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Bergogne-Berezin E, Even P, Berthelot G, Pierre J. Cefuroxime: Pharmacokinetic Study in Bronchial Secretions. Proc R Soc Med 2016. [DOI: 10.1177/00359157770700s907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- E Bergogne-Berezin
- (Department of Microbiology, Bichat Hospital and Department of Chest Disease, Laennec Hospital, Paris, France
| | - P Even
- (Department of Microbiology, Bichat Hospital and Department of Chest Disease, Laennec Hospital, Paris, France
| | - G Berthelot
- (Department of Microbiology, Bichat Hospital and Department of Chest Disease, Laennec Hospital, Paris, France
| | - J Pierre
- (Department of Microbiology, Bichat Hospital and Department of Chest Disease, Laennec Hospital, Paris, France
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Brusse-Keizer M, VanderValk P, van der Zanden RW, Nijdam L, van der Palen J, Hendrix R, Movig K. Amoxicillin concentrations in relation to beta-lactamase activity in sputum during exacerbations of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2015; 10:455-61. [PMID: 25767383 PMCID: PMC4354398 DOI: 10.2147/copd.s70355] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Acute exacerbations of chronic obstructive pulmonary disease (COPD) are often treated with antibiotics. Theoretically, to be maximally effective, the antibiotic concentration at sites of infection should exceed the minimum inhibitory concentration at which 90% of the growth of potential pathogens is inhibited (MIC90). A previous study showed that most hospitalized COPD patients had sputum amoxicillin concentrations <LMIC90 when treated with amoxicillin/clavulanic acid. Those with adequate sputum concentrations had better clinical outcomes. Low amoxicillin concentrations can be caused by beta-lactamase activity in the lungs. This study investigated whether patients with sputum amoxicillin concentrations <MIC90 had higher beta-lactamase activity in sputum than patients with a concentration ≥MIC90. Methods In total, 23 patients hospitalized for acute exacerbations of COPD and treated with amoxicillin/clavulanic acid were included. Sputum and serum samples were collected at day 3 of treatment to determine beta-lactamase activity in sputum and amoxicillin concentrations in both sputum and serum. Results We found no difference in beta-lactamase activity between patients with sputum amoxicillin concentrations <MIC90 and ≥MIC90 (P=0.79). Multivariate logistic regression analysis showed no significant relationship between beta-lactamase activity and sputum amoxicillin concentrations <MIC90 or ≥MIC90 (odds ratio 0.53; 95% confidence interval 0.23–1.2; P=0.13). Amoxicillin concentrations were <MIC90 in 78% of sputum samples and in 30% of serum samples. Conclusion In patients treated with amoxicillin/clavulanic acid for an acute exacerbation of COPD, sputum beta-lactamase activity did not differ between those with sputum amoxicillin concentrations <MIC90 or ≥MIC90. The finding that the majority of patients had sputum amoxicillin concentrations <MIC90 suggests that current treatment with antibiotics for acute exacerbations of COPD should be optimized.
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Affiliation(s)
| | - Paul VanderValk
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Rogier W van der Zanden
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Lars Nijdam
- Department of Clinical Pharmacy, Medisch Spectrum Twente, the Netherlands
| | - Job van der Palen
- Medical School Twente, Medisch Spectrum Twente, Enschede, the Netherlands ; Department of Research Methodology, Measurement and Data Analysis, University of Twente, the Netherlands
| | - Ron Hendrix
- Regional Laboratory of Public Health, Enschede, the Netherlands ; Department of Medical Microbiology, University Medical Centre Groningen, and University of Groningen, Groningen, the Netherlands
| | - Kris Movig
- Department of Clinical Pharmacy, Medisch Spectrum Twente, the Netherlands
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Brusse-Keizer M, ten Bokum L, Movig K, van der Valk P, Kerstjens H, van der Palen J, Hendrix R. Relation between amoxicillin concentration in sputum of COPD patients and length of hospitalization. COPD 2011; 8:66-70. [PMID: 21495834 DOI: 10.3109/15412555.2011.558863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Amoxicillin is a widely used antibiotic in COPD. Little is known about the transfer of amoxicillin into sputum of COPD patients. The objective was to investigate the relationship between the concentration of amoxicillin in sputum in hospitalized COPD patients and length of hospitalization. To be effective against bacterial pathogens, the amoxicillin concentration in target tissues should be higher than the Minimal Inhibiting Concentration (MIC) of 2 mg/l. Therefore, this was also used as the cut-off value for the amoxicillin concentration in sputum, as a marker for lung tissue concentration. Fifty-two COPD in-patients with an exacerbation, treated with amoxicillin clavulanic acid, were included in this cohort study. Of these patients 7 also had pneumonia. Patients were divided in patients with an amoxicillin sputum concentration ≥ 2 mg/l and < 2 mg/l. Furthermore, inflammation markers in sputum and serum and clinical parameters were obtained. Of the 33 patients with usable sputum, 11 had a concentration in sputum ≥ 2 mg/l. The mean length of hospitalization for patients with concentrations below the MIC90 to common respiratory pathogens was 11.0 days, while for patients with concentrations at or above the MIC90 this was 7.0 days (p = 0.005). COPD patients admitted for an acute exacerbation of COPD, with a sputum concentration of amoxicillin ≥ 2 mg/l had a markedly reduced length of hospitalization compared to patients with a concentration < 2 mg/l. It is worthwhile testing whether individualized treatment based on sputum amoxicillin concentrations of patients during hospitalization for acute exacerbations can effectively reduce hospital stay.
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Cruciani M, Gatti G, Cazzadori A, Concia E. Pharmacokinetics of antimicrobial agents in the respiratory tract. ZENTRALBLATT FUR BAKTERIOLOGIE : INTERNATIONAL JOURNAL OF MEDICAL MICROBIOLOGY 1996; 284:1-31. [PMID: 8837365 DOI: 10.1016/s0934-8840(96)80150-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The ability of antibiotics to penetrate into the respiratory tract has been investigated at several sites, namely, sputum and bronchial secretions, tissue homogenates, pleural fluid and, more recently, epithelial lining fluid and alveolar macrophages. The major reason for such investigations is that these data may be helpful to a more thorough understanding of drug distribution in the lung tissue and fluids and to a more accurate prediction of clinical outcome. However, the study of drug concentration at each of these sites presents problems in terms of methodology and data interpretation. The advantages and disadvantages of each of these methods are considered, and the data on penetration of betalactams, aminoglycosides, macrolides, fluoroquinolones and other antimicrobial agents (including antifungal and antiprotozoan drugs) are reviewed.
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Affiliation(s)
- M Cruciani
- Institute of Immunology and Infectious Diseases, Università degli Studi di Verona, Ospedale Civile Maggiore, Italy
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6
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Hill SL, Burnett D, Lovering AL, Stockley RA. Use of an enzyme-linked immunosorbent assay to assess penetration of amoxicillin into lung secretions. Antimicrob Agents Chemother 1992; 36:1545-52. [PMID: 1510453 PMCID: PMC191618 DOI: 10.1128/aac.36.7.1545] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
An enzyme-linked immunosorbent assay (ELISA) was developed to measure total amoxicillin concentrations penetrating lung secretions, which were compared with "active" concentrations measured by conventional bioassay. An antibody was raised in rabbits to amoxicillin conjugated to bovine serum albumin and used in a competitive binding ELISA (sensitivity, 10 ng/ml; precision [coefficient of variation], 9%). The measurement of amoxicillin in lung secretions by using the ELISA method was verified by high-performance liquid chromatography. Amoxicillin concentrations were found to be similar in both whole sonicated sputum and sol-phase sputum obtained by ultracentrifugation following single oral doses of 3 g (4.6 mg/liter for sonicated and 4.7 mg/liter for sol-phase preparations) and 250 mg (0.23 mg/liter for both preparations). Eight patients with bronchiectasis received 500 mg of amoxicillin three times daily. On the second day of therapy (4 h after the morning dose), the mean concentration of amoxicillin in sputum was 0.88 mg/liter (standard error of the mean [SEM], 0.11) by ELISA and 0.40 mg/liter (SEM, 0.05) by bioassay, suggesting a significant degree of local inactivation. This difference between total and active amoxicillin levels was found to correlate significantly (r = 0.693; P less than 0.05) with beta-lactamase levels (mean, 29.5 mU/ml; SEM, 9.4). A pharmacokinetic study on day 3 revealed maximum levels in secretions 2 to 4 h after dosing (mean, 1.36 mg/liter; SEM, 0.26). At the end of successful therapy (day 14), total and active levels were lower (mean, 0.48 mg/liter; SEM, 0.11 [total]; mean, 0.21 mg/liter; SEM, 0.06 [active]); this result was associated with a reduction in lung inflammation (decreased serum-derived albumin in the lung secretions). In conclusion, antibiotic penetration is partly dependent on the degree of lung inflammation. The differences observed in total and active levels of amoxicillin and the relationship to beta-lactamase activity in sputum suggest why higher doses of antibiotic may be required to produce a therapeutic response in some patients.
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Affiliation(s)
- S L Hill
- Lung Immunobiochemical Research Laboratory, General Hospital, Birmingham, United Kingdom
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Baldwin DR, Honeybourne D, Wise R. Pulmonary disposition of antimicrobial agents: in vivo observations and clinical relevance. Antimicrob Agents Chemother 1992; 36:1176-80. [PMID: 1416817 PMCID: PMC190300 DOI: 10.1128/aac.36.6.1176] [Citation(s) in RCA: 96] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- D R Baldwin
- Department of Thoracic Medicine, Dudley Road Hospital, Birmingham, United Kingdom
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Baldwin DR, Honeybourne D, Wise R. Pulmonary disposition of antimicrobial agents: methodological considerations. Antimicrob Agents Chemother 1992; 36:1171-5. [PMID: 1416816 PMCID: PMC190295 DOI: 10.1128/aac.36.6.1171] [Citation(s) in RCA: 139] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- D R Baldwin
- Department of Thoracic Medicine, Dudley Road Hospital, Birmingham, United Kingdom
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Trigg CJ, Wilks M, Herdman MJ, Clague JE, Tabaqchali S, Davies RJ. A double-blind comparison of the effects of cefaclor and amoxycillin on respiratory tract and oropharyngeal flora and clinical response in acute exacerbations of bronchitis. Respir Med 1991; 85:301-8. [PMID: 1947367 DOI: 10.1016/s0954-6111(06)80101-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Fifty-one patients admitted to hospital with severe exacerbations of chronic bronchitis entered a double-blind trial of treatment with cefaclor (500 mg tds) compared with amoxycillin (500 mg tds) for 7 days. Twenty-six patients received cefaclor and 25 amoxycillin. Sputum and throat swabs were collected on admission, after 7 days of therapy and at outpatient follow-up, 3 weeks after treatment had finished. Clinical status and spirometry were assessed on admission and at the third, seventh and 28th day. There was no significant difference between the two regimes for clinical outcome, spirometry or numbers of infecting pathogens. Opportunistic colonization with resistant Gram-negative organisms and Candida species was highly prevalent on admission (56%) in both groups, perhaps because of previous antibiotic administration and general debility of the majority of patients. The high prevalence of opportunistic colonizing organisms persisted at follow-up (48%) with a significant excess of new organisms (Enterobacter cloacae, Klebsiella species and Candida species) present in sputum in the amoxycillin-treated patients. Cefaclor may be less damaging to normal flora than amoxycillin with a consequently reduced risk of colonization and superinfection of the respiratory tract with resistant Gram-negative organisms and yeasts.
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Affiliation(s)
- C J Trigg
- Department of Respiratory Medicine, St. Bartholomew's Hospital and Medical College, West Smithfield, London, U.K
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Symonds J. Penetration of antibiotics into the respiratory tract. BMJ : BRITISH MEDICAL JOURNAL 1987; 294:1181-2. [PMID: 3594149 PMCID: PMC1246348 DOI: 10.1136/bmj.294.6581.1181] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Fassl A, Muhr R, Pirker S, Nahler G. Amoxycillin in bronchitis. Comparison of two versus three daily doses. J Int Med Res 1987; 15:76-82. [PMID: 3582722 DOI: 10.1177/030006058701500203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Fifty patients with moderate or severe bronchitis were randomly allocated into groups receiving orally either 1000 mg amoxycillin twice daily or 750 mg three times daily. Overall cure rates (both 92%) and the incidence of side-effects (4% and 8%, respectively) were similar in both groups. A twice daily regimen, therefore, seems to be as effective as conventional treatment and has the advantage of being more convenient for the patient.
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Pedersen M, Støvring S, Mørkassel E, Koch C, Høiby N. A comparative study of amoxycillin and pivampicillin in persistent Haemophilus influenzae infection of the lower respiratory tract in children with chronic lung disease. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1986; 18:245-54. [PMID: 3526532 DOI: 10.3109/00365548609032334] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A double-blind cross-over study was undertaken to compare the efficacy of amoxycillin and pivampicillin on Haemophilus influenzae infection of the lower respiratory tract in children. 20 patients with cystic fibrosis (CF) or chronic obstructive pulmonary disease (COPD) due to other causes were included in the study. All patients had a history of regularly harbouring H. influenzae in sputum and repeated treatment failures with pivampicillin. 18 completed two 14-day courses in random order with equimolar doses of pivampicillin (80 mg/kg/day) and amoxycillin (62 mg/kg/day). Both drugs were well tolerated with no serious side effects, but pivampicillin was associated with more pronounced nausea. In steady state the mean serum concentrations of antibiotics 2 and 4 h after medication were 9.7 and 3.7 micrograms/ml for pivampicillin and 19.1 and 7.9 micrograms/ml for amoxycillin (p less than 0.01). Eradication of H. influenzae and clinical improvement was seen in one-third of the courses with both drugs. Betalactamase producing ampicillin-resistant strains emerged during 58% of the amoxycillin courses, but only in 16% of the pivampicillin courses (p less than 0.001). The high number of treatment failures and the development of resistant strains indicate that betalactamase inhibitors may possibly improve the efficacy of these drugs, especially of amoxycillin, in these patients.
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Relations entre le degré de purulence des expectorations, évalué par le dosage de l'A.D.N., et leurs concentrations en Sisomicine, chez des porteurs d'infections bronchopulmonaires. Med Mal Infect 1982. [DOI: 10.1016/s0399-077x(82)80001-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Havard C, Fernando A, Brumfitt W, Hamilton-Miller J. A pilot study of ‘Augmentin’ in lower respiratory tract infections: Pharmacokinetic and clinical results. ACTA ACUST UNITED AC 1982. [DOI: 10.1016/0007-0971(82)90050-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Anderson G, Jariwalla AG, Saour J. A comparison of ampicillin and amoxycillin in acute on chronic bronchitis. Thorax 1979; 34:814-6. [PMID: 396690 PMCID: PMC471203 DOI: 10.1136/thx.34.6.814] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Twenty-five patients with an acute exacerbation of chronic bronchitis completed a double-blind trial of amoxycillin 1.5 g v ampicillin 4 g daily. After treatment for one week there was no difference between the treatments in the rates of achieving mucoid sputum, reduction in sputum volume, improvement in peak expiratory flow rate, or duration of hospital stay. In the doses studied ampicillin and amoxycillin are effective drugs of about equal cost.
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Reeves DS, Bullock DW. The aminopenicillins: development and comparative properties. Infection 1979; 7 Suppl 5:S425-33. [PMID: 389819 DOI: 10.1007/bf01659764] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In this review we have compared and contrasted the antibacterial and pharmacological properties of the aminopenicillins currently available. It is apparent that there is little hard evidence (except in the case of thphoid fever) that either amoxycillin or the pro-drug esters of ampicillin are significantly more effective than ampicillin itself, despite their better absorption and higher serum levels. However, amoxycillin and the ampicillin pro-drug esters do cause fewer bowel side-effects than ampicillin, which may justify their use despite the extra cost involved. The problem of susceptibility to penicillinases is unlikely to be solved by modification of the aminopenicillin molecule. A more likely solution is administration of these substances with beta-lactamase inhibitors such as clavulanic acid. Trials with such combinations are already under way.
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Davies B, Maesen F. Serum and sputum antibiotic levels after ampicillin, amoxycillin and bacampicillin chronic bronchitis patients. Infection 1979; 7 Suppl 5:S465-8. [PMID: 315930 DOI: 10.1007/bf01659773] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Serum and sputum concentrations of ampicillin or amoxycillin were measured in patients admitted to hospital for acute exacerbations of chronic bronchitis with purulent sputum. Mean peak serum levels of nearly 12 mg/l were found after 1600 mg bacampicillin (mean peak level in sputum 0.85 mg/l). The serum and sputum concentrations after 750 mg amoxycillin and 800 mg bacampicillin were comparable (mean peak serum levels approximately 9.5 mg/l, sputum concentrations 0.4 to 0.5 mg/l) although the drugs were not given in equimolar doses. Results after 1000 mg ampicillin by mouth were less satisfactory (mean peak serum level 7.8 mg/l) and only 0.25 mg/l was attained in the sputum. Minimum inhibitory concentrations of ampicillin and amoxycillin were measured for 177 Haemophilus influenzae strains. Most of the ampicillin MIC values were between 0.125 and 0.5 mg/l but more of the strains required 0.5 mg/l of amoxycillin. The amoxycillin MIC values were often one or two dilutions higher than those of ampicillin (p less than 0.001).
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