Pharmacokinetics, metabolism, and renal excretion of sulfadimidine and its N4-acetyl and hydroxy metabolites in humans

Impact of low-level exposure to antibiotics on bile acid homeostasis in adults: Implication for human safety thresholds

Bile acid homeostasis is critical to human health. Low-level exposure to antibiotics has been suggested to potentially disrupt bile acid homeostasis by affecting gut microbiota, but relevant data are still lacking in humans, especially for the level below human safety threshold. We conducted a cross-sectional study in 4247 Chinese adults by measuring 34 parent antibiotics and their metabolites from six common categories (i.e., tetracyclines, qinolones, macrolides, sulfonamides, phenicols, and lincosamides) and ten representative bile acids in fasting morning urine using liquid chromatography coupled to mass spectrometry. Daily exposure dose of antibiotics was estimated from urinary concentrations of parent antibiotics and their metabolites. Urinary bile acids and their ratios were used to reflect bile acid homeostasis. The estimated daily exposure doses (EDED) of five antibiotic categories with a high detection frequency (i.e., tetracyclines, qinolones, macrolides, sulfonamides, and phenicols) were significantly associated with urinary concentrations of bile acids and decreased bile acid ratios in all adults and the subset of 3898 adults with a cumulative ratio of antibiotic EDED to human safety threshold of less than one. Compared to a negative detection of antibiotics, the lowest EDED quartiles of five antibiotic categories and four individual antibiotics with a high detection frequency (i.e., ciprofloxacin, ofloxacin, trimethoprim, and florfenicol) in the adults with a positive detection of antibiotics had a decrease of bile acid ratio between 6.6% and 76.6%. Except for macrolides (1.2×102 ng/kg/day), the medians of the lowest EDED quartile of antibiotic categories and individual antibiotics ranged from 0.32 ng/kg/day to 10 ng/kg/day, which were well below human safety thresholds. These results suggested that low-level antibiotic exposure could disrupt bile acid homeostasis in adults and existing human safety thresholds may be inadequate in safeguarding against the potential adverse health effects of low-level exposure to antibiotics.

Metabolites and metabolic pathway analysis of sulfadimidine in carp (Cyprinus carpio) based on UHPLC-Q-orbitrap HRMS

Sulfadimidine (SM2) is an N-substituted derivative of p-aminobenzenesulfonyl structure. This study aimed to analyze the metabolism of SM2 in carp (Cyprinus carpio). The carps were fed with SM2 at a dose of 200 mg/(kg · bw) and then killed. The blood, muscle, liver, kidney, gill, other guts, and carp aquaculture water samples were collected. The UHPLC-Q-Exactive Plus Orbitrap-MS was adopted for determining the metabolites of SM2 in the aforementioned samples. Twelve metabolites, which were divided into metabolites in vivo and metabolites in vitro, were identified using Compound Discoverer software. The metabolic pathways in vivo of SM2 in carp included acetylation, hydroxylation, glucoside conjugation, glycine conjugation, carboxylation, glucuronide conjugation, reduction, and methylation. The metabolic pathways in vitro included oxidation and acetylation. This study clarified the metabolites and metabolic pathways of SM2 in carp and provided a reference for further pharmacodynamic evaluation and use in aquaculture.

Bioaccumulation, Biotransformation, and Multicompartmental Toxicokinetic Model of Antibiotics in Sea Cucumber (Apostichopus japonicus)

Extensive application of antibiotics leads to their ubiquitous occurrence in coastal aquatic environments. However, it remains largely unknown whether antibiotics can be bioaccumulated and biotransformed in major mariculture organisms such as sea cucumbers and toxicokinetic models for Echinodermata are lacking. In this study, laboratory exposure experiments on juvenile sea cucumber (Apostichopus japonicus) were performed for seven antibiotics (sulfadiazine, sulfamethoxazole, trimethoprim, enrofloxacin, ofloxacin, clarithromycin, and azithromycin). Field sea cucumber and surrounding seawater samples were also analyzed. Results show that the sea cucumbers tend to accumulate high concentrations of the antibiotics with kinetic bioconcentration factors (BCFs) up to 1719.7 L·kg^-1 for ofloxacin. The BCFs determined in the laboratory agree well with those estimated from the field measurements. Seven biotransformation products (BTPs) of the antibiotics were identified, four of which were not reported previously in aquatic organisms. The BTPs were mainly found in the digestive tract, indicating its high capacity in the biotransformation. A multicompartmental toxicokinetic model based on the principles of passive diffusion was developed, which can successfully predict time-course concentrations of the antibiotics in different compartments of the juvenile sea cucumbers. The findings may offer a scientific basis for assessing health risks and guiding healthy mariculture of sea cucumbers.

Determination of the elemental composition of trace analytes in complex matrices using exact masses of product ions and corresponding neutral losses

The emergence of time-of-flight (TOF) and hybrid quadrupole/time-of-flight (Q-TOF) mass spectrometers has offered new possibilities for determining the elemental composition of analytes present at trace levels. The mass accuracy provided by these instruments is currently in the range of 2-5 m m/z units, permitting the determination of the elemental composition of small molecules. The orthogonal information of relative isotopic abundances (RIAs) is used to reduce the number of elemental compositions that are possible, based on consideration of exact masses. Elimination of additional possible compositions has been reported when the analyte is fragmented and its resulting product ions and corresponding neutral losses are carefully analyzed. Published algorithms reduce the number of proposed precursor ions by deleting each precursor candidate which cannot be explained by summing any combination of postulated product ion and corresponding neutral loss elemental composition candidates. An extension of such algorithms is described in this paper. This approach compares not only the precursor ion with the different fragments, but tests the possible descent of any ion from all other recorded ions. This extended algorithm has been tested by processing published data. Algorithms analyzing product ion spectra can be used for real-life data. However, there is a risk that an ion which originates from the mobile phase or from a co-eluting matrix compound can be mathematically correlated to the investigated precursor ion. Such an incorrect correlation can lead to the deletion of a correct elemental composition. This is an important issue if TOF rather than Q-TOF instruments are used. Therefore, ultra-performance liquid chromatography (UPLC) and a peak deconvolution algorithm were used to generate and process TOF chromatograms in order to minimize the number of ions which are not related to the analyte precursor ion. The combined use of chromatographic deconvolution and product ion spectra has been tested and is critically discussed.

Pharmacokinetics and acetylation of sulfa-2-monomethoxine in humans

In humans sulfa-2-monomethoxine (S) is metabolized by N4-acetylation (39.9 +/- 8.0 per cent). After an oral dose, S is eliminated biphasically (t1/2, 5.2 +/- 1.6 h and 13.2 +/- 3.4 h) which is similar in both fast and slow acetylators. The metabolite N4-acetylsulfa-2-monomethoxine (N4) is eliminated monophasically (t1/2, 30.0 +/- 5.7 h). The intrinsic mean residence time (MRT) of N4 is 33.5 +/- 8.8 h. The mean total body clearance of S is 11.6 +/- 2.7 ml min-1, and the Vdss is 12.3 +/- 1.01. The renal clearance of S during the first day was twice as high as on the following days for two of the six volunteers (8 vs 4 ml min-1). The renal clearance of N4 during the first day, for four out of the six volunteers, was twice as high as on the following days (8 vs 4 ml min-1). The protein binding of S is 95 per cent and that of its conjugate N4 98 per cent. Approximately 80 per cent of the oral dose of S is excreted in the urine as parent drug (41.0 +/- 6.2 per cent) and as N4 acetyl conjugate (39.9 +/- 8.0 per cent).

Pharmacokinetics, N1-glucuronidation and N4-acetylation of sulfamethomidine in humans

Sulfamethomidine metabolism was studied in 6 volunteers. In humans, only N1-glucuronidation and N4-acetylation take place, leading to the final double conjugate N4-acetylsulfamethomidine N1-glucuronide. The N1-glucuronides were directly measured by high pressure liquid chromatography. Fast and slow acetylators show a similar half-life for sulfamethomidine (26 +/- 6 h) and its conjugates sulfamethomidine (26 +/- 6 h) and N4-acetylsulfamethomidine (36 +/- 16 h). Approximately 50-60% of the oral dose of sulfamethomidine is excreted in the urine, leaving 40-50% for excretion into bile and faeces. The main metabolite of sulfamethomidine is its N1-glucuronide, which accounts for 36 +/- 7% of the dose, followed by N4-acetylsulfamethomidine (16 +/- 8%). N1-glucuronidation results in a 75% decrease in protein binding of sulfamethomidine. N4-acetylsulfamethomidine and its N1-glucuronide showed the same high protein binding of 99%. The renal clearance of N4-acetylsulfamethomidine is 7.9 +/- 2.2 ml/min and approximately 20 times as high as that of the parent drug (0.46 +/- 0.16 ml/min). Total body clearance of sulfamethomidine is 4.5 +/- 0.9 ml/min and the volume of distribution in steady state 10.6 +/- 1.7 1. No measurable plasma concentrations of the N1-glucuronides from sulfamethomidine are found in plasma. This may be explained by renal glucuronidation after active tubular reabsorption.

Pharmacokinetics of sulfadimidine and its N4-acetyl metabolite in healthy and diseased rabbits infected with Pasteurella multocida

The pharmacokinetics of sulfadimidine (SDM) and its N4-acetyl metabolite (N4SDM) were investigated after intravenous bolus injection of a single dose (200 mg/kg) of SDM in normal and diseased New Zealand white rabbits. The apparent distribution volume at steady state, total body clearance and elimination half-life of SDM in normal animals were 0.7 +/- 0.3 l/kg, 0.57 +/- 0.24 l/kg/h and 1.6 +/- 1.3 h, respectively. Of the administered dose, 62.1% was metabolized by N4-acetylation, and 12.7 +/- 1.1 and 2.8 +/- 1.8% of the dose was excreted as free drug by the kidney and gastrointestinal tract, respectively. The 'apparent' formation and elimination half-lives of N4SDM were 0.6 +/- 0.4 and 2.2 +/- 1.1 h, respectively. The metabolite was eliminated mainly by excretion through the kidney. There was no significant effect of acute pasteurellosis on the pharmacokinetics of either SDM or N4SDM in rabbits.

Pharmacokinetics, N1-glucuronidation and N4-acetylation of sulfadimethoxine in man

Sulfadimethoxine is metabolized by O-dealkylation, N4-acetylation and N1-glucuronidation. In man, only N1-glucuronidation and N4-acetylation takes place, leading to the final double conjugate N4-acetylsulfadimethoxine-N1-glucuronide. The N1-glucuronides are directly measured by high pressure liquid chromatography. When N4-acetylsulfadimethoxine is administered as parent drug, 30% of the dose is N1-glucuronidated and excreted. Fast acetylators show a shorter half-life for sulfadimethoxine than slow acetylators (27.8 +/- 4.2 h versus 36.3 +/- 5.4 h; P = 0.013), similarly the half-life of the N4-acetyl conjugate is also shorter in fast acetylators (41.3 +/- 5.2 h versus 53.5 +/- 8.5 h, P = 0.036). No measurable plasma concentrations of the N1-glucuronides from sulfadimethoxine are found in plasma. N1-glucuronidation results in a 75% decrease in protein binding of sulfadimethoxine. N4-acetylsulfadimethoxine and its N1-glucuronide showed the same high protein binding of 99%. Approximately 50-60% of the oral dose of sulfadimethoxine is excreted in the urine, leaving 40-50% for excretion into bile and faeces.

Pharmacokinetics and renal clearance of sulphadimidine, sulphamerazine and sulphadiazine and their N4-acetyl and hydroxy metabolites in pigs

The effect of molecular structure on the drug disposition and protein binding in plasma, the urinary recovery, and the renal clearance of sulphamerazine (SMR), sulphadiazine (SDZ), and sulphadimidine (SDM) and their N4-acetyl and hydroxy derivatives were studied in pigs. Following IV administration of SDM, SMR and SDZ, their mean elimination half-lives were 12.4 h, 4.3 h and 4.9 h respectively. The plasma concentrations of parent sulphonamide were higher than those of the metabolites, and ran parallel. The acetylated derivatives were the main metabolites; traces of 6-hydroxymethylsulphamerazine and 4-hydroxysulphadiazine were detected in plasma. The urine recovery data showed that in pigs acetylation is the major elimination pathway of SDM, SMR and SDZ; hydroxylation became more important in case of SMR (6-hydroxymethyl and 4-hydroxy derivatives) and SDZ (4-hydroxy derivatives) than in SDM. In pigs methyl substitution of the pyrimidine side chain decreased the renal clearance of the parent drug and made the parent compound less accessible for hydroxylation. Acetylation and hydroxylation speeded up drug elimination, because their renal clearance values were higher than those of the parent drug.

Successful treatment of massive carbamazepine overdose

Overdose of carbamazepine (CBZ) can be fatal. We report the case of a patient with near-lethal toxicity due to delayed absorption of drug. A 36-year-old woman was admitted with coma, hypotension, and unusual movements. Carbamazepine (CBZ) level several hours later was 36 mg/L. Gastric lavage revealed no pill fragments, and activated charcoal was administered. CBZ level initially fell, reaching 28 mg/L 36 h after admission. Blood level then rose sharply, reaching 54 mg/L 64 h after admission. The pattern of rise suggested renewed absorption of drug. Vigorous cathartics were given, and further doses of charcoal were administered. Three hours after onset of diarrhea, roving eye movements occurred. Two hours later she grimaced to pain. Eight hours after the onset of diarrhea, she was awake. In CBZ overdose, activated charcoal therapy coupled with aggressive intestinal purging helps prevent continued absorption of drug, late exacerbation of symptoms, and potentially fatal outcome.