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Cui C, Li X, Liang H, Hou Z, Tu S, Dong Z, Yao X, Zhang M, Zhang X, Li H, Zuo X, Liu D. Physiologically based pharmacokinetic model of renally cleared antibacterial drugs in Chinese renal impairment patients. Biopharm Drug Dispos 2021; 42:24-34. [PMID: 33340419 PMCID: PMC7898311 DOI: 10.1002/bdd.2258] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 11/13/2020] [Accepted: 12/01/2020] [Indexed: 01/10/2023]
Abstract
To preliminarily develop physiologically based population models for Chinese renal impairment patients and to evaluate the prediction performance of new population models by renally cleared antibacterial drugs. First, demographic data and physiological parameters of Chinese renal impairment patients were collected, and then the coefficients of the relative demographic and physiological equation were recalibrated to construct the new population models. Second, drug‐independent parameters of ceftazidime, cefodizime, vancomycin, and cefuroxime were collected and verified by Chinese healthy volunteers, Caucasian healthy volunteers, and Caucasian renal impairment population models built in Simcyp. Finally, the newly developed population models were applied to predict the plasma concentration of four antibacterial drugs in Chinese renal impairment patients. The new physiologically based pharmacokinetic (PBPK) population models can predict the main pharmacokinetic parameters, including area under the plasma concentration–time curve extrapolated to infinity (AUCinf), renal clearance (CLr), and peak concentration (Cmax), of ceftazidime, cefodizime, vancomycin, and cefuroxime following intravenous administrations with less than twofold error in mild, moderate, and severe Chinese renal impairment patients. The accuracy and precision of the predictions were improved compared with the Chinese healthy volunteers and Caucasian renal impairment population models. The PBPK population models were preliminarily developed and the first‐step validation results of four antibacterial drugs following intravenous administration showed acceptable accuracy and precision. The population models still need more systematic validation by using more drugs and scenarios in future studies to support their applications on dosage recommendation for Chinese renal impairment patients.
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Affiliation(s)
- Cheng Cui
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, People's Republic of China.,Institute of Medical Innovation, Peking University Third Hospital, Beijing, People's Republic of China
| | - Xiaobei Li
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, People's Republic of China.,School of Pharmaceutical Sciences, Peking University, Beijing, People's Republic of China
| | - Hao Liang
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, People's Republic of China.,Institute of Medical Innovation, Peking University Third Hospital, Beijing, People's Republic of China
| | - Zhe Hou
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, People's Republic of China.,Institute of Medical Innovation, Peking University Third Hospital, Beijing, People's Republic of China
| | - Siqi Tu
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, People's Republic of China.,School of Pharmaceutical Sciences, Peking University, Beijing, People's Republic of China
| | - Zhongqi Dong
- Janssen China R&D Center, Shanghai, People's Republic of China
| | - Xueting Yao
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, People's Republic of China.,Institute of Medical Innovation, Peking University Third Hospital, Beijing, People's Republic of China
| | - Miao Zhang
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, People's Republic of China.,Institute of Medical Innovation, Peking University Third Hospital, Beijing, People's Republic of China
| | - Xuan Zhang
- School of Pharmaceutical Sciences, Peking University, Beijing, People's Republic of China
| | - Haiyan Li
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, People's Republic of China.,Institute of Medical Innovation, Peking University Third Hospital, Beijing, People's Republic of China.,Department of Cardiology, Peking University Third Hospital, Beijing, People's Republic of China
| | - Xiaocong Zuo
- Center of Clinical Pharmacology, Third Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Dongyang Liu
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, People's Republic of China.,Institute of Medical Innovation, Peking University Third Hospital, Beijing, People's Republic of China
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Zhou L, Tong X, Sharma P, Xu H, Al‐Huniti N, Zhou D. Physiologically based pharmacokinetic modelling to predict exposure differences in healthy volunteers and subjects with renal impairment: Ceftazidime case study. Basic Clin Pharmacol Toxicol 2019; 125:100-107. [DOI: 10.1111/bcpt.13209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/01/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Li Zhou
- Quantitative Clinical Pharmacology, Early Clinical Development, IMED Biotech Unit AstraZeneca Boston Massachusetts
| | - Xiao Tong
- Quantitative Clinical Pharmacology, Early Clinical Development, IMED Biotech Unit AstraZeneca Boston Massachusetts
| | - Pradeep Sharma
- Mechanistic Safety and ADME Sciences, Drug Safety and Metabolism, IMED Biotech Unit AstraZeneca Cambridge UK
| | - Hongmei Xu
- Quantitative Clinical Pharmacology, Early Clinical Development, IMED Biotech Unit AstraZeneca Boston Massachusetts
| | - Nidal Al‐Huniti
- Quantitative Clinical Pharmacology, Early Clinical Development, IMED Biotech Unit AstraZeneca Boston Massachusetts
| | - Diansong Zhou
- Quantitative Clinical Pharmacology, Early Clinical Development, IMED Biotech Unit AstraZeneca Boston Massachusetts
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Karambelkar A, Kasekar R, Palevsky PM. Perioperative Pharmacologic Management of Patients with End Stage Renal Disease. Semin Dial 2015; 28:392-6. [PMID: 25876523 DOI: 10.1111/sdi.12384] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The pharmacokinetics of numerous medications used in the perioperative period are altered in patients with end-stage renal disease. Clearance of drugs, or their metabolites, that are normally excreted by the kidney is markedly reduced in ESRD. In addition, patients with ESRD may also have alterations in gastrointestinal absorption, volume of distribution, protein binding, and metabolic clearance of pharmacologic agents. Finally, drug removal may be augmented during dialysis. All of these factors contribute to the need for dose adjustment of medications, including analgesics, anesthetics, neuromuscular blockers, and antimicrobial agents, which may be used in the perioperative management of the ESRD patient.
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Affiliation(s)
- Ameet Karambelkar
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Riyaj Kasekar
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Paul M Palevsky
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Renal Section, Medical Service, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
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Angus BJ, Smith MD, Suputtamongkol Y, Mattie H, Walsh AL, Wuthiekanun V, Chaowagul W, White NJ. Pharmacokinetic-pharmacodynamic evaluation of ceftazidime continuous infusion vs intermittent bolus injection in septicaemic melioidosis. Br J Clin Pharmacol 2000; 50:184-91. [PMID: 10930972 PMCID: PMC2014399 DOI: 10.1111/j.1365-2125.2000.00179.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIMS Experimental studies have suggested that constant intravenous infusion would be preferable to conventional intermittent bolus administration of beta-lactam antibiotics for serious Gram-negative infections. Severe melioidosis (Burkholderia pseudomallei infection) carries a mortality over 40% despite treatment with high dose ceftazidime. The aim of this study was to measure the pharmacokinetic and pharmacodynamic effects of continuous infusion of ceftazidime vs intermittent bolus dosing in septicaemic melioidosis. METHODS Patients with suspected septicaemic melioidosis were randomised to receive ceftazidime 40 mg kg(-1) 8 hourly by bolus injection or 4 mg kg(-1) h(-1) by constant infusion following a 12 mg kg(-1) priming dose and pharmacokinetic and pharmacodynamic parameters were compared. RESULTS Of the 34 patients studied 16 (59%) died. Twenty patients had cultures positive for B. pseudomallei of whom 12 (60%) died. The median MIC90 of B. pseudomallei was 2 mg l(-1), giving a minimum target concentration (4*MIC) of 8 mg l(-1). The median (range) estimated total apparent volume of distribution, systemic clearance and terminal elimination half-lives of ceftazidime were 0.468 (0.241-0. 573) l kg(-1), 0.058 (0.005-0.159) l kg(-1) h(-1) and 7.74 (1.95-44.71) h, respectively. Clearance of ceftazidime and creatinine clearance were correlated closely (r = 0.71; P < 0.001) and there was no evidence of significant nonrenal clearance. CONCLUSIONS Simulations based on these data and the ceftazidime sensitivity of the B. pseudomallei isolates indicated that administration by constant infusion would allow significant dose reduction and cost saving. With conventional 8 h intermittent dosing to patients with normal renal function, plasma ceftazidime concentrations could fall below the target concentration but this would be unlikely with a constant infusion. Correction for renal failure, which is common in patients with meliodosis is Clearance = k(*) creatinine clearance where k = 0.72. Calculation of a loading dose gives median (range) values of loading dose, DL of 18.7 mg kg(-1) (9.5-23) and infusion rate I = 3.5 mg k(-1) h(-1) (0.4-13) (which equals 84 mg kg(-1) day(-1)). A nomogram for adjustment in renal failure is given.
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Affiliation(s)
- B J Angus
- Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok 10400, Thailand
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Angus BJ, Smith MD, Suputtamongkol Y, Mattie H, Walsh AL, Wuthiekanun V, Chaowagul W, White NJ. Pharmacokinetic-pharmacodynamic evaluation of ceftazidime continuous infusion vs intermittent bolus injection in septicaemic melioidosis. Br J Clin Pharmacol 2000; 49:445-52. [PMID: 10792202 PMCID: PMC2014958 DOI: 10.1046/j.1365-2125.2000.00179.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AIMS Experimental studies have suggested that constant intravenous infusion would be preferable to conventional intermittent bolus administration of beta-lactam antibiotics for serious Gram-negative infections. Severe melioidosis (Burkholderia pseudomallei infection) carries a mortality of 40% despite treatment with high dose ceftazidime. The aim of this study was to measure the pharmacokinetic and pharmacodynamic effects of continuous infusion of ceftazidime vs intermittent bolus dosing in septicaemic melioidosis. METHODS Patients with suspected septicaemic melioidosis were randomised to receive ceftazidime 40 mg kg-1 8 hourly by bolus injection or 4 mg kg-1 h-1 by constant infusion following a 12 mg kg-1 priming dose to perform estimation of pharmacokinetic and pharmacodynamic parameters. RESULTS Of the 34 patients studied 16 (59%) died. Twenty patients had cultures positive for B. pseudomallei of whom 12 (60%) died. The median MIC90 of B. pseudomallei was 2 mg l-1, giving a target concentration CT, of 8 mg l-1. The median (range) estimated total apparent volume of distribution, systemic clearance and terminal elimination half-lives of ceftazidime were 0.468 (0.241-0.573) l kg-1, 0.058 (0.005-0.159) l kg-1 h-1 and 7.74 (1.95-44.71) h, respectively. Clearance of ceftazidime and creatinine clearance were correlated closely (r = 0. 71; P < 0.001) and there was no evidence of significant nonrenal clearance. CONCLUSIONS Simulations based on these data and the ceftazidime sensitivity of the B. pseudomallei isolates indicated that administration by constant infusion would allow significant dose reduction and cost saving. With conventional 8 h intermittent dosing to patients with normal renal function, plasma ceftazidime concentrations could fall below the target concentration but this would be unlikely with a constant infusion. Correction for renal failure which is common in these patients is Clearance = k * creatinine clearance where k = 0.072. Calculation of a loading dose gives median (range) values of loading dose, DL of 3.7 mg kg-1 (1. 9-4.6) and infusion rate I = 0.46 mg kg h-1 (0.04-1.3) (which equals 14.8 mg kg-1 day-1). A nomogram for adjustment in renal failure is given.
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Affiliation(s)
- B J Angus
- Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok 10400, Thailand
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