METHODS A prospective population pharmacokinetic study of ethambutol was performed in Amazonas State, Brazil. Probability of target attainment was determined using AUC/MIC > 11.9 and Cmax/MIC > 0.48 values. Optimized dosing regimens were simulated at steady state. RESULTS Ten ICU patients and 20 outpatients were recruited. Ethambutol pharmacokinetics were best described using a two-compartment model with first-order oral absorption. Neither ICU patients nor outpatients consistently achieved optimal ethambutol exposures. The absorption rate for ethambutol was 2-times higher in ICU patients (p < 0.05). Mean bioavailability for ICU patients was >5-times higher than outpatients (p < 0.0001). Clearance and volume of distribution were 93% (p < 0.0001) and 53% (p = 0.002) lower in ICU patients, respectively. CONCLUSIONS ICU patients displayed significantly different pharmacokinetics for an oral fixed-dose combination administration of ethambutol compared to outpatients, and neither patient group consistently achieved pre-defined therapeutic exposures.
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Affiliation(s)
- Francisco Beraldi-Magalhaes
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-000, Brazil; (L.S.G.); (B.K.S.C.); (M.C.-S.)
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus 69040-000, Brazil
- Secretaria de Estado da Saúde do Paraná, Curitiba 80010-130, Brazil
- School of Medicine, Faculdades Pequeno Príncipe, Curitiba 80230-020, Brazil
- Correspondence:
| | - Suzanne L. Parker
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD 4029, Australia; (S.L.P.); (J.L.); (J.A.R.)
| | - Cristina Sanches
- Department of Pharmacy, Universidade Federal de São João del-Rei, Divinopolis 35501-296, Brazil;
| | - Leandro Sousa Garcia
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-000, Brazil; (L.S.G.); (B.K.S.C.); (M.C.-S.)
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus 69040-000, Brazil
| | - Brenda Karoline Souza Carvalho
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-000, Brazil; (L.S.G.); (B.K.S.C.); (M.C.-S.)
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus 69040-000, Brazil
| | - Mariana Millan Fachi
- Department of Pharmacy, Universidade Federal do Paraná, Curitiba 80210-170, Brazil; (M.M.F.); (R.P.)
| | - Marcus Vinicius de Liz
- Department of Chemistry and Biology, Universidade Federal Tecnológica do Paraná, Curitiba 81280-340, Brazil;
| | - Roberto Pontarolo
- Department of Pharmacy, Universidade Federal do Paraná, Curitiba 80210-170, Brazil; (M.M.F.); (R.P.)
| | - Jeffrey Lipman
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD 4029, Australia; (S.L.P.); (J.L.); (J.A.R.)
- Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, QLD 4029, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, 30900 Nimes, France
| | - Marcelo Cordeiro-Santos
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-000, Brazil; (L.S.G.); (B.K.S.C.); (M.C.-S.)
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus 69040-000, Brazil
- School of Medicine, Universidade Nilton Lins, Manaus 69058-040, Brazil
| | - Jason A. Roberts
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD 4029, Australia; (S.L.P.); (J.L.); (J.A.R.)
- Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, QLD 4029, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, 30900 Nimes, France
- Department of Pharmacy, Royal Brisbane and Women’s Hospital, Brisbane, QLD 4029, Australia
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