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Kerling DA, Clarke SC, DeLuca JP, Evans MO, Kress AT, Nadeau RJ, Selig DJ. Systematic Review and Meta-Analysis of the Effect of Loop Diuretics on Antibiotic Pharmacokinetics. Pharmaceutics 2023; 15:pharmaceutics15051411. [PMID: 37242653 DOI: 10.3390/pharmaceutics15051411] [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: 03/21/2023] [Revised: 04/19/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Loop diuretics and antibiotics are commonly co-prescribed across many clinical care settings. Loop diuretics may alter antibiotic pharmacokinetics (PK) via several potential drug interactions. A systematic review of the literature was performed to investigate the impact of loop diuretics on antibiotic PK. The primary outcome metric was the ratio of means (ROM) of antibiotic PK parameters such as area under the curve (AUC) and volume of distribution (Vd) on and off loop diuretics. Twelve crossover studies were amenable for metanalysis. Coadministration of diuretics was associated with a mean 17% increase in plasma antibiotic AUC (ROM 1.17, 95% CI 1.09-1.25, I2 = 0%) and a mean decrease in antibiotic Vd by 11% (ROM 0.89, 95% CI 0.81-0.97, I2 = 0%). However, the half-life was not significantly different (ROM 1.06, 95% CI 0.99-1.13, I2 = 26%). The remaining 13 observational and population PK studies were heterogeneous in design and population, as well as prone to bias. No large trends were collectively observed in these studies. There is currently not enough evidence to support antibiotic dosing changes based on the presence or absence of loop diuretics alone. Further studies designed and powered to detect the effect of loop diuretics on antibiotic PK are warranted in applicable patient populations.
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Affiliation(s)
- David A Kerling
- Walter Reed National Military Medical Center, Internal Medicine, Bethesda, MD 20889, USA
| | - Sarah C Clarke
- Walter Reed National Military Medical Center, Internal Medicine, Bethesda, MD 20889, USA
| | - Jesse P DeLuca
- Walter Reed Army Institute of Research, Clinical Pharmacology Fellowship, Silver Spring, MD 20910, USA
| | - Martin O Evans
- Walter Reed Army Institute of Research, Clinical Pharmacology Fellowship, Silver Spring, MD 20910, USA
| | - Adrian T Kress
- Walter Reed Army Institute of Research, Clinical Pharmacology Fellowship, Silver Spring, MD 20910, USA
| | - Robert J Nadeau
- Walter Reed Army Institute of Research, Clinical Pharmacology Fellowship, Silver Spring, MD 20910, USA
| | - Daniel J Selig
- Walter Reed Army Institute of Research, Clinical Pharmacology Fellowship, Silver Spring, MD 20910, USA
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Lin S, Cheng X, Zhu J, Wang B, Jelinek D, Zhao Y, Wu TY, Horrillo A, Tan J, Yeung J, Yan W, Forman S, Coller HA, Milla C, Emaminejad S. Wearable microneedle-based electrochemical aptamer biosensing for precision dosing of drugs with narrow therapeutic windows. SCIENCE ADVANCES 2022; 8:eabq4539. [PMID: 36149955 PMCID: PMC9506728 DOI: 10.1126/sciadv.abq4539] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/09/2022] [Indexed: 05/31/2023]
Abstract
Therapeutic drug monitoring is essential for dosing pharmaceuticals with narrow therapeutic windows. Nevertheless, standard methods are imprecise and involve invasive/resource-intensive procedures with long turnaround times. Overcoming these limitations, we present a microneedle-based electrochemical aptamer biosensing patch (μNEAB-patch) that minimally invasively probes the interstitial fluid (ISF) and renders correlated, continuous, and real-time measurements of the circulating drugs' pharmacokinetics. The μNEAB-patch is created following an introduced low-cost fabrication scheme, which transforms a shortened clinical-grade needle into a high-quality gold nanoparticle-based substrate for robust aptamer immobilization and efficient electrochemical signal retrieval. This enables the reliable in vivo detection of a wide library of ISF analytes-especially those with nonexistent natural recognition elements. Accordingly, we developed μNEABs targeting various drugs, including antibiotics with narrow therapeutic windows (tobramycin and vancomycin). Through in vivo animal studies, we demonstrated the strong correlation between the ISF/circulating drug levels and the device's potential clinical use for timely prediction of total drug exposure.
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Affiliation(s)
- Shuyu Lin
- Interconnected and Integrated Bioelectronics Lab (IBL), University of California, Los Angeles, Los Angeles, CA, USA
- Department of Electrical and Computer Engineering, University of California, Los Angeles, Los Angeles, CA, USA
| | - Xuanbing Cheng
- Interconnected and Integrated Bioelectronics Lab (IBL), University of California, Los Angeles, Los Angeles, CA, USA
- Department of Electrical and Computer Engineering, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Materials Science and Engineering, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jialun Zhu
- Interconnected and Integrated Bioelectronics Lab (IBL), University of California, Los Angeles, Los Angeles, CA, USA
- Department of Electrical and Computer Engineering, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Materials Science and Engineering, University of California, Los Angeles, Los Angeles, CA, USA
| | - Bo Wang
- Interconnected and Integrated Bioelectronics Lab (IBL), University of California, Los Angeles, Los Angeles, CA, USA
- Department of Electrical and Computer Engineering, University of California, Los Angeles, Los Angeles, CA, USA
| | - David Jelinek
- Department of Molecular, Cell and Developmental Biology, University of California, Los Angeles, Los Angeles, CA, USA
- Weintraub Center for Reconstructive Biotechnology, School of Dentistry, University of California, Los Angeles, Los Angeles, CA, USA
| | - Yichao Zhao
- Interconnected and Integrated Bioelectronics Lab (IBL), University of California, Los Angeles, Los Angeles, CA, USA
- Department of Electrical and Computer Engineering, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Materials Science and Engineering, University of California, Los Angeles, Los Angeles, CA, USA
| | - Tsung-Yu Wu
- Interconnected and Integrated Bioelectronics Lab (IBL), University of California, Los Angeles, Los Angeles, CA, USA
- Department of Electrical and Computer Engineering, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Materials Science and Engineering, University of California, Los Angeles, Los Angeles, CA, USA
| | - Abraham Horrillo
- Department of Molecular, Cell and Developmental Biology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jiawei Tan
- Interconnected and Integrated Bioelectronics Lab (IBL), University of California, Los Angeles, Los Angeles, CA, USA
- Department of Electrical and Computer Engineering, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Materials Science and Engineering, University of California, Los Angeles, Los Angeles, CA, USA
| | - Justin Yeung
- Interconnected and Integrated Bioelectronics Lab (IBL), University of California, Los Angeles, Los Angeles, CA, USA
- Department of Materials Science and Engineering, University of California, Los Angeles, Los Angeles, CA, USA
| | - Wenzhong Yan
- Department of Mechanical and Aerospace Engineering, University of California, Los Angeles, Los Angeles, CA, USA
| | - Sarah Forman
- Interconnected and Integrated Bioelectronics Lab (IBL), University of California, Los Angeles, Los Angeles, CA, USA
- Department of Molecular, Cell and Developmental Biology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Hilary A. Coller
- Department of Molecular, Cell and Developmental Biology, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Biological Chemistry, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Molecular Biology Institute, University of California, Los Angeles, Los Angeles, CA, USA
| | - Carlos Milla
- The Stanford Cystic Fibrosis Center, Center for Excellence in Pulmonary Biology, Stanford School of Medicine, Stanford, CA, USA
| | - Sam Emaminejad
- Interconnected and Integrated Bioelectronics Lab (IBL), University of California, Los Angeles, Los Angeles, CA, USA
- Department of Electrical and Computer Engineering, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, USA
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