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Wu CT, Tsai YT, Jung HK, Fu SL, Hsiung CA, Liu HY, Lai JN. Metformin and the Risk of Anemia of Advanced Chronic Kidney Disease in Patients With Type 2 Diabetes Mellitus. J Clin Pharmacol 2021; 62:276-284. [PMID: 34510471 DOI: 10.1002/jcph.1965] [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: 05/10/2021] [Accepted: 09/07/2021] [Indexed: 11/06/2022]
Abstract
This retrospective cohort study determines whether metformin monotherapy or combination therapies can decrease anemia risk in the progress of advanced chronic kidney disease for patients with type 2 diabetes mellitus. The data set was obtained from the National Health Insurance Research Database, containing 1 million randomly selected beneficiaries. After matching, 9303 pairs (1:1) of metformin users and nonusers were acquired. Every patient was individually recorded from 1997 to 2012 to identify anemia incidence (hemoglobin <9 gm/dL). Cox regression models were used to compute hazard ratios and 95% confidence intervals (CIs). There were 305 (0.7%) and 76 (0.8%) erythropoietin-stimulating agent cases in the metformin and non-metformin cohorts over a mean follow-up period of 6.8 and 5.6 years. After matching, the use of metformin decreased the risk of usage of erythropoietin-stimulating agents with an adjusted hazard ratio of 0.76 (95%CI, 0.45-1.29) for dosage of <357 g to 0.30 (95%CI, 0.17-0.56) for >1368 g. The combination of metformin and dipeptidyl peptidase-4 inhibitors decreased with a hazard ratio of 0.42 (95%CI, 0.18-0.99), compared to metformin alone. Metformin combined with dipeptidyl peptidase-4 inhibitors is superior to metformin monotherapy or non-metformin antidiabetic therapies for reducing the risk of anemia in the progress of advanced chronic kidney disease among patients with type 2 diabetes.
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Affiliation(s)
- Chien-Tung Wu
- Institute of Traditional Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Chinese Medicine, Taipei City Hospital, Taipei, Taiwan
| | - Yueh-Ting Tsai
- School of Post Baccalaureate Chinese Medicine, China Medical University, Taichung, Taiwan.,Department of Traditional Chinese Medicine, Kuang Tien General Hospital, Taichung, Taiwan
| | - Hsuan-Kuang Jung
- Department of Internal Medicine and Nephrology, Taipei City Hospital Yangming Branch, Taipei, Taiwan.,School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Shu-Ling Fu
- Institute of Traditional Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chao Agnes Hsiung
- Institute of Population Health Sciences, National Health Research Institutes, Taiwan
| | - Hsiao-Yu Liu
- Institute of Population Health Sciences, National Health Research Institutes, Taiwan
| | - Jung-Nien Lai
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
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Le J, Greenberg RG, Benjamin DK, Yoo Y, Zimmerman KO, Cohen-Wolkowiez M, Wade KC. Prolonged Post-Discontinuation Antibiotic Exposure in Very Low Birth Weight Neonates at Risk for Early-Onset Sepsis. J Pediatric Infect Dis Soc 2021; 10:615-621. [PMID: 33491088 PMCID: PMC8163059 DOI: 10.1093/jpids/piaa172] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 12/28/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND Premature, very low birth weight (VLBW) neonates are at risk for early-onset sepsis and receive ampicillin and gentamicin post-birth. Antimicrobial stewardship supports short-course antibiotics, but how long antibiotic concentrations remain therapeutic post-last dose is unknown. METHODS Using Monte Carlo simulations (NONMEM 7.3), we analyzed antibiotic exposures in a retrospective cohort of 34 689 neonates (<1500 g, 22-27 weeks of gestation). Therapeutic exposure for ampicillin and gentamicin was evaluated relative to the minimum inhibitory concentration (MIC) for common pathogens (MIC 0.25-8 mcg/mL for group B streptococcus [GBS] and Escherichia coli). Post-discontinuation antibiotic exposure (PDAE) was defined as the time from the last dose to time when concentration decreased below MIC. RESULTS Neonates had a median (range) gestational age of 26 (22-27) weeks and BW, 790 g (400-1497) . All ampicillin dosing regimens (50-100 mg/kg every 8-12 hours for 2-6 doses) achieved therapeutic exposures > MIC range. After the last dose, the PDAE mean (95% confidence interval [CI]) ranged from 34 to 50 hours (17-79) for E. coli (MIC 8) and 82 to 104 hours (95% CI: 39-122) for GBS (MIC 0.25); longer PDAE occurred with higher dose, shorter interval, and longer course. Short-course ampicillin (2 doses, 50 mg/kg every 12 hours) provided PDAE 34 hours for E. coli and 82 hours for GBS. Single-dose 5 mg/kg gentamicin provided PDAE > MIC 2 for 26 hours. CONCLUSIONS In VLBW neonates, ampicillin exposure remains therapeutic long after the last dose. Short-course ampicillin provided therapeutic exposures throughout the typical blood culture incubation period.
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Affiliation(s)
- Jennifer Le
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California–San Diego, La Jolla, California, USA
| | - Rachel G Greenberg
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Daniel K Benjamin
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - YoungJun Yoo
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California–San Diego, La Jolla, California, USA
| | - Kanecia O Zimmerman
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Michael Cohen-Wolkowiez
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Kelly C Wade
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Schoster A, Amsler M, Kirchgaessner C, Saleh L, Schwarzwald C, Schmitt S. Gentamicin plasma concentrations in hospitalized horses and retrospective minimal inhibitory concentrations of gram-negative equine pathogens. J Vet Emerg Crit Care (San Antonio) 2020; 31:323-330. [PMID: 33274835 DOI: 10.1111/vec.13035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 05/14/2019] [Accepted: 06/08/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The optimal dosage regimen of gentamicin in horses is still under investigation. The objectives of this study were to determine gentamicin plasma concentrations in hospitalized horses treated with 10 mg/kg gentamicin (IV, q 24 h) and to determine whether a plasma concentration to minimum inhibitory concentration (MIC) ratio of 10:1 is reached for equine pathogens using this dose. DESIGN Prospective clinical observational study; retrospective study on MICs of 131 gram-negative bacteria isolated from horses (2012-2015). SETTING University teaching hospital. ANIMALS Ninety-eight horses >6 months old, treated with gentamicin for their primary disease, consecutive samples. MEASUREMENTS AND MAIN RESULTS Plasma concentrations were measured 1 hour (C1h ) and 20 hours (C20h ) after gentamicin administration using fluorescence polarization. Presence of systemic inflammatory response syndrome (SIRS) and azotemia was recorded, as well as the reason for antimicrobial administration (primary disease) and whether administration was prophylactic or therapeutic. The target C1h of ≥20 µg/mL gentamicin was reached in 90% of horses and was sufficient to reach a plasma concentration:MIC of 10:1 in 32 of 131 (24%) of gram-negative aerobic bacteria. A C20h ≤ 2 µg/mL was reached in 97% horses. Therapeutic versus prophylactic administration, primary disease, azotemia, and systemic inflammatory response syndrome were not associated with a failure to reach a desired peak or trough. CONCLUSIONS The gentamicin dose of 10 mg/kg every 24 hours should be further investigated and safety assessed because a target gentamicin plasma concentration of ≥20 µg/mL was achieved in the majority of cases. Nephrotoxic side effects were not assessed. Individual drug monitoring should be performed because clinical factors are unreliable predictors of plasma concentrations. A gentamicin target concentration of ≥40 µg/mL does not offer additional benefits compared to ≥20 µg/mL, due to the bimodal distribution of resistance in bacterial isolates.
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Affiliation(s)
- Angelika Schoster
- Vetsuisse Faculty, Equine Department, Clinic for Equine Internal Medicine, University of Zurich, Zurich, Switzerland
| | - Morena Amsler
- Vetsuisse Faculty, Equine Department, Clinic for Equine Internal Medicine, University of Zurich, Zurich, Switzerland
| | - Constanze Kirchgaessner
- Vetsuisse Faculty, Institute of Veterinary Bacteriology, University of Zurich, Zurich, Switzerland
| | - Lanja Saleh
- University Hospital, Institute for Clinical Chemistry, University of Zurich, Zurich, Switzerland
| | - Colin Schwarzwald
- Vetsuisse Faculty, Equine Department, Clinic for Equine Internal Medicine, University of Zurich, Zurich, Switzerland
| | - Sarah Schmitt
- Vetsuisse Faculty, Institute of Veterinary Bacteriology, University of Zurich, Zurich, Switzerland
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Corcione S, De Nicolò A, Lupia T, Segala FV, Pensa A, Corgiat Loia R, Romeo MR, Di Perri G, Stella M, D'Avolio A, De Rosa FG. Observed concentrations of amikacin and gentamycin in the setting of burn patients with gram-negative bacterial infections: Preliminary data from a prospective study. Therapie 2020; 76:409-414. [PMID: 33257012 DOI: 10.1016/j.therap.2020.10.003] [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: 05/19/2020] [Revised: 09/19/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
AIM OF THE STUDY Critically ill populations often have shown subtherapeutic aminoglycosides' concentrations mostly because of unavoidable changes in drug volume distribution and clearance. We present a real life prospective study evaluating plasma concentrations for once-daily dosing for amikacin and gentamycin among a population of severe burn adults. METHODS We conducted a real life prospective study on the plasma observed concentrations of amikacin and gentamycin among severe burn patients, using aminoglycoside as combination therapy. Antibiotics were prescribed at the standard doses of 15-20mg/kg/day for amikacin and 3-5mg/kg/day for gentamycin. RESULTS Eight patients (4 in amikacin and 4 in gentamycin groups, respectively) were enrolled in the study. All subjects were admitted for severe burns. The most common site of infection was bloodstream (5; 62.5%) and pneumonia (4; 50%). Pseudomonas aeruginosa, followed by Klebsiella pneumoniae and multi-drug resistant Acinetobacter baumannii were the most prevalent agents isolated. Amikacin and gentamycin never achieved the target peak concentration of 60mg/L and 30mg/L: in our study Cmax, for amikacin, was 33.1±15.6mg/L (SD), while for gentamycin was 14.3mg/L±9. Cmax and total body surface area have shown a strong negative correlation with borderline statistical significance (amikacin: ρ=0.922, P=0.078; gentamycin: ρ=0.937, P=0.063). At the standard dosage, the pharmacokinetic/pharmacodynamic (PK/PD) target of Cmax>8×highest MIC was reached for 8 (53.3%) out of 15 isolated pathogens. CONCLUSIONS The present study found that, in a population of septic burn patients, standard doses of gentamycin and amikacin most often lead to plasma concentrations under the PK/PD target.
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Affiliation(s)
- Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Via Verdi 8, 10124 Turin, Italy; Tufts University School of Medicine, 02111 Boston, MA, USA
| | - Amedeo De Nicolò
- Department of Medical Sciences, University of Turin-ASL Città di Torino Laboratory of Clinical Pharmacology and Pharmacogenetics, Amedeo di Savoia Hospital, 10149 Turin, Italy
| | - Tommaso Lupia
- Department of Medical Sciences, Infectious Diseases, University of Turin, Via Verdi 8, 10124 Turin, Italy.
| | - Francesco Vladimiro Segala
- Department of Medical Sciences, Infectious Diseases, University of Turin, Via Verdi 8, 10124 Turin, Italy
| | - Anna Pensa
- Burn Centre, C.T.O Hospital, A.O.U.Città della Salute e della Scienza, 10126 Turin, Italy
| | - Riccardo Corgiat Loia
- Department of Medical Sciences, Infectious Diseases, University of Turin, Via Verdi 8, 10124 Turin, Italy
| | - Maria Rosa Romeo
- Burn Centre, C.T.O Hospital, A.O.U.Città della Salute e della Scienza, 10126 Turin, Italy
| | - Giovanni Di Perri
- Department of Medical Sciences, Infectious Diseases, University of Turin, Via Verdi 8, 10124 Turin, Italy
| | - Maurizio Stella
- Burn Centre, C.T.O Hospital, A.O.U.Città della Salute e della Scienza, 10126 Turin, Italy
| | - Antonio D'Avolio
- Department of Medical Sciences, University of Turin-ASL Città di Torino Laboratory of Clinical Pharmacology and Pharmacogenetics, Amedeo di Savoia Hospital, 10149 Turin, Italy
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, Via Verdi 8, 10124 Turin, Italy
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Rajkhan AT, Esmat A, Alharthi SE. Protective Effect of Celastrol on Gentamicin-induced Nephrotoxicity in Mice. INT J PHARMACOL 2020. [DOI: 10.3923/ijp.2020.126.135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ben Romdhane H, Ben Fredj N, Chaabane A, Ben Aicha S, Chadly Z, Ben Fadhel N, Boughattas N, Aouam K. Interest of therapeutic drug monitoring of aminoglycosides administered by a monodose regimen. Nephrol Ther 2019; 15:110-114. [PMID: 30660586 DOI: 10.1016/j.nephro.2018.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/24/2018] [Accepted: 08/28/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Although the once-daily regimen of aminoglycosides (AG) is considered as predominantly used by many centers, the level of evidence of Therapeutic Drug Monitoring (TDM) of AG in cases of once-daily has not been clearly defined. The objective of this study is to evaluate the impact of TDM in achievement or maintaining target serum concentrations in patients receiving once-daily administration of AG. METHODS We performed a retrospective analysis of data from patients having received a once daily amikacin or gentamicin and underwent routine TDM. A longitudinal follow up was performed. Data were analyzed according to the adhesion or not to recommendations. A logistic regression was performed in order to evaluate the effect of covariates (age, gender, weight, creatinine clearance [CLcr], TDM-based dose adjustment, weighted dose of AG) on the achievement of non-toxic Cmin. RESULTS A total 437 blood samples issued from 324 patients were analyzed. The cut-off value of Clcr associated with a risk of toxic Cmin was≤41.66mL/min (OR: 11.29; 95%CI: 7.21-17.61; P<0.0001). Eighty-eight patients (27.1%) have at least two sampling points. The univariate analysis showed that the age, weight, CLcr and TDM-based dose adjustment were found to be significant factors in the achievement of non-toxic Cmin. In multivariate analysis, only TDM-based dose adjustment remains a significant factor in the achievement of non-toxic Cmin (OR: 6.66; 95%CI: 2.26-19.63; P=0.0006). CONCLUSION Our study demonstrates the usefulness of TDM-based dosing adjustment of AG antibiotics in achieving nontoxic trough concentrations, particularly in critically ill patients, as they are prone to a renal impairment.
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Affiliation(s)
- Haifa Ben Romdhane
- EPS Monastir, service de pharmacologie clinique, laboratoire de pharmacologie, faculté de médecine de Monastir, rue Avicenne, 5019 Monastir, Tunisia
| | - Nadia Ben Fredj
- EPS Monastir, service de pharmacologie clinique, laboratoire de pharmacologie, faculté de médecine de Monastir, rue Avicenne, 5019 Monastir, Tunisia.
| | - Amel Chaabane
- EPS Monastir, service de pharmacologie clinique, laboratoire de pharmacologie, faculté de médecine de Monastir, rue Avicenne, 5019 Monastir, Tunisia
| | - Sana Ben Aicha
- EPS Monastir, service de pharmacologie clinique, laboratoire de pharmacologie, faculté de médecine de Monastir, rue Avicenne, 5019 Monastir, Tunisia
| | - Zohra Chadly
- EPS Monastir, service de pharmacologie clinique, laboratoire de pharmacologie, faculté de médecine de Monastir, rue Avicenne, 5019 Monastir, Tunisia
| | - Najeh Ben Fadhel
- EPS Monastir, service de pharmacologie clinique, laboratoire de pharmacologie, faculté de médecine de Monastir, rue Avicenne, 5019 Monastir, Tunisia
| | - Naceur Boughattas
- EPS Monastir, service de pharmacologie clinique, laboratoire de pharmacologie, faculté de médecine de Monastir, rue Avicenne, 5019 Monastir, Tunisia
| | - Karim Aouam
- EPS Monastir, service de pharmacologie clinique, laboratoire de pharmacologie, faculté de médecine de Monastir, rue Avicenne, 5019 Monastir, Tunisia
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Germovsek E, Barker CIS, Sharland M, Standing JF. Scaling clearance in paediatric pharmacokinetics: All models are wrong, which are useful? Br J Clin Pharmacol 2016; 83:777-790. [PMID: 27767204 PMCID: PMC5346879 DOI: 10.1111/bcp.13160] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 10/06/2016] [Accepted: 10/15/2016] [Indexed: 12/11/2022] Open
Abstract
Linked Articles This article is commented on in the editorial by Holford NHG and Anderson BJ. Why standards are useful for predicting doses. Br J Clin Pharmacol 2017; 83: 685–7. doi: 10.1111/bcp.13230 Aim When different models for weight and age are used in paediatric pharmacokinetic studies it is difficult to compare parameters between studies or perform model‐based meta‐analyses. This study aimed to compare published models with the proposed standard model (allometric weight0.75 and sigmoidal maturation function). Methods A systematic literature search was undertaken to identify published clearance (CL) reports for gentamicin and midazolam and all published models for scaling clearance in children. Each model was fitted to the CL values for gentamicin and midazolam, and the results compared with the standard model (allometric weight exponent of 0.75, along with a sigmoidal maturation function estimating the time in weeks of postmenstrual age to reach half the mature value and a shape parameter). For comparison, we also looked at allometric size models with no age effect, the influence of estimating the allometric exponent in the standard model and, for gentamicin, using a fixed allometric exponent of 0.632 as per a study on glomerular filtration rate maturation. Akaike information criteria (AIC) and visual predictive checks were used for evaluation. Results No model gave an improved AIC in all age groups, but one model for gentamicin and three models for midazolam gave slightly improved global AIC fits albeit using more parameters: AIC drop (number of parameters), –4.1 (5), –9.2 (4), –10.8 (5) and –10.1 (5), respectively. The 95% confidence interval of estimated CL for all top performing models overlapped. Conclusion No evidence to reject the standard model was found; given the benefits of standardised parameterisation, its use should therefore be recommended.
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Affiliation(s)
- Eva Germovsek
- Inflammation, Infection and Rheumatology Section, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | - Charlotte I S Barker
- Inflammation, Infection and Rheumatology Section, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.,Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK.,St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, UK
| | - Mike Sharland
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK.,St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, UK
| | - Joseph F Standing
- Inflammation, Infection and Rheumatology Section, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.,Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
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Antibiotic prescribing practices: A national survey of Cambodian physicians. Am J Infect Control 2016; 44:1144-1148. [PMID: 27324610 DOI: 10.1016/j.ajic.2016.03.062] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/09/2016] [Accepted: 03/09/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Antibiotic resistance is a threat to global health security. We assessed knowledge, attitudes, and practices in regard to antibiotic prescribing and resistance in Cambodian physicians from public hospitals. METHODS A cross-sectional knowledge, attitudes, and practices survey was distributed to physicians from 19 public hospitals. RESULTS The response rate was 78% (689 out of 881). The majority (88%; 607 out of 686) of physicians understood that antibiotic resistance was a local challenge. More than half (54%; 366 out of 682) believed that antibiotic prescribing was inappropriate in their hospital and 93% (638 out of 684) had difficulties in selecting appropriate antibiotics to treat common infections. The majority (86%; 574 out of 667) and one-third of physicians (36%; 236 out of 665) would prescribe antibiotics for uncomplicated common cold and diarrhea in children < 5 years of age, respectively. Half (58%; 385 out of 668) had experience treating methicillin-resistant Staphylococcus aureus infection, but the majority (73%; 188 out of 258) could not identify antibiotics to treat this infection. Only 17% (115 out of 667) had experience treating endemic melioidosis. All physicians agreed that knowledge about local antibiotic resistance, treatment guidelines, and educational programs were necessary. CONCLUSIONS Cambodian physicians are aware of antibiotic resistance challenges but they do not possess the required knowledge of local antibiotic resistance patterns that would assist their prescribing practices. Cambodian physicians need support to improve antibiotic prescribing.
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Gautier JC, Zhou X, Yang Y, Gury T, Qu Z, Palazzi X, Léonard JF, Slaoui M, Veeranagouda Y, Guizon I, Boitier E, Filali-Ansary A, van den Berg BHJ, Poetz O, Joos T, Zhang T, Wang J, Detilleux P, Li B. Evaluation of novel biomarkers of nephrotoxicity in Cynomolgus monkeys treated with gentamicin. Toxicol Appl Pharmacol 2016; 303:1-10. [PMID: 27105553 DOI: 10.1016/j.taap.2016.04.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 04/11/2016] [Accepted: 04/15/2016] [Indexed: 11/16/2022]
Abstract
Most studies to evaluate kidney safety biomarkers have been performed in rats. This study was conducted in Cynomolgus monkeys in order to evaluate the potential usefulness of novel biomarkers of nephrotoxicity in this species. Groups of 3 males were given daily intramuscular injections of gentamicin, a nephrotoxic agent known to produce lesions in proximal tubules, at dose-levels of 10, 25, or 50mg/kg/day for 10days. Blood and 16-h urine samples were collected on Days -7, -3, 2, 4, 7, and at the end of the dosing period. Several novel kidney safety biomarkers were evaluated, with single- and multiplex immunoassays and in immunoprecipitation-LC/MS assays, in parallel to histopathology and conventional clinical pathology parameters. Treatment with gentamicin induced a dose-dependent increase in kidney tubular cell degeneration/necrosis, ranging from minimal to mild severity at 10mg/kg/day, moderate at 25mg/kg/day, and to severe at 50mg/kg/day. The results showed that the novel urinary biomarkers, microalbumin, α1-microglobulin, clusterin, and osteopontin, together with the more traditional clinical pathology parameters, urinary total protein and N-acetyl-β-D-glucosaminidase (NAG), were more sensitive than blood urea nitrogen (BUN) and serum creatinine (sCr) to detect kidney injury in the monkeys given 10mg/kg/day gentamicin for 10days, a dose leading to an exposure which is slightly higher than the desired therapeutic exposure in clinics. Therefore, these urinary biomarkers represent non-invasive biomarkers of proximal tubule injury in Cynomolgus monkeys which may be potentially useful in humans.
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Affiliation(s)
| | - Xiaobing Zhou
- National Center for Safety Evaluation of Drugs (NCSED), National Institutes for Food and Drug Control, Beijing, China
| | - Yi Yang
- Sanofi R&D, Bridgewater, USA
| | | | - Zhe Qu
- National Center for Safety Evaluation of Drugs (NCSED), National Institutes for Food and Drug Control, Beijing, China
| | | | | | | | | | | | | | | | | | - Oliver Poetz
- Natural and Medical Sciences Institute at the University Tübingen, Germany
| | - Thomas Joos
- Natural and Medical Sciences Institute at the University Tübingen, Germany
| | | | - Jufeng Wang
- National Center for Safety Evaluation of Drugs (NCSED), National Institutes for Food and Drug Control, Beijing, China
| | | | - Bo Li
- National Center for Safety Evaluation of Drugs (NCSED), National Institutes for Food and Drug Control, Beijing, China.
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Zhuang L, He Y, Xia H, Liu Y, Sy SKB, Derendorf H. Gentamicin dosing strategy in patients with end-stage renal disease receiving haemodialysis: evaluation using a semi-mechanistic pharmacokinetic/pharmacodynamic model. J Antimicrob Chemother 2015; 71:1012-21. [PMID: 26702923 DOI: 10.1093/jac/dkv428] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 11/10/2015] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Gentamicin is widely used in end-stage renal disease (ESRD) patients for the treatment of infections. The goal of this study was to find the most reasonable dosing regimen for gentamicin in ESRD patients receiving haemodialysis. METHODS The in vitro antimicrobial activity of gentamicin was evaluated by static and dynamic time-kill experiments against three bacterial strains of MSSA, MRSA and Pseudomonas aeruginosa. A semi-mechanistic pharmacokinetic/pharmacodynamic (PK/PD) model was established afterwards, allowing the characterization of the antibacterial effect of gentamicin in the human body. The model was utilized to assess dosing regimens of gentamicin in ESRD patients receiving haemodialysis, taking both efficacy and safety into account. RESULTS The PK/PD model was capable of describing the bacterial response to gentamicin exposure in all three strains. Simulation based on the PK/PD model showed that pre-dialysis and post-dialysis dosing would bring comparable benefit to the ESRD patient regardless of whether the PK/PD target (fCmax/MIC >8-fold) was achieved, while the post-dialysis dosing resulted in a significantly lower trough concentration. The result of simulated dose fractionation demonstrated that both fCmax/MIC and fAUC(0-24)/MIC are strong predictors of drug effectiveness, but the PK/PD model would provide a more precise prediction of antibacterial activity as well as valuable information on dose selection in ESRD patients receiving haemodialysis. CONCLUSIONS Our study supports the original FDA label with regard to the dosing regimen of gentamicin in ESRD patients, which offers adequate clinical benefit as well as an acceptable safety profile.
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Affiliation(s)
- Luning Zhuang
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA Division of Pharmacometrics, Office of Clinical Pharmacology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD 10903, USA
| | - Yang He
- Department of Molecular Genetics and Microbiology, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Huiming Xia
- Division of Clinical Pharmacology IV, Office of Clinical Pharmacology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD 10903, USA
| | - Yajun Liu
- Division of Bioequivalence II, Office of Generic Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD 10903, USA
| | - Sherwin K B Sy
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA Post-Graduate Program in Biostatistics, Department of Statistics, Maringa State University, Maringa, PR 87020, Brazil
| | - Hartmut Derendorf
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
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Sy SKB, Zhuang L, Derendorf H. Pharmacokinetics and pharmacodynamics in antibiotic dose optimization. Expert Opin Drug Metab Toxicol 2015; 12:93-114. [DOI: 10.1517/17425255.2016.1123250] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Bauquier JR, Boston RC, Sweeney RW, Wilkins PA, Nolen-Walston RD. Plasma Peak and Trough Gentamicin Concentrations in Hospitalized Horses Receiving Intravenously Administered Gentamicin. J Vet Intern Med 2015; 29:1660-6. [PMID: 26426540 PMCID: PMC4895685 DOI: 10.1111/jvim.13626] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 06/17/2015] [Accepted: 08/26/2015] [Indexed: 12/03/2022] Open
Abstract
Background Gentamicin is an aminoglycoside antimicrobial commonly used in horses at 6.6 mg/kg IV once daily. Therapeutic drug monitoring (TDM) can confirm desired peak concentration is reached for common bacterial isolates, and detect toxicosis associated with high trough values. Objectives Determine the relationship between gentamicin dose and plasma concentration in hospitalized horses, and identify a starting dose range to achieve peaks > 32 μg/mL. Animals Sixty‐five horses (2002–2010) receiving once‐daily gentamicin with TDM performed (N = 99 sets). Methods Retrospective study. Data from hospitalized horses including weight, dose, plasma peak, and trough gentamicin concentration, creatinine concentrations and presence of focal or systemic disease were collected from medical records. Peak concentrations measured 25–35 minutes after administration were included (N = 77). Data were divided into low (<7.7 mg/kg), medium (7.7–9.7 mg/kg) and high (>9.7 mg/kg) dose groups, and were grouped by the horse having focal or systemic disease. Results Peak concentrations resulting from doses ≥7.7 mg/kg were 5.74 μg/mL (SE 2.1 μg/mL) greater than peaks from doses <7.7 mg/kg (P = .007). Peak concentrations was 3.6 times more likely to be >32 μg/mL if dose was ≥7.7 mg/kg (P = .04). There were no significant effects of dose on trough or creatinine concentration. At a given dose, horses with focal disease had higher peaks than those with systemic disease (P = .039). Conclusions and Clinical Importance These data suggest gentamicin dosage should be individually determined in horses using TDM, but support an initial once‐daily dose of 7.7–9.7 mg/kg IV to achieve peaks >32 μg/mL and trough concentrations <2 μg/mL. Further studies evaluating the safety of doses >6.6 mg/kg are required.
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Affiliation(s)
- J R Bauquier
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA
| | - R C Boston
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA
| | - R W Sweeney
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA
| | - P A Wilkins
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA
| | - R D Nolen-Walston
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA
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