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Dalla Zuanna P, Curci D, Lucafò M, Addobbati R, Fabretto A, Stocco G. Preanalytical Stability of 13 Antibiotics in Biological Samples: A Crucial Factor for Therapeutic Drug Monitoring. Antibiotics (Basel) 2024; 13:675. [PMID: 39061358 PMCID: PMC11274111 DOI: 10.3390/antibiotics13070675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 07/16/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024] Open
Abstract
The stability of antibiotic preanalytical samples is a critical factor in therapeutic drug monitoring (TDM), a practice of undoubted importance for the proper therapeutic use of antibiotics, especially in complex management patients, such as pediatrics. This review aims to analyze the data in the literature regarding the preanalytical stability of some of the antibiotics for which TDM is most frequently requested. The literature regarding the preanalytical stability of amikacin, ampicillin, cefepime, ceftazidime, ciprofloxacin, daptomycin, gentamicin, levofloxacin, linezolid, meropenem, piperacillin, teicoplanin, and vancomycin in plasma, serum, whole blood, and dried blood/plasma spot samples was analyzed. Various storage temperatures (room temperature, 4 °C, -20 °C, and -80 °C) and various storage times (from 1 h up to 12 months) as well as subjecting to multiple freeze-thaw cycles were considered. The collected data showed that the non-beta-lactam antibiotics analyzed were generally stable under the normal storage conditions used in analytical laboratories. Beta-lactam antibiotics have more pronounced instability, particularly meropenem, piperacillin, cefepime, and ceftazidime. For this class of antibiotics, we suggest that storage at room temperature should be limited to a maximum of 4 h, storage at 2-8 °C should be limited to a maximum of 24 h, and storage at -20 °C should be limited to a maximum of 7 days; while, for longer storage, freezing at -80 °C is suggested.
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Affiliation(s)
- Paolo Dalla Zuanna
- Clinical and Experimental Pharmacology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy;
| | - Debora Curci
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, 34137 Trieste, Italy; (D.C.); (R.A.); (A.F.)
| | - Marianna Lucafò
- Department of Life Science, University of Trieste, 34127 Trieste, Italy;
| | - Riccardo Addobbati
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, 34137 Trieste, Italy; (D.C.); (R.A.); (A.F.)
| | - Antonella Fabretto
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, 34137 Trieste, Italy; (D.C.); (R.A.); (A.F.)
| | - Gabriele Stocco
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, 34137 Trieste, Italy; (D.C.); (R.A.); (A.F.)
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy
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Palayer M, Chaussenery-Lorentz O, Boubekeur L, Urbina T, Maury E, Maubert MA, Pilon A, Bourgogne E. Quantitation of 10 antibiotics in plasma: sulfosalicylic acid combined with 2D-LC-MS/MS is a robust assay for beta-lactam therapeutic drug monitoring. J Chromatogr B Analyt Technol Biomed Life Sci 2023; 1221:123685. [PMID: 37023569 DOI: 10.1016/j.jchromb.2023.123685] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 03/17/2023] [Accepted: 03/19/2023] [Indexed: 03/30/2023]
Abstract
Therapeutic drug monitoring (TDM) of antibiotics is particularly important in populations with high pharmacokinetic variabilities, such as critically ill patients, leading to unpredictable plasma concentrations and clinical outcomes. Here, we i) describe an original method for the simultaneous quantification of ten antibiotics (cefepime, ceftazidime, ampicillin, piperacillin/tazobactam, cefotaxime, amoxicillin, cloxacillin, oxacillin, linezolid) using 5-sulfosalicylic acid dihydrate (SSA) solution for protein precipitation together with 2D-LC-MS/MS, and ii) evaluate its impact in a one-year retrospective study. The method involved simple dilution with an aqueous mix of deuterated internal standards and plasma protein precipitation with SSA. Twenty microliters of the supernatant was injected into a C8 SPE online cartridge (30 × 2.1 mm) without any evaporation step and back-flushed onto a C18 UHPLC (100 × 2.1 mm) analytical column. Mass spectrometry detection (Xevo TQD) was performed in positive electrospray, in scheduled MRM mode. Overall analytical runtime was 7 min. Due to analytical constraints and the physicochemical properties of the antibiotics, protein precipitation using organic solvents could not be applied. As an alternative, SSA used with 2D-LC offered various advantages: i) lack of dilution resulting in better assay sensitivity, and ii) good chromatography of hydrophilic compounds. Ten microliters of 30% SSA in water eliminated>90% of plasma proteins, including the most abundant high molecular weight proteins at 55 and 72 kDa. The assay was successfully validated according to FDA and EMA guidelines for all the antibiotics, and the coefficients of variation of the quality control (QC) run during sample analysis over one year were below 10%, whatever the QC levels or the antibiotics. The use of 2D-LC combined with SSA precipitation allowed development of a robust, sensitive and rapid quantification assay. Feedback to clinicians was reduced to 24 h, thus allowing rapid dosage adjustment. During one year, 3,304 determinations were performed in our laboratory: 41% were not in the therapeutic range, 58% of which were sub-therapeutic, underlining the importance of early TDM of antibiotics to limit therapeutic failures and the emergence of bacterial resistance.
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Preanalytical Stability of Flucloxacillin, Piperacillin, Tazobactam, Meropenem, Cefalexin, Cefazolin, and Ceftazidime in Therapeutic Drug Monitoring: A Structured Review. Ther Drug Monit 2022; 44:709-719. [PMID: 35175248 DOI: 10.1097/ftd.0000000000000975] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/22/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND Therapeutic drug monitoring is increasingly being used to optimize beta-lactam antibiotic dosing. Because beta-lactams are inherently unstable, confirming preanalytical sample stability is critical for reporting reliable results. This review aimed to summarize the published literature on the preanalytical stability of selected widely prescribed beta-lactams used in therapeutic drug monitoring. METHODS The published literature (2010-2020) on the preanalytical stability of flucloxacillin, piperacillin, tazobactam, meropenem, cefalexin, cefazolin, and ceftazidime in human plasma, serum, and whole blood was reviewed. Articles examining preanalytical stability at room temperature, refrigerated, or frozen (-20°C) using liquid chromatography with mass spectrometry or ultraviolet detection were included. RESULTS Summarizing the available data allowed for general observations to be made, although data were conflicting in some cases (piperacillin, tazobactam, ceftazidime, and meropenem at room temperature, refrigerated, or -20°C) or limited (cefalexin, cefazolin, and flucloxacillin at -20°C). Overall, with the exception of the more stable cefazolin, preanalytical instability was observed after 6-12 hours at room temperature, 2-3 days when refrigerated, and 1-3 weeks when frozen at -20°C. In all cases, excellent stability was detected at -70°C. Studies focusing on preanalytical stability reported poorer stability than studies investigating stability as part of method validation. CONCLUSIONS Based on this review, as general guidance, clinical samples for beta-lactam analysis should be refrigerated and analyzed within 2 days or frozen at -20°C and analyzed within 1 week. For longer storage times, freezing at -70°C was required to ensure sample stability. This review highlights the importance of conducting well-designed preanalytical stability studies on beta-lactams and other potentially unstable drugs under clinically relevant conditions.
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Wang Q, Zheng Y, Liu L, Ji P, Jiang W, Zhao J, Ren J, Yang L. Simultaneous Determination of Ceftazidime and Avibactam in Human Plasma and Cerebrospinal Fluid by High-Performance Liquid Chromatography – Tandem Mass Spectrometry (HPLC-MS/MS). ANAL LETT 2022. [DOI: 10.1080/00032719.2022.2105859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Qinhui Wang
- Department of Pharmacy, The Second Affiliated Hospital of Air Force Medical University, Xi’an, China
| | - Yao Zheng
- Department of Pharmacy, The Second Affiliated Hospital of Air Force Medical University, Xi’an, China
| | - Linna Liu
- Department of Pharmacy, The Second Affiliated Hospital of Air Force Medical University, Xi’an, China
| | - Peigang Ji
- Department of Thoracic Surgery, The Second Affiliated Hospital of Air Force Medical University, Xi’an, China
| | - Wei Jiang
- Department of Pharmacy, The Second Affiliated Hospital of Air Force Medical University, Xi’an, China
| | - Jun Zhao
- Department of Pharmacy, The Second Affiliated Hospital of Air Force Medical University, Xi’an, China
| | - Jing Ren
- Department of Pharmacy, The Second Affiliated Hospital of Air Force Medical University, Xi’an, China
| | - Le Yang
- Department of Pharmacy, The Second Affiliated Hospital of Air Force Medical University, Xi’an, China
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Anjos MVD, Possa E, Fonseca GDS, Bergoza L, Santos PRD, Silva SME, Tasso L. Development and validation of an LC-ESI-QTOF-MS method to measure cefepime in the plasma and peritoneal fluid of rats using microdialysis: application in a pilot pharmacokinetic study. Biomed Chromatogr 2022; 36:e5470. [PMID: 35904365 DOI: 10.1002/bmc.5470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 11/06/2022]
Abstract
Cefepime (CEF) is a cephalosporin and can be administered in secondary peritonitis together with metronidazole to treat sepsis. This study aimed to develop and validate a method of LC-ESI-QTOF-MS for the quantification of cefepime in the plasma and peritoneal microdialysate of healthy Wistar rats. Chromatographic separation was performed using a CLC-ODS C18 column (250 mm x 4.6 mm), a C18 pre-column (4 mm, 5 μm) and isocratic elution. Gallic acid was used as the internal standard (IS). The mobile phase consisted of (A) ultrapure water (pH adjusted to 3.5) and (B) acetonitrile (80:20, v/v) at 0.8 mL/min. Quantification was performed using a mass spectrometer with electrospray ionization in positive mode to monitor ions with m/z 481.1322 (CEF) and m/z 171.0288 (IS). The method was validated for selectivity, precision, accuracy, linearity, stability, lower limit of quantification, carryover, recovery, and matrix effect. Calibration was done in the range of 1-40 μg/mL and 1-100 μg/mL for the peritoneal microdialysate and plasma, respectively. Plasma extraction recovery ranged from 93.9% to 99.9%. The technique was validated and successfully applied in a pilot pharmacokinetic study for estimating the free concentration of CEF in the peritoneal microdialysate of rats for the first time.
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Affiliation(s)
- Michele Vaz Dos Anjos
- Laboratório de Farmacocinética, Programa de Pós-graduação em Ciências da Saúde, Universidade de Caxias do Sul, Rio Grande do Sul, Brasil
| | - Eduarda Possa
- Curso de Farmácia, Universidade de Caxias do Sul, Rio Grande do Sul, Brasil
| | - Gisele da Silva Fonseca
- Programa de Pós-graduação em Biotecnologia, Universidade de Caxias do Sul, Rio Grande do Sul, Brasil
| | - Larissa Bergoza
- Laboratório de Farmacocinética, Programa de Pós-graduação em Ciências da Saúde, Universidade de Caxias do Sul, Rio Grande do Sul, Brasil
| | - Paulo Roberto Dos Santos
- Programa de Pós-graduação em Biotecnologia, Universidade de Caxias do Sul, Rio Grande do Sul, Brasil
| | - Sidnei Moura E Silva
- Programa de Pós-graduação em Biotecnologia, Universidade de Caxias do Sul, Rio Grande do Sul, Brasil
| | - Leandro Tasso
- Laboratório de Farmacocinética, Programa de Pós-graduação em Ciências da Saúde, Universidade de Caxias do Sul, Rio Grande do Sul, Brasil.,Curso de Farmácia, Universidade de Caxias do Sul, Rio Grande do Sul, Brasil.,Programa de Pós-graduação em Biotecnologia, Universidade de Caxias do Sul, Rio Grande do Sul, Brasil
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Review on Characterization, Properties, and Analytical Methods of Cefepime. Int J Anal Chem 2022; 2022:6909528. [PMID: 35814263 PMCID: PMC9259364 DOI: 10.1155/2022/6909528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/24/2022] [Indexed: 11/25/2022] Open
Abstract
Infection is one of the most important reasons for the increase in the number of deaths worldwide; it can be a bacterial or viral infection. As a result, there are many effective drugs against this infection, especially bacterial ones. Cefepime (CP) is one of the fourth generations of cephalosporins and is distinguished from others in that it can kill both positive and negative bacteria. Therefore, this study focused on the chemical properties of the drug, its uses, and its stability against bacteria. All analysis methods for this drug in pharmaceutical preparations, blood, or plasma were also presented. One of the important problems in these methods is using toxic solvents, which poses a danger to society and the environment. The presentation of these solvents will allow companies to manufacture and use more effective and less toxic solvents.
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Tůma P, Jaček M, Sommerová B, Dlouhý P, Jarošíková R, Husáková J, Wosková V, Fejfarová V. Monitoring of amoxicilline and ceftazidime in the microdialysate of diabetic foot and serum by capillary electrophoresis with contactless conductivity detection. Electrophoresis 2022; 43:1129-1139. [PMID: 35072285 DOI: 10.1002/elps.202100366] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/17/2021] [Accepted: 12/23/2021] [Indexed: 11/11/2022]
Abstract
Determination of the broad-spectrum antibiotics amoxicilline (AMX) and ceftazidime (CTZ) in blood serum and microdialysates of the subcutaneous tissue of the lower limbs is performed using CE with contactless conductivity detection (C4 D). Baseline separation of AMX is achieved in 0.5 M acetic acid as the background electrolyte and separation of CTZ in 3.2 M acetic acid with addition of 13% v/v methanol. The CE-C4 D determination is performed in a 25 µm capillary with suppression of the EOF using INST-coating on an effective length of 18 cm and the attained migration time is 4.2 min for AMX and 4.4 min for CTZ. The analysis was performed using 20 µl of serum and 15 µl of microdialysate, treated by the addition of acetonitrile in a ratio of 1/3 v/v and the sample is injected into the capillary using the large volume sample stacking technique. The LOQ attained in the microdialysate is 148 ng/ml for AMX and 339 ng/ml for CTZ, and in serum 143 ng/ml for AMX and 318 ng/ml for CTZ. The CE-C4 D method is employed for monitoring the passage of AMX and CTZ from the blood circulatory system into the subcutaneous tissue at the sites of diabetic ulceration in patients suffering from diabetic foot syndrome and also for measuring the pharmacokinetics following intravenous application of bolus antibiotic doses.
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Affiliation(s)
- Petr Tůma
- Department of Hygiene, Third Faculty of Medicine, Charles University, Prague 10, Czech Republic
| | - Martin Jaček
- Department of Hygiene, Third Faculty of Medicine, Charles University, Prague 10, Czech Republic
| | - Blanka Sommerová
- Department of Hygiene, Third Faculty of Medicine, Charles University, Prague 10, Czech Republic
| | - Pavel Dlouhý
- Department of Hygiene, Third Faculty of Medicine, Charles University, Prague 10, Czech Republic
| | - Radka Jarošíková
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague 4, Czech Republic
| | - Jitka Husáková
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague 4, Czech Republic
| | - Veronika Wosková
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague 4, Czech Republic
| | - Vladimíra Fejfarová
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague 4, Czech Republic
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8
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Cheng Y, Chen M, Zhang B, Lin H, Li X, Cai Y, Zhang H, Que W, Liu M, Qiu H. Rapid, simple, and economical LC-MS/MS method for simultaneous determination of ceftazidime and avibactam in human plasma and its application in therapeutic drug monitoring. J Clin Pharm Ther 2022; 47:1426-1437. [PMID: 35633089 DOI: 10.1111/jcpt.13693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/11/2022] [Accepted: 05/04/2022] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Carbapenem-resistant Gram-negative bacterial pathogens continue to threaten public health. Avibactam (AVI), a novel non-β-lactam β-lactamase inhibitor, has been approved for use with ceftazidime (CAZ) mainly against carbapenem-resistant Enterobacteriaceae. Therapeutic drug monitoring (TDM) is urgently needed to optimize dosage regimens to maximize efficacy, minimize toxicity, and delay the emergence of resistance. This study aims to develop and validate a rapid, simple, and economical LC-MS/MS method for simultaneous determination of CAZ/AVI in human plasma. METHODS Samples were processed by simple protein precipitation, and gradient elution strategy was applied to separate CAZ and AVI on a reverse-phase C18 column; with subsequent detection by the mass spectrometer in a positive and negative ion switching mode. Plasma samples from patients were analysed. RESULTS AND DISCUSSION A 4-min run of LC-MS/MS was developed. The precision, trueness, matrix effect, extraction recovery, carry-over, dilution integrity, and stability were all acceptable for a bioanalytical method. The method was successfully applied to the determination of CAZ and AVI in patients, and a considerable PK variability of CAZ/AVI was observed among patients. WHAT IS NEW AND CONCLUSION A robust, rapid, simple, and economical LC-MS/MS method for the simultaneous determination of CAZ and AVI was developed. The considerable PK variability of CAZ/AVI among patients demonstrates the clinical significance of TDM.
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Affiliation(s)
- Yu Cheng
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, People's Republic of China.,College of Pharmacy, Fujian Medical University, Fuzhou, People's Republic of China.,Department of Pharmacy, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Maohua Chen
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, People's Republic of China
| | - Bingqing Zhang
- College of Pharmacy, Fujian Medical University, Fuzhou, People's Republic of China
| | - Hailin Lin
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, People's Republic of China
| | - Xueyong Li
- College of Pharmacy, Fujian Medical University, Fuzhou, People's Republic of China
| | - Yipeng Cai
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, People's Republic of China
| | - Hui Zhang
- Department of Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou, People's Republic of China
| | - Wancai Que
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, People's Republic of China
| | - Maobai Liu
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, People's Republic of China
| | - Hongqiang Qiu
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, People's Republic of China.,College of Pharmacy, Fujian Medical University, Fuzhou, People's Republic of China
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9
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Methods for Determination of Meropenem Concentration in Biological Samples. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2022. [DOI: 10.2478/sjecr-2022-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Measuring the concentration of antibiotics in biological samples allow implementation of therapeutic monitoring of these drugs and contribute to the adjustment of the dosing regimen in patients. This increases the effectiveness of antimicrobial therapy, reduces the toxicity of these drugs and prevents the development of bacterial resistance. This review article summarizes current knowledge on methods for determining concentration of meropenem, an antibiotic drug from the group of carbapenems, in different biological samples. It provides a brief discussion of the chemical structure, physicochemical and pharmacokinetic properties of meropenem, different sample preparation techniques, use of apparatus and equipment, knowledge of the advantages and limitations of available methods, as well as directions in which new methods should be developed. This review should facilitate clinical laboratories to select and apply one of the established methods for measuring of meropenem, as well as to provide them with the necessary knowledge to develop new methods for quantification of meropenem in biological samples according to their needs.
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Bergman J, Harvill L, Hawkins S, Sladky K, Cox S. Determination of ceftazidime in plasma by RP-HPLC and ultraviolet detection. Biomed Chromatogr 2021; 35:e5104. [PMID: 33629742 DOI: 10.1002/bmc.5104] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/25/2021] [Accepted: 02/23/2021] [Indexed: 11/11/2022]
Abstract
A simple high-performance liquid chromatography method for the determination of ceftazidime in plasma has been developed. Using an ultrafiltration technique samples were separated by reverse-phase high-performance liquid chromatography on a Symmetry C18 4.6 × 250 mm column (5.0 μm) and ultraviolet absorbance was measured at 260 nm. The mobile phase was a mixture of 10 mm potassium phosphate monobasic pH 2.5 with phosphoric acid and acetonitrile (90:10). The standard curve ranged from 0.1 to 100 μg/ml. Intra- and inter-assay variability for ceftazidime was <12%, and the average recovery was 89%. The lower limit of quantification was 0.1 μg/ml. This method has been used successfully to analyze frog plasma samples at this institution and it could be applied to other small volume samples in a clinical or research setting.
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Affiliation(s)
- Joan Bergman
- College of Veterinary Medicine, Department of Biomedical and Diagnostic Sciences, The University of Tennessee, Knoxville, TN, USA
| | - Lainey Harvill
- College of Veterinary Medicine, Department of Biomedical and Diagnostic Sciences, The University of Tennessee, Knoxville, TN, USA
| | - Shawna Hawkins
- Department of Surgical Sciences, School of Veterinary Medicine, The University of Wisconsin, Madison, WI, USA
| | - Kurt Sladky
- Department of Surgical Sciences, School of Veterinary Medicine, The University of Wisconsin, Madison, WI, USA
| | - Sherry Cox
- College of Veterinary Medicine, Department of Biomedical and Diagnostic Sciences, The University of Tennessee, Knoxville, TN, USA
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11
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Amiri A, Faridbod F, Zoughi S. An optical nanosensor fabricated by carbon dots embedded in silica molecularly imprinted polymer for sensitive detection of ceftazidime antibiotic. J Photochem Photobiol A Chem 2021. [DOI: 10.1016/j.jphotochem.2020.113111] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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12
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Roth T, Weber L, Niestroj M, Cipa F, Löscher A, Mihai S, Parsch H. Simultaneous determination of six antibiotics in human serum by high-performance liquid chromatography with UV detection. Biomed Chromatogr 2020; 35:e5010. [PMID: 33119907 DOI: 10.1002/bmc.5010] [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: 05/18/2020] [Revised: 10/02/2020] [Accepted: 10/16/2020] [Indexed: 11/07/2022]
Abstract
Antibiotics are widely used in intensive care patients to treat severe infections. To avoid bacterial resistance or toxic side effects, the determination of serum concentration of ABs is advisable. Therefore, in this study, we developed and validated a simple and fast high-performance liquid chromatography method with UV detection for the simultaneous determination of four β-lactam ABs (meropenem, imipenem, ceftazidime, and piperacillin) and two coadministered substances (cilastatin and tazobactam) in human serum. Sample preparation required a simple protein precipitation by methanol. The separation of the ABs occurred within a timeframe of 17 min. For this purpose, we used a Kinetex F5 column with a linear gradient of acetonitrile and phosphate buffer (pH 6.9). The UV detector recorded two separate chromatograms at 220 and 295 nm simultaneously. Validation has demonstrated that the method is linear, accurate, and precise within the clinically relevant range for each substance.
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Affiliation(s)
- Thomas Roth
- Central Laboratory, University Hospital Erlangen, Erlangen, Germany
| | - Lea Weber
- Central Laboratory, University Hospital Erlangen, Erlangen, Germany
| | - Marion Niestroj
- Central Laboratory, University Hospital Erlangen, Erlangen, Germany
| | - Franziska Cipa
- Central Laboratory, University Hospital Erlangen, Erlangen, Germany
| | - Astrid Löscher
- Central Laboratory, University Hospital Erlangen, Erlangen, Germany
| | - Sidonia Mihai
- Central Laboratory, University Hospital Erlangen, Erlangen, Germany
| | - Hans Parsch
- Central Laboratory, University Hospital Erlangen, Erlangen, Germany
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13
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Mameli M, Vezzelli A, Verze' S, Biondi S, Motta P, Greco A, Michi M, Breda M. Liquid chromatography-tandem mass spectrometry for the simultaneous quantitation of enmetazobactam and cefepime in human plasma. J Pharm Biomed Anal 2019; 174:655-662. [PMID: 31288188 DOI: 10.1016/j.jpba.2019.06.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 06/27/2019] [Accepted: 06/28/2019] [Indexed: 10/26/2022]
Abstract
A simple ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method was developed and validated for the simultaneous analysis enmetazobactam (also known as AAI101) and cefepime in human plasma. Sample preparation was based on protein precipitation with acetonitrile. Separation was performed on Acquity BEH HILIC column (50 mm × 2.1 mm, 1.7 μm) with a mobile phase containing ammonium formate in water and acetonitrile. The analytes were analyzed with the corresponding isotopically labeled internal standards and were detected in multiple reactions monitoring (MRM) using API 5000 triple-quadrupole mass spectrometer with electrospray (ESI) source operating in positive ion mode. The calibration curves were linear over the selected ranges (r > 0.9970 for both analytes). The intra and inter-assay precision of the Quality Control samples showed CV ≤ 15% and the accuracy was within 85 and 115% in all cases for both compounds. The lower limit of quantification was 0.05 μg/mL for enmetazobactam and 0.5 μg/mL for cefepime.
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Affiliation(s)
- M Mameli
- Aptuit (Verona) S.r.l., an Evotec Company, Bioanalytical Group, Verona, Italy
| | - A Vezzelli
- Aptuit (Verona) S.r.l., an Evotec Company, Bioanalytical Group, Verona, Italy
| | - S Verze'
- Aptuit (Verona) S.r.l., an Evotec Company, Bioanalytical Group, Verona, Italy
| | - S Biondi
- Allecra Therapeutics SAS, 10 rue Alexandre Freund, 68300, Saint Louis, France
| | - P Motta
- Allecra Therapeutics SAS, 10 rue Alexandre Freund, 68300, Saint Louis, France
| | - A Greco
- Aptuit (Verona) S.r.l., an Evotec Company, Bioanalytical Group, Verona, Italy
| | - M Michi
- Aptuit (Verona) S.r.l., an Evotec Company, Bioanalytical Group, Verona, Italy
| | - M Breda
- Aptuit (Verona) S.r.l., an Evotec Company, Bioanalytical Group, Verona, Italy.
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A Population Pharmacokinetic Analysis to Study the Effect of Extracorporeal Membrane Oxygenation on Cefepime Disposition in Children. Pediatr Crit Care Med 2019; 20:62-70. [PMID: 30431557 PMCID: PMC6323642 DOI: 10.1097/pcc.0000000000001786] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Limited data exist on the effects of extracorporeal membrane oxygenation on pharmacokinetics of cefepime in critically ill pediatric patients. The objective was to describe cefepime disposition in children treated with extracorporeal membrane oxygenation using population pharmacokinetic modeling. DESIGN Multicenter, prospective observational study. SETTING The pediatric and cardiac ICUs of six sites of the Collaborative Pediatric Critical Care Research Network. PATIENTS Seventeen critically ill children (30 d to < 2 yr old) on extracorporeal membrane oxygenation who received cefepime as standard of care between January 4, 2014, and August 24, 2015, were enrolled. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A pharmacokinetic model was developed to evaluate cefepime disposition differences due to extracorporeal membrane oxygenation. A two-compartment model with linear elimination, weight effects on clearance, intercompartmental clearance (Q), central volume of distribution (V1), and peripheral volume of distribution (V2) adequately described the data. The typical value of clearance in this study was 7.1 mL/min (1.9 mL/min/kg) for a patient weighing 5.8 kg. This value decreased by approximately 40% with the addition of renal replacement therapy. The typical value for V1 was 1,170 mL. In the setting of blood transfusions, V1 increased by over two-fold but was reduced with increasing age of the extracorporeal membrane oxygenation circuit oxygenator. CONCLUSIONS Cefepime clearance was reduced in pediatric patients treated with extracorporeal membrane oxygenation compared with previously reported values in children not receiving extracorporeal membrane oxygenation. The model demonstrated that the age of the extracorporeal membrane oxygenation circuit oxygenator is inversely correlated to V1. For free cefepime, only 14 of the 19 doses (74%) demonstrated a fT_minimum inhibitory concentration of 16 mg/L, an appropriate target for the treatment of pseudomonal infections, for greater than 70% of the dosing interval. Pediatric patients on extracorporeal membrane oxygenation might benefit from the addition of therapeutic drug monitoring of cefepime to assure appropriate dosing.
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Razmi R, Shahpari B, Pourbasheer E, Boustanifar MH, Azari Z, Ebadi A. Preconcentration and determination of ceftazidime in real samples using dispersive liquid-liquid microextraction and high-performance liquid chromatography with the aid of experimental design. J Sep Sci 2016; 39:4116-4123. [DOI: 10.1002/jssc.201600639] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 08/25/2016] [Accepted: 08/26/2016] [Indexed: 11/12/2022]
Affiliation(s)
- Rasoul Razmi
- Department of Chemistry, Chemical Engineering, Dashtestan Branch; Islamic Azad University; Borazjan Iran
| | - Behrouz Shahpari
- Department of Chemistry; Payame Noor University (PNU); Tehran Iran
| | | | - Mohammad Hasan Boustanifar
- Department of Chemistry, Chemical Engineering, Dashtestan Branch; Islamic Azad University; Borazjan Iran
| | - Zhila Azari
- Department of Chemistry; Payame Noor University (PNU); Tehran Iran
| | - Amin Ebadi
- Department of Chemistry, Kazerun Branch; Islamic Azad University; Kazerun Iran
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Abdel-Aziz O, Abdel-Ghany MF, Nagi R, Abdel-Fattah L. Application of Savitzky-Golay differentiation filters and Fourier functions to simultaneous determination of cefepime and the co-administered drug, levofloxacin, in spiked human plasma. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2015; 139:449-455. [PMID: 25576942 DOI: 10.1016/j.saa.2014.12.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 11/18/2014] [Accepted: 12/16/2014] [Indexed: 06/04/2023]
Abstract
The present work is concerned with simultaneous determination of cefepime (CEF) and the co-administered drug, levofloxacin (LEV), in spiked human plasma by applying a new approach, Savitzky-Golay differentiation filters, and combined trigonometric Fourier functions to their ratio spectra. The different parameters associated with the calculation of Savitzky-Golay and Fourier coefficients were optimized. The proposed methods were validated and applied for determination of the two drugs in laboratory prepared mixtures and spiked human plasma. The results were statistically compared with reported HPLC methods and were found accurate and precise.
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Affiliation(s)
- Omar Abdel-Aziz
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Maha F Abdel-Ghany
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Reham Nagi
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt.
| | - Laila Abdel-Fattah
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Misr University for Science and Technology, Giza, Egypt
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17
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Tarinc D, Dogan-Topal B, Golcu A, Ozkan SA. Electrochemical investigation and determination of ceftazidime in pharmaceutical dosage forms and human urine. JOURNAL OF ANALYTICAL CHEMISTRY 2014. [DOI: 10.1134/s1061934814090056] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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18
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Dąbrowska M, Starek M, Krzek J, Papp E, Król P. A degradation study of cefepime hydrochloride in solutions under various stress conditions by TLC-densitometry. Biomed Chromatogr 2014; 29:388-95. [PMID: 25042047 DOI: 10.1002/bmc.3288] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 04/29/2014] [Accepted: 06/06/2014] [Indexed: 11/06/2022]
Abstract
A rapid, accurate and sensitive thin-layer chromatography (TLC) method with densitometric detection has been developed and validated for the determination of cefepime in pharmaceuticals. Chromatographic separation was achieved on a silica gel TLC F254 plates with a mobile phase consisting of ethanol-2-propanol-glacial acetic acid 99.5%-water (4:4:1:3, v/v). Densitometric detection was carried out at wavelength of 266 nm in reflectance/absorbance mode. The validation of the method was found to be satisfactory with high accuracy (from 99.24 to 101.37%) and precision (RSD from 0.06 to 0.36%). Additionally, the stability of cefepime in solution was investigated, including the effect of pH, temperature and incubation time. Favorable retention parameters (Rf , Rs, α) were obtained under the developed conditions, which guaranteed good separation of the studied components. The degradation process of cefepime hydrochloride was described by kinetic and thermodynamic parameters (k, t0.1 , t0.5 and Ea ). Moreover, the chemical properties of degradation products were characterized by the Rf values, absorption spectra, HPLC-MS/MS and TLC-densitometry analysis. As the method could effectively separate the active substance from its main degradation product (1-methylpyrrolidine), it can be employed as a method to indicate the stability of this drug.
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Affiliation(s)
- Monika Dąbrowska
- Department of Inorganic and Analytical Chemistry, Faculty of Pharmacy, Collegium Medicum, Jagiellonian University, 9 Medyczna Str, 30-688, Kraków, Poland
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19
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Guerrero L, Carcelero E, Ribas J, Soy D. A FAST AND ACCURATE HIGH PERFORMANCE LIQUID CHROMATOGRAPHY ASSAY TO QUANTIFY PLASMA CEFTAZIDIME CONCENTRATIONS FOR CLINICAL ROUTINE. J LIQ CHROMATOGR R T 2013. [DOI: 10.1080/10826076.2012.698679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Laura Guerrero
- a Pharmacy Service , Hospital Clínic Barcelona, University of Barcelona , Barcelona , Spain
- b IDIPABS , Barcelona , Spain
- c Ciber de Enfermedades Respiratorias (CibeRes, CB06/06/0028), University of Barcelona , Barcelona , Spain
| | - Esther Carcelero
- a Pharmacy Service , Hospital Clínic Barcelona, University of Barcelona , Barcelona , Spain
| | - Josep Ribas
- a Pharmacy Service , Hospital Clínic Barcelona, University of Barcelona , Barcelona , Spain
| | - Dolors Soy
- a Pharmacy Service , Hospital Clínic Barcelona, University of Barcelona , Barcelona , Spain
- b IDIPABS , Barcelona , Spain
- c Ciber de Enfermedades Respiratorias (CibeRes, CB06/06/0028), University of Barcelona , Barcelona , Spain
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Aoki Y, Urakami T, Magarifuchi H, Nagasawa Z, Nagata M, Fukuoka M. The importance of pharmacokinetic consultation of cefepime treatment for Pseudomonas aeruginosa bacteremia: a case report of severe thermal burn injury. J Infect Chemother 2011; 17:407-11. [DOI: 10.1007/s10156-010-0119-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Accepted: 08/19/2010] [Indexed: 11/30/2022]
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El-Rabbat NA, Abdel-Wadood HM, Sayed M, Mousa HS. High-performance liquid chromatographic determination and pharmacokinetic study of cefepime in goat plasma and milk after pre-column derivatization with Hg(I). J Sep Sci 2010; 33:2599-609. [DOI: 10.1002/jssc.201000294] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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22
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López KJV, Bertoluci DF, Vicente KM, Dell'Aquilla AM, Santos SRCJ. Simultaneous determination of cefepime, vancomycin and imipenem in human plasma of burn patients by high-performance liquid chromatography. J Chromatogr B Analyt Technol Biomed Life Sci 2007; 860:241-5. [PMID: 18023625 DOI: 10.1016/j.jchromb.2007.10.041] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Revised: 10/24/2007] [Accepted: 10/25/2007] [Indexed: 10/22/2022]
Abstract
A liquid chromatographic method with UV detection for simultaneous determination of cefepime, vancomycin and imipenem has been developed. Cefuroxime was used as internal standard. After the clean up of samples by plasma protein precipitation, 5 microl of the extract were injected into the chromatograph and peaks were eluted from the Sulpelcosil LC-18 column using a mobile phase consisting of 0.075 M acetate buffer:acetonitrile (92:8, v/v), pH 5.0 at low rate (0.8 ml/min). The detection wavelength was 230 nm. The limit of detection was 0.4 microg/ml for cefepime and 0.2 microg/ml for vancomycin and imipenem. The method was applied to plasma samples of burn patients, and only small volumes of plasma were required for the simultaneous determination of those antimicrobial agents.
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Affiliation(s)
- K J Vera López
- School of Pharmaceutical Sciences of University of Sao Paulo, SP, Brazil
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El-Shaboury SR, Saleh GA, Mohamed FA, Rageh AH. Analysis of cephalosporin antibiotics. J Pharm Biomed Anal 2007; 45:1-19. [PMID: 17689910 DOI: 10.1016/j.jpba.2007.06.002] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2007] [Revised: 05/06/2007] [Accepted: 06/05/2007] [Indexed: 11/21/2022]
Abstract
A comprehensive review with 276 references for the analysis of members of an important class of drugs, cephalosporin antibiotics, is presented. The review covers most of the methods described for the analysis of these drugs in pure forms, in different pharmaceutical dosage forms and in biological fluids.
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Affiliation(s)
- Salwa R El-Shaboury
- Department of Pharmaceutical Analytical Chemistry, Facutly of Pharmacy, Assiut Univeristy, 71526 Assiut, Egypt
| | - Gamal A Saleh
- Department of Pharmaceutical Analytical Chemistry, Facutly of Pharmacy, Assiut Univeristy, 71526 Assiut, Egypt.
| | - Fardous A Mohamed
- Department of Pharmaceutical Analytical Chemistry, Facutly of Pharmacy, Assiut Univeristy, 71526 Assiut, Egypt
| | - Azza H Rageh
- Department of Pharmaceutical Analytical Chemistry, Facutly of Pharmacy, Assiut Univeristy, 71526 Assiut, Egypt
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Isla A, Gascón AR, Maynar J, Arzuaga A, Sánchez-Izquierdo JA, Pedraz JL. In vitro AN69 and Polysulphone Membrane Permeability to Ceftazidime and in vivo Pharmacokinetics during Continuous Renal Replacement Therapies. Chemotherapy 2007; 53:194-201. [PMID: 17356270 DOI: 10.1159/000100864] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2005] [Accepted: 04/24/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Ceftazidime is a third-generation cephalosporin almost entirely eliminated by glomerular filtration and dose reductions are essential in patients with renal impairment. The physicochemical and pharmacokinetic properties of ceftazidime make it susceptible to be eliminated by continuous renal replacement therapies (CRRT), but there is little clinical information to guide the correct administration in patients undergoing these techniques. METHODS In vitro procedures were carried out in three different fluids, using AN69 or polysulphone membranes. Four patients entered the in vivo study. Two patients received 1,000 mg every 6 h and the other two 2,000 mg every 6 h. Concentrations of ceftazidime were measured by high-performance liquid chromatography. RESULTS No differences were detected in thesieving coefficients (Sc) or saturation coefficients (Sa)between membranes during continuous venovenous hemofiltration (CVVH) or continuous venovenous hemodiafiltration (CVVHD). Sc-Sa values were close to 1 when Ringer's lactate was used as ceftazidime vehicle, but were lower in plasma samples (p < 0.05). In patients, the Sc-Sa was 0.93 +/- 0.06 and correlated well with the unbound fraction (0.86 +/- 0.08). The contribution of CRRT to ceftazidime clearance was higher in anuric patients than in nonanuric patients. CONCLUSIONS No differences were shown in vitro in the Sc obtained with both membranes during CVVH or the Sa obtained during CVVHD. The contribution of clearance by CRRT to total clearance is clearly dependent on the renal function. The administration of ceftazidime every 6 h could be associated with unnecessarily high trough levels which increase the risk of drug nephrotoxicity. Nonanuric patients undergoing CRRT need higher ceftazidime doses to reach adequate plasma concentrations against pathogens isolated in the critically ill.
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Affiliation(s)
- Arantxazu Isla
- Laboratory of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of the Basque Country, Vitoria-Gasteiz, Spain
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Panomvana D, Kiatjaroensin SA, Phiboonbanakit D. Correlation of the Pharmacokinetic Parameters of Amikacin and Ceftazidime. Clin Pharmacokinet 2007; 46:859-66. [PMID: 17854235 DOI: 10.2165/00003088-200746100-00004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND AND OBJECTIVES Ceftazidime and amikacin are often prescribed concomitantly to treat infections caused by Gram-negative bacteria. Their physicochemical properties are quite similar. Both drugs are highly soluble in water, have low plasma protein binding and are >95% excreted unchanged by the kidney via glomerular filtration. Their pharmacokinetic parameters are therefore expected to correlate. This study was performed to explore the correlation between the pharmacokinetic parameters of these two drugs. PATIENTS AND METHODS Patients at Phramongkutklao Hospital, Bangkok, Thailand, who met the inclusion criteria participated in the study. They all received ceftazidime and amikacin concomitantly to treat their infections. After steady-state conditions had been reached, two blood samples were collected during the elimination phase of both drugs. Plasma drug concentrations were analysed and the pharmacokinetic parameters of each drug were calculated. The pharmacokinetic parameters that were examined included total drug clearance (CL), the elimination rate constant (k(e)), the elimination half life (t(1/2)) and the volume of distribution (V(d)). The correlations of the pharmacokinetic parameters of amikacin and ceftazidime were determined using regression analysis. RESULTS Regression analysis showed that the pharmacokinetic parameters of ceftazidime and amikacin were highly correlated. The correlation coefficients (r) of CL, k(e), t(1/2) and V(d) of the two drugs were 0.966, 0.943, 0.888 and 0.671, respectively. The correlation between amikacin clearance and ceftazidime clearance was higher than the correlation between either amikacin or ceftazidime clearance and creatinine clearance, for which the r values were 0.647 and 0.661, respectively. CONCLUSIONS The pharmacokinetic parameters of ceftazidime and amikacin were highly correlated. Knowledge of the pharmacokinetic parameters of one of these drugs can be used to predict the pharmacokinetic parameters of the other drug.
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Affiliation(s)
- Duangchit Panomvana
- Department of Pharmacy (Clinical), Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand.
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Mariat C, Venet C, Jehl F, Mwewa S, Lazarevic V, Diconne E, Fonsale N, Carricajo A, Guyomarc'h S, Vermesch R, Aubert G, Bidault R, Bertrand JC, Zeni F. Continuous infusion of ceftazidime in critically ill patients undergoing continuous venovenous haemodiafiltration: pharmacokinetic evaluation and dose recommendation. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2006; 10:R26. [PMID: 16507147 PMCID: PMC1550796 DOI: 10.1186/cc3993] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2005] [Revised: 12/12/2005] [Accepted: 01/16/2006] [Indexed: 11/30/2022]
Abstract
Introduction In seriously infected patients with acute renal failure and who require continuous renal replacement therapy, data on continuous infusion of ceftazidime are lacking. Here we analyzed the pharmacokinetics of ceftazidime administered by continuous infusion in critically ill patients during continuous venovenous haemodiafiltration (CVVHDF) in order to identify the optimal dosage in this setting. Method Seven critically ill patients were prospectively enrolled in the study. CVVHDF was performed using a 0.6 m2 AN69 high-flux membrane and with blood, dialysate and ultrafiltration flow rates of 150 ml/min, 1 l/hour and 1.5 l/hour, respectively. Based on a predicted haemodiafiltration clearance of 32.5 ml/min, all patients received a 2 g loading dose of ceftazidime, followed by a 3 g/day continuous infusion for 72 hours. Serum samples were collected at 0, 3, 15 and 30 minutes and at 1, 2, 4, 6, 8, 12, 24, 36, 48 and 72 hours; dialysate/ultrafiltrate samples were taken at 2, 8, 12, 24, 36 and 48 hours. Ceftazidime concentrations in serum and dialysate/ultrafiltrate were measured using high-performance liquid chromatography. Results The mean (± standard deviation) elimination half-life, volume of distribution, area under the concentration-time curve from time 0 to 72 hours, and total clearance of ceftazidime were 4 ± 1 hours, 19 ± 6 l, 2514 ± 212 mg/h per l, and 62 ± 5 ml/min, respectively. The mean serum ceftazidime steady-state concentration was 33.5 mg/l (range 28.8–36.3 mg/l). CVVHDF effectively removed continuously infused ceftazidime, with a sieving coefficient and haemodiafiltration clearance of 0.81 ± 0.11 and 33.6 ± 4 mg/l, respectively. Conclusion We conclude that a dosing regimen of 3 g/day ceftazidime, by continuous infusion, following a 2 g loading dose, results in serum concentrations more than four times the minimum inhibitory concentration for all susceptible pathogens, and we recommend this regimen in critically ill patients undergoing CVVHDF.
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Affiliation(s)
- Christophe Mariat
- Service de Néphrologie, Hôpital Nord, CHU de Saint-Etienne, Saint-Etienne, France
| | - Christophe Venet
- Service d'Urgences et de Réanimation, Hôpital Bellevue, CHU de Saint-Etienne, St Etienne, France
| | - François Jehl
- Laboratoire de Bactériologie, Faculté de Médecine, Strasbourg, France
| | - Sandrine Mwewa
- Unité de Pharmacologie Clinique, Laboratoire Glaxo Wellcome, Marly Le Roi, France
| | - Vesna Lazarevic
- Unité de Pharmacologie Clinique, Laboratoire Glaxo Wellcome, Marly Le Roi, France
| | - Eric Diconne
- Service d'Urgences et de Réanimation, Hôpital Bellevue, CHU de Saint-Etienne, St Etienne, France
| | - Nathalie Fonsale
- Service de Bactériologie, Hôpital Bellevue, CHU de Saint-Etienne, St Etienne France
| | - Anne Carricajo
- Service de Bactériologie, Hôpital Bellevue, CHU de Saint-Etienne, St Etienne France
| | - Stéphane Guyomarc'h
- Service d'Urgences et de Réanimation, Hôpital Bellevue, CHU de Saint-Etienne, St Etienne, France
| | - Régine Vermesch
- Service d'Urgences et de Réanimation, Hôpital Bellevue, CHU de Saint-Etienne, St Etienne, France
| | - Gérald Aubert
- Service de Bactériologie, Hôpital Bellevue, CHU de Saint-Etienne, St Etienne France
| | - Roselyne Bidault
- Unité de Pharmacologie Clinique, Laboratoire Glaxo Wellcome, Marly Le Roi, France
| | - Jean-Claude Bertrand
- Service d'Urgences et de Réanimation, Hôpital Bellevue, CHU de Saint-Etienne, St Etienne, France
| | - Fabrice Zeni
- Service d'Urgences et de Réanimation, Hôpital Bellevue, CHU de Saint-Etienne, St Etienne, France
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