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Reeder JA, O’Sullivan CT, Xu M, Wu N, Ince D, Rogers WK, An G. Model-Informed Clinical Practice - Determining an Appropriate Ampicillin-Sulbactam Redosing Regimen in Surgical Patients by Utilizing Population Pharmacokinetics and Target Attainment Analysis. Antimicrob Agents Chemother 2023; 67:e0124822. [PMID: 36920230 PMCID: PMC10112153 DOI: 10.1128/aac.01248-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 02/04/2023] [Indexed: 03/16/2023] Open
Abstract
In the current study, population pharmacokinetic (PK) of ampicillin-sulbactam was performed based on the clinical pharmacokinetics data collected from a prospective study conducted in 40 surgical patients undergoing prolonged surgery where antibiotic redosing was implemented. A population PK model was successfully developed to characterize the disposition of ampicillin and sulbactam. The final models were two-compartment models for both drugs, with creatinine clearance and heart failure affecting clearance and body surface area having an impact on the central volume of distribution of both ampicillin and sulbactam. Comprehensive Monte Carlo simulations were performed to evaluate the probability of target attainment (PTA) of 24 different redosing scenarios. Simulation results indicated that the ampicillin-sulbactam 2-h redosing scheme recommended by ASHP guidelines is likely too conservative given that 3-g dose (2-g ampicillin/1-g sulbactam) with 4-h redosing interval can reach the breakpoint of 2 mg/L for ampicillin in all populations even with the aggressive pharmacokinetic/pharmacodynamic (PK/PD) target of 100% fT > MIC. With the target 50% fT > MIC, all redosing schemes evaluated, including the 8-h redosing scenario, are predicted to be able to reach the breakpoint of 64 mg/L in all patients. According to our findings, redosing of ampicillin-sulbactam should be every 4 h instead of the currently recommended 2-h redosing schedule. Our PTA results should inform future updates to existing general antibiotic redosing guidelines; and, when used in combination with the availability of institution- and/or unit-specific ampicillin susceptibility patterns, our PTA results may be used to customize SSI prophylaxis redosing recommendations for ampicillin-sulbactam at individual hospitals.
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Affiliation(s)
- Joshua A. Reeder
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa, Iowa City, Iowa, USA
| | - Cormac T. O’Sullivan
- College of Nursing, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Min Xu
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa, Iowa City, Iowa, USA
| | - Nan Wu
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa, Iowa City, Iowa, USA
| | - Dilek Ince
- Department of Internal Medicine, Division of Infectious Diseases, Carver College of Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - William K. Rogers
- Department of Anesthesia, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Guohua An
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa, Iowa City, Iowa, USA
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2
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Onita T, Ikawa K, Ishihara N, Tamaki H, Yano T, Naora K, Morikawa N. Pulmonary Pharmacokinetic and Pharmacodynamic Evaluation of Ampicillin/Sulbactam Regimens for Pneumonia Caused by Various Bacteria, including Acinetobacter baumannii. Antibiotics (Basel) 2023; 12:antibiotics12020303. [PMID: 36830214 PMCID: PMC9952633 DOI: 10.3390/antibiotics12020303] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/25/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
This study aimed to assess the dosing regimens of ampicillin/sulbactam for pneumonia based on pulmonary pharmacokinetic (PK)/pharmacodynamic (PD) target attainment. Using the literature data, we developed pulmonary PK models and estimated the probabilities of attaining PK/PD targets in lung tissue. Against bacteria other than A. baumannii (the general treatment), the PK/PD target was set as both 50% time above the minimum inhibitory concentration (T > MIC) for ampicillin and 50% T > 0.5 MIC for sulbactam. For the A. baumannii treatment, the PK/PD target was set as 60% T > MIC for sulbactam. The pulmonary PK/PD breakpoint was defined as the highest minimum inhibitory concentration (MIC) at which the target attainment probability in the lung tissue was ≥90%. The lung tissue/serum area under the drug concentration-time curve from 0 to 3 h (AUC0-3h) ratios for ampicillin and sulbactam were 0.881 and 0.368, respectively. The ampicillin/sulbactam AUC0-3h ratio in the lung tissue was 3.89. For the general treatment, the pulmonary PK/PD breakpoint for ampicillin/sulbactam at 3 g four times daily in typical patients with creatinine clearance (CLcr) of 60 mL/min was 2 μg/mL, which covered the MIC90s (the MICs that inhibited the growth of 90% of the strains) of most gram-positive and gram-negative bacteria. For the A. baumannii treatment, the pulmonary PK/PD breakpoint for ampicillin/sulbactam at 9 g 4-h infusion three times daily (27 g/day) in patients with a CLcr of 60 mL/min was 4 μg/mL, which covered the MIC90 of A. baumannii. A PK/PD evaluation for pneumonia should be performed in the lung tissue (the target site) rather than in the blood because sulbactam concentrations are lower in lung tissue. These findings should facilitate the selection of ampicillin/sulbactam regimens for pneumonia caused by various bacteria, including A. baumannii.
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Affiliation(s)
- Tetsushu Onita
- Department of Clinical Pharmacotherapy, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
- Department of Pharmacy, Shimane University Hospital, 89-1 Enya, Izumo 693-8501, Japan
- Correspondence: ; Tel.: +81-85-320-2465; Fax: +81-85-320-2475
| | - Kazuro Ikawa
- Department of Clinical Pharmacotherapy, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Noriyuki Ishihara
- Department of Pharmacy, Shimane University Hospital, 89-1 Enya, Izumo 693-8501, Japan
| | - Hiroki Tamaki
- Department of Pharmacy, Shimane University Hospital, 89-1 Enya, Izumo 693-8501, Japan
| | - Takahisa Yano
- Department of Pharmacy, Shimane University Hospital, 89-1 Enya, Izumo 693-8501, Japan
| | - Kohji Naora
- Department of Pharmacy, Shimane University Hospital, 89-1 Enya, Izumo 693-8501, Japan
| | - Norifumi Morikawa
- Department of Clinical Pharmacotherapy, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
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Oliveira RC, Bandeira PN, Lemos TLG, Dos Santos HS, Scherf JR, Rocha JE, Pereira RLS, Freitas TS, Freitas PR, Pereira-Junior FN, Marinho MM, Marinho EM, Marinho ES, Nogueira CES, Coutinho HDM, Teixeira AMR. In silico and in vitro evaluation of efflux pumps inhibition of α,β-amyrin. J Biomol Struct Dyn 2022; 40:12785-12799. [PMID: 34528866 DOI: 10.1080/07391102.2021.1976277] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The use of the bacterial efflux pump mechanism to reduce the concentrations of antibiotics in the intracellular to the extracellular region is one of the main mechanisms by which bacteria acquire resistance to antibiotics. The present study aims to evaluate the antibacterial activity of the α,β-amyrin mixture isolated from Protium heptaphyllum against the multidrug-resistant strains of Escherichia coli 06 and Staphylococcus aureus 10, and to verify the inhibition of the efflux resistance mechanisms against the strains of S. aureus 1199B and K2068, carrying the NorA and MepA efflux pumps, respectively. The α,β-amyrin did not show clinically relevant direct bacterial activity. However, the α,β-amyrin when associated with the gentamicin antibiotic presented synergistic effect against the multidrug-resistant bacterial strain of S. aureus 10. In strains with efflux pumps, α,β-amyrin was able to inhibit the action of the efflux protein NorA against Ethidium Bromide. However, this inhibitory effect was not observed in the MepA efflux pump. In addition, when evaluating the effect of standard efflux pump inhibitors, clorptomazine and CCCP, α,β-amyrin showed a decrease in MIC, demonstrating the presence of the efflux mechanism through synergism. Docking studies indicate that α, β-amyrin have a higher affinity energy to MepA, and NorA than ciprofloxacin and norfloxacin. Also, α, β-amyrin bind to the same region of the binding site as these antibiotics. It was concluded that the α, β-amyrin has the potential to increase antibacterial activity with the association of antibiotics, together with the ability to be a strong candidate for an efflux pump inhibitor.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Raíssa C Oliveira
- Graduate Program in Biological Chemistry, Department of Biological Chemistry, Regional University of Cariri, Crato, CE, Brazil
| | - Paulo N Bandeira
- Science and Technology Centre, Course of Chemistry, State University Vale do Acaraú, Sobral, CE, Brazil
| | - Telma L G Lemos
- Department of Organic and Inorganic Chemistry, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Hélcio S Dos Santos
- Graduate Program in Biological Chemistry, Department of Biological Chemistry, Regional University of Cariri, Crato, CE, Brazil.,Science and Technology Centre, Course of Chemistry, State University Vale do Acaraú, Sobral, CE, Brazil
| | - Jackelyne R Scherf
- Graduate Program in Biological Chemistry, Department of Biological Chemistry, Regional University of Cariri, Crato, CE, Brazil
| | - Janaina E Rocha
- Graduate Program in Biological Chemistry, Department of Biological Chemistry, Regional University of Cariri, Crato, CE, Brazil
| | - Raimundo L S Pereira
- Graduate Program in Biological Chemistry, Department of Biological Chemistry, Regional University of Cariri, Crato, CE, Brazil
| | - Thiago S Freitas
- Graduate Program in Biological Chemistry, Department of Biological Chemistry, Regional University of Cariri, Crato, CE, Brazil
| | - Priscila R Freitas
- Graduate Program in Biological Chemistry, Department of Biological Chemistry, Regional University of Cariri, Crato, CE, Brazil
| | - Francisco N Pereira-Junior
- Center of Agricultural Sciences and of the Biodiversity, Federal University of Cariri, Juazeiro do Norte, CE, Brazil
| | - Márcia M Marinho
- Faculty of Education, Sciences and Letters of Iguatu, State University of Ceará, Campus FECLI, Iguatu, CE, Brazil
| | - Emanuelle M Marinho
- Department of Analytical Chemistry and Physical Chemistry, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Emmanuel S Marinho
- Group of Theoretical Chemistry and Electrochemistry, State University of Ceará, Campus FAFIDAM, Limoeiro do Norte, CE, Brazil
| | - Carlos E S Nogueira
- Graduate Program in Biological Chemistry, Department of Biological Chemistry, Regional University of Cariri, Crato, CE, Brazil.,Department of Physics, Regional University of Cariri, Juazeiro do Norte, CE, Brazil
| | - Henrique D M Coutinho
- Graduate Program in Biological Chemistry, Department of Biological Chemistry, Regional University of Cariri, Crato, CE, Brazil
| | - Alexandre M R Teixeira
- Graduate Program in Biological Chemistry, Department of Biological Chemistry, Regional University of Cariri, Crato, CE, Brazil.,Department of Physics, Regional University of Cariri, Juazeiro do Norte, CE, Brazil
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Hemília de Souza Nunes P, Sampaio de Freitas T, Esmeraldo Rocha J, Luiz Silva Pereira R, Machado Marinho M, de Oliveira MR, Santos Oliveira L, Machado Marinho E, Silva Marinho E, Sousa Aquino S, Emidio Sampaio Nogueira C, Douglas Melo Coutinho H, Nogueira Bandeira P, Magno Rodrigues Teixeira A, dos Santos HS. Potentiation of antibiotic activity, and efflux pumps inhibition by (2
E
)‐1‐(4‐aminophenyl)‐3‐(4‐fluorophenyl)prop‐2‐en‐1‐one. Fundam Clin Pharmacol 2022; 36:1066-1082. [DOI: 10.1111/fcp.12785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/25/2022] [Accepted: 04/25/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Paula Hemília de Souza Nunes
- Graduate Program in Biotechnology, Northeast Network of Biotechnology State University of Ceará, Campus Itaperi Fortaleza CE Brazil
| | - Thiago Sampaio de Freitas
- Graduate Program in Biological Chemistry, Department of Biological Chemistry Regional University of Cariri Crato CE Brazil
| | - Janaína Esmeraldo Rocha
- Graduate Program in Biological Chemistry, Department of Biological Chemistry Regional University of Cariri Crato CE Brazil
| | - Raimundo Luiz Silva Pereira
- Graduate Program in Biological Chemistry, Department of Biological Chemistry Regional University of Cariri Crato CE Brazil
| | - Marcia Machado Marinho
- Faculty of Education, Sciences and Letters of Iguatu State University of Ceará, Campus FECLI Iguatu CE Brazil
| | | | - Larissa Santos Oliveira
- Science and Technology Centre, Course of Chemistry State University Vale do Acaraú Sobral CE Brazil
| | - Emanuelle Machado Marinho
- Group of Theoretical Chemistry and Electrochemistry State University of Ceará, Campus FAFIDAM Limoeiro do Norte CE Brazil
| | - Emmanuel Silva Marinho
- Department of Organic and Inorganic Chemistry Federal University of Ceará Fortaleza CE Brazil
| | - Silvia Sousa Aquino
- Graduate Program in Biotechnology, Northeast Network of Biotechnology State University of Ceará, Campus Itaperi Fortaleza CE Brazil
| | - Carlos Emidio Sampaio Nogueira
- Graduate Program in Biological Chemistry, Department of Biological Chemistry Regional University of Cariri Crato CE Brazil
- Department of Physics Regional University of Cariri Juazeiro do Norte CE Brazil
| | - Henrique Douglas Melo Coutinho
- Graduate Program in Biological Chemistry, Department of Biological Chemistry Regional University of Cariri Crato CE Brazil
| | - Paulo Nogueira Bandeira
- Science and Technology Centre, Course of Chemistry State University Vale do Acaraú Sobral CE Brazil
| | - Alexandre Magno Rodrigues Teixeira
- Graduate Program in Biotechnology, Northeast Network of Biotechnology State University of Ceará, Campus Itaperi Fortaleza CE Brazil
- Graduate Program in Biological Chemistry, Department of Biological Chemistry Regional University of Cariri Crato CE Brazil
- Department of Physics Regional University of Cariri Juazeiro do Norte CE Brazil
| | - Hélcio Silva dos Santos
- Graduate Program in Biotechnology, Northeast Network of Biotechnology State University of Ceará, Campus Itaperi Fortaleza CE Brazil
- Graduate Program in Biological Chemistry, Department of Biological Chemistry Regional University of Cariri Crato CE Brazil
- Science and Technology Centre, Course of Chemistry State University Vale do Acaraú Sobral CE Brazil
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Onita T, Ikawa K, Ishihara N, Tamaki H, Yano T, Naora K, Morikawa N. Pharmacodynamic Evaluation of Ampicillin-sulbactam in Pediatric Patients Using Plasma and Urine Data. Pediatr Infect Dis J 2022; 41:411-416. [PMID: 35195566 DOI: 10.1097/inf.0000000000003496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND We aimed to develop population pharmacokinetic (PK) models of ampicillin and sulbactam using pooled data analysis and to optimize dosing regimens of ampicillin-sulbactam (combination ratio of 2:1) in pediatric patients. METHODS Population PK models of ampicillin and sulbactam were separately developed by simultaneously fitting plasma and urine data from pediatric patients in 14 published studies. Based on these models, we estimated the probability of attaining a pharmacodynamic (PD) target [50% of time that free drug concentrations above the minimum inhibitory concentration, 50% fT > minimum inhibitory concentration (MIC)] against MIC90 [MIC that blocked the growth of 90% of the strains] of common bacteria in community-acquired pneumonia. RESULTS The analysis included 54 pediatric patients (0.083-16.42 years of age, 4.0-77.0 kg of body weight). A total of 284 plasma concentrations and 90 urinary excretions from 0 to 6 hours after administration were used for population PK modeling. The data were adequately described by 2-compartment models for ampicillin and sulbactam. Age was not a statistically significant covariate in the PK of either drug. The PK/PD breakpoint MICs for 45 mg/kg 3 times daily and 75 mg/kg 4 times daily (q.i.d.) were 0.25 and 1 μg/mL, respectively. For empiric therapy of community-acquired pneumonia, because MIC90 values for the main target pathogens is high (MIC90 = 2 μg/mL for Streptococcus pneumoniae and MIC90 = 4 μg/mL for Haemophilus influenzae), 75 mg/kg q.i.d. (Food and Drug Administration-approved maximum dosage in United States) might be better than 45 mg/kg 3 times daily (within approved dosage in Japan) to cover many pathogens. CONCLUSIONS From the results of this PK/PD approach, 75 mg/kg q.i.d. (Food and Drug Administration-approved maximum dosage) should be recommended in the empiric therapy of community-acquired pneumonia.
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Affiliation(s)
- Tetsushu Onita
- From the Department of Clinical Pharmacotherapy, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Japan
- Department of Pharmacy, Shimane University Hospital, 89-1 Enya-cho, Izumo, Shimane, Japan
| | - Kazuro Ikawa
- From the Department of Clinical Pharmacotherapy, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Japan
| | - Noriyuki Ishihara
- Department of Pharmacy, Shimane University Hospital, 89-1 Enya-cho, Izumo, Shimane, Japan
| | - Hiroki Tamaki
- Department of Pharmacy, Shimane University Hospital, 89-1 Enya-cho, Izumo, Shimane, Japan
| | - Takahisa Yano
- Department of Pharmacy, Shimane University Hospital, 89-1 Enya-cho, Izumo, Shimane, Japan
| | - Kohji Naora
- Department of Pharmacy, Shimane University Hospital, 89-1 Enya-cho, Izumo, Shimane, Japan
| | - Norifumi Morikawa
- From the Department of Clinical Pharmacotherapy, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Japan
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