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Pereira LC, de Fátima MA, Santos VV, Brandão CM, Alves IA, Azeredo FJ. Pharmacokinetic/Pharmacodynamic Modeling and Application in Antibacterial and Antifungal Pharmacotherapy: A Narrative Review. Antibiotics (Basel) 2022; 11:986. [PMID: 35892376 PMCID: PMC9330032 DOI: 10.3390/antibiotics11080986] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 02/04/2023] Open
Abstract
Pharmacokinetics and pharmacodynamics are areas in pharmacology related to different themes in the pharmaceutical sciences, including therapeutic drug monitoring and different stages of drug development. Although the knowledge of these disciplines is essential, they have historically been treated separately. While pharmacokinetics was limited to describing the time course of plasma concentrations after administering a drug-dose, pharmacodynamics describes the intensity of the response to these concentrations. In the last decades, the concept of pharmacokinetic/pharmacodynamic modeling (PK/PD) emerged, which seeks to establish mathematical models to describe the complete time course of the dose-response relationship. The integration of these two fields has had applications in optimizing dose regimens in treating antibacterial and antifungals. The anti-infective PK/PD models predict the relationship between different dosing regimens and their pharmacological activity. The reviewed studies show that PK/PD modeling is an essential and efficient tool for a better understanding of the pharmacological activity of antibacterial and antifungal agents.
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Affiliation(s)
- Laiz Campos Pereira
- Laboratory of Pharmacokinetics and Pharmacometrics, Faculty of Pharmacy, Federal University of Bahia (UFBA), Rua Barão de Jeremoabo, 147, Salvador 40170-115, BA, Brazil; (L.C.P.); (M.A.d.F.); (V.V.S.); (C.M.B.); (I.A.A.)
- Pharmacy Graduate Program, Federal University of Bahia, Rua Barão de Jeremoabo, 147, Salvador 40170-115, BA, Brazil
| | - Marcelo Aguiar de Fátima
- Laboratory of Pharmacokinetics and Pharmacometrics, Faculty of Pharmacy, Federal University of Bahia (UFBA), Rua Barão de Jeremoabo, 147, Salvador 40170-115, BA, Brazil; (L.C.P.); (M.A.d.F.); (V.V.S.); (C.M.B.); (I.A.A.)
| | - Valdeene Vieira Santos
- Laboratory of Pharmacokinetics and Pharmacometrics, Faculty of Pharmacy, Federal University of Bahia (UFBA), Rua Barão de Jeremoabo, 147, Salvador 40170-115, BA, Brazil; (L.C.P.); (M.A.d.F.); (V.V.S.); (C.M.B.); (I.A.A.)
- Pharmacy Graduate Program, Federal University of Bahia, Rua Barão de Jeremoabo, 147, Salvador 40170-115, BA, Brazil
| | - Carolina Magalhães Brandão
- Laboratory of Pharmacokinetics and Pharmacometrics, Faculty of Pharmacy, Federal University of Bahia (UFBA), Rua Barão de Jeremoabo, 147, Salvador 40170-115, BA, Brazil; (L.C.P.); (M.A.d.F.); (V.V.S.); (C.M.B.); (I.A.A.)
| | - Izabel Almeida Alves
- Laboratory of Pharmacokinetics and Pharmacometrics, Faculty of Pharmacy, Federal University of Bahia (UFBA), Rua Barão de Jeremoabo, 147, Salvador 40170-115, BA, Brazil; (L.C.P.); (M.A.d.F.); (V.V.S.); (C.M.B.); (I.A.A.)
| | - Francine Johansson Azeredo
- Pharmacy Graduate Program, Federal University of Bahia, Rua Barão de Jeremoabo, 147, Salvador 40170-115, BA, Brazil
- Center for Pharmacometrics & Systems Pharmacology, Department of Pharmaceutics, College of Pharmacy, Orlando, FL 328827, USA
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Roberts MG, Burgess S, Toombs-Ruane LJ, Benschop J, Marshall JC, French NP. Combining mutation and horizontal gene transfer in a within-host model of antibiotic resistance. Math Biosci 2021; 339:108656. [PMID: 34216634 DOI: 10.1016/j.mbs.2021.108656] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/25/2022]
Abstract
Antibiotics are used extensively to control infections in humans and animals, usually by injection or a course of oral tablets. There are several methods by which bacteria can develop antimicrobial resistance (AMR), including mutation during DNA replication and plasmid mediated horizontal gene transfer (HGT). We present a model for the development of AMR within a single host animal. We derive criteria for a resistant mutant strain to replace the existing wild-type bacteria, and for co-existence of the wild-type and mutant. Where resistance develops through HGT via conjugation we derive criteria for the resistant strain to be excluded or co-exist with the wild-type. Our results are presented as bifurcation diagrams with thresholds determined by the relative fitness of the bacteria strains, expressed in terms of reproduction numbers. The results show that it is possible that applying and then relaxing antibiotic control may lead to the bacterial load returning to pre-control levels, but with an altered structure with regard to the variants that comprise the population. Removing antimicrobial selection pressure will not necessarily reduce AMR and, at a population level, other approaches to infection prevention and control are required, particularly when AMR is driven by both mutation and mobile genetic elements.
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Affiliation(s)
- M G Roberts
- School of Natural & Computational Sciences, Massey University, Private Bag 102 904, North Shore Mail Centre, Auckland, 0745, New Zealand; New Zealand Institute for Advanced Study, Massey University, Private Bag 102 904, North Shore Mail Centre, Auckland, 0745, New Zealand; Infectious Disease Research Centre, Massey University, Private Bag 11-222, Palmerston North, 4442, New Zealand.
| | - S Burgess
- Infectious Disease Research Centre, Massey University, Private Bag 11-222, Palmerston North, 4442, New Zealand; School of Veterinary Sciences, Massey University, Private Bag 11-222, Palmerston North, 4442, New Zealand; mEpilab, Massey University, Private Bag 11-222, Palmerston North, 4442, New Zealand
| | - L J Toombs-Ruane
- Infectious Disease Research Centre, Massey University, Private Bag 11-222, Palmerston North, 4442, New Zealand; School of Veterinary Sciences, Massey University, Private Bag 11-222, Palmerston North, 4442, New Zealand; mEpilab, Massey University, Private Bag 11-222, Palmerston North, 4442, New Zealand
| | - J Benschop
- Infectious Disease Research Centre, Massey University, Private Bag 11-222, Palmerston North, 4442, New Zealand; School of Veterinary Sciences, Massey University, Private Bag 11-222, Palmerston North, 4442, New Zealand; mEpilab, Massey University, Private Bag 11-222, Palmerston North, 4442, New Zealand
| | - J C Marshall
- Infectious Disease Research Centre, Massey University, Private Bag 11-222, Palmerston North, 4442, New Zealand; mEpilab, Massey University, Private Bag 11-222, Palmerston North, 4442, New Zealand; School of Fundamental Sciences, Massey University, Private Bag 11-222, Palmerston North, 4442, New Zealand
| | - N P French
- New Zealand Institute for Advanced Study, Massey University, Private Bag 102 904, North Shore Mail Centre, Auckland, 0745, New Zealand; Infectious Disease Research Centre, Massey University, Private Bag 11-222, Palmerston North, 4442, New Zealand; mEpilab, Massey University, Private Bag 11-222, Palmerston North, 4442, New Zealand; New Zealand Food Safety Science & Research Centre, Massey University, Private Bag 11-222, Palmerston North, 4442, New Zealand
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Ciprofloxacin Pharmacokinetics/Pharmacodynamics against Susceptible and Low-Level Resistant Escherichia coli Isolates in an Experimental Ascending Urinary Tract Infection Model in Mice. Antimicrob Agents Chemother 2020; 65:AAC.01804-20. [PMID: 33106267 DOI: 10.1128/aac.01804-20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/19/2020] [Indexed: 12/13/2022] Open
Abstract
The mouse ascending urinary tract infection model was used to study the pharmacokinetic/pharmacodynamic (PKPD) relationships of the effect of ciprofloxacin in subcutaneous treatment for 3 days with varying doses and dosing intervals against a susceptible Escherichia coli strain (MIC, 0.032 mg/liter). Further, a humanized dose of ciprofloxacin was administered for 3 days against three E. coli strains with low-level resistance, i.e., MICs of 0.06, 0.25, and 1 mg/liter, respectively. Against the susceptible isolate, ciprofloxacin was highly effective in clearing the urine with daily doses from 10 mg/kg, but the dosing regimen had to be divided into at least two doses for optimal effect. Ciprofloxacin could not clear the urine or kidneys for the low-level-resistant strains. PKPD correlations with all strains combined showed that for the AUC24/MIC there was a slightly higher correlation with effect in urine and kidneys (R 2, 0.71 and 0.69, respectively) than the %T>MIC (R 2, 0.41 and 0.61, respectively). Equal correlations for the two PKPD indices were found for reduction of colony counts (CFU) in the bladder tissue, but not even the highest dose of 28 mg/kg × 6 could clear the bladder tissue. In conclusion, ciprofloxacin is highly effective in clearing the urine and kidney tissue for fully susceptible E. coli, while even low-level resistance in E. coli obscures this effect. While the effect of ciprofloxacin is mostly AUC/MIC driven against E. coli infection in the urinary tract, the effect in urine depends on the presence of ciprofloxacin in the urine during most of a 24-h period.
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