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Le Merdy M, Spires J, Tan ML, Zhao L, Lukacova V. Clinical Ocular Exposure Extrapolation for a Complex Ophthalmic Suspension Using Physiologically Based Pharmacokinetic Modeling and Simulation. Pharmaceutics 2024; 16:914. [PMID: 39065612 PMCID: PMC11280076 DOI: 10.3390/pharmaceutics16070914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/29/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024] Open
Abstract
The development of generic ophthalmic drug products with complex formulations is challenging due to the complexity of the ocular system and a lack of sensitive testing to evaluate the interplay of its physiology with ophthalmic drugs. New methods are needed to facilitate the development of ophthalmic generic drug products. Ocular physiologically based pharmacokinetic (O-PBPK) models can provide insight into drug partitioning in eye tissues that are usually not accessible and/or are challenging to sample in humans. This study aims to demonstrate the utility of an ocular PBPK model to predict human exposure following the administration of ophthalmic suspension. Besifloxacin (Bes) suspension is presented as a case study. The O-PBPK model for Bes ophthalmic suspension (Besivance® 0.6%) accounts for nasolacrimal drainage, suspended particle dissolution in the tears, ocular absorption, and distribution in the rabbit eye. A topical controlled release formulation was used to integrate the effect of Durasite® on Bes ocular retention. The model was subsequently used to predict Bes exposure after its topical administration in humans. Drug-specific parameters were used as validated for rabbits. The physiological parameters were adjusted to match human ocular physiology. Simulated human ocular pharmacokinetic profiles were compared with the observed ocular tissue concentration data to assess the OCAT models' ability to predict human ocular exposure. The O-PBPK model simulations adequately described the observed concentrations in the eye tissues following the topical administration of Bes suspension in rabbits. After adjustment of physiological parameters to represent the human eye, the extrapolation of clinical ocular exposure following a single ocular administration of Bes suspension was successful.
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Affiliation(s)
- Maxime Le Merdy
- Simulations Plus, Inc., 42505 10th Street West, Lancaster, CA 93534, USA
| | - Jessica Spires
- Simulations Plus, Inc., 42505 10th Street West, Lancaster, CA 93534, USA
| | - Ming-Liang Tan
- Division of Quantitative Methods and Modeling, Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - Liang Zhao
- Division of Quantitative Methods and Modeling, Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - Viera Lukacova
- Simulations Plus, Inc., 42505 10th Street West, Lancaster, CA 93534, USA
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Besifloxacin liposomes with positively charged additives for an improved topical ocular delivery. Sci Rep 2020; 10:19285. [PMID: 33159142 PMCID: PMC7648625 DOI: 10.1038/s41598-020-76381-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/22/2020] [Indexed: 02/08/2023] Open
Abstract
Topical ophthalmic antibiotics show low efficacy due to the well-known physiological defense mechanisms of the eye, which prevents the penetration of exogenous substances. Here, we aimed to incorporate besifloxacin into liposomes containing amines as positively charged additives and to evaluate the influence of this charge on drug delivery in two situations: (i) iontophoretic and (ii) passive treatments. Hypothesis are (i) charge might enhance the electromigration component upon current application improving penetration efficiency for a burst drug delivery, and (ii) positive charge might prolong formulation residence time, hence drug penetration. Liposomes elaborated with phosphatidylcholine (LP PC) or phosphatidylcholine and spermine (LP PC: SPM) were stable under storage at 6 ºC for 30 days, showed mucoadhesive characteristics, and were non-irritant, according to HET-CAM tests. Electron paramagnetic resonance spectroscopy measurements showed that neither the drug nor spermine incorporations produced evident alterations in the fluidity of the liposome's membranes, which retained their structural stability even under iontophoretic conditions. Mean diameter and zeta potential were 177.2 ± 2.7 nm and − 5.7 ± 0.3 mV, respectively, for LP PC; and 175.4 ± 1.9 nm and + 19.5 ± 1.0 mV, respectively, for LP PC:SPM. The minimal inhibitory concentration (MIC) and the minimal bactericide concentration (MBC) of the liposomes for P. aeruginosa showed values lower than the commercial formulation (Besivance). Nevertheless, both formulations presented a similar increase in permeability upon the electric current application. Hence, liposome charge incorporation did not prove to be additionally advantageous for iontophoretic therapy. Passive drug penetration was evaluated through a novel in vitro ocular model that simulates the lacrimal flow and challenges the formulation resistance in the passive delivery situation. As expected, LP PC: SPM showed higher permeation than the control (Besivance). In conclusion, besifloxacin incorporation into positively charged liposomes improved passive topical delivery and can be a good strategy to improve topical ophthalmic treatments.
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Crowell EL, Koduri VA, Groat RS, Lee DA. Cost comparison of commonly used postoperative topical ophthalmic antibiotics. J Cataract Refract Surg 2019; 43:1322-1327. [PMID: 29120716 DOI: 10.1016/j.jcrs.2017.07.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 07/19/2017] [Accepted: 07/23/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To provide information on the actual fill level and cost of currently available antibiotic drops used perioperatively. DESIGN Prospective laboratory investigation. SETTING Robert Cizik Eye Clinic, Houston, Texas USA. METHODS The following 9 medications were tested: moxifloxacin, gatifloxacin (branded and generic), besifloxacin, levofloxacin, ciprofloxacin, ofloxacin, trimethoprim/polymyxin B, tobramycin, and gentamicin. Actual bottle-fill volume and number of drops per bottle were measured using 10 bottles of each formulation. The percentage of the bottle used and the perioperative cost (using average wholesale price) were calculated for 3 times a day and 4 times a day dosing for 7-day, 10-day, and 14-day courses. Formulations were compared using 1-way analysis of variance with Tukey multiple comparisons. RESULTS For medications with sticker volumes of at least 5 mL, all but 2 medications (ofloxacin, 4 times a day for 14 days; gentamicin, 4 times a day for 14 days) covered 2 perioperative courses. Besifloxacin had a fill volume less than the sticker volume. The most cost-effective perioperative antibiotic prophylaxis was trimethoprim-polymyxin B (4 times a day: $12.87 for 7-day, 10-day, and 14-day courses, and $46.88 for 4-day course; 3 times a day: $12.87 for 7-day, 10-day, and 14-day courses). CONCLUSIONS Most antibiotics had an actual fill volume greater than sticker volume, which is a sufficient drug regimen for 2 perioperative courses. The costs of common postoperative topical antibiotic regimens vary widely depending on the drug and dosing regimen. Cost considerations for perioperative antibiotics will be increasingly important because the number of cataract surgeries is expected to increase with the growing and aging population.
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Affiliation(s)
- Eric L Crowell
- From the Ruiz Department of Ophthalmology and Visual Science (Crowell, Koduri, Groat, Lee), McGovern Medical School at The University of Texas Health Science Center at Houston, and the Robert Cizik Eye Clinic (Crowell, Groat, Lee), Houston, Texas, USA
| | - Vivek A Koduri
- From the Ruiz Department of Ophthalmology and Visual Science (Crowell, Koduri, Groat, Lee), McGovern Medical School at The University of Texas Health Science Center at Houston, and the Robert Cizik Eye Clinic (Crowell, Groat, Lee), Houston, Texas, USA
| | - R Scott Groat
- From the Ruiz Department of Ophthalmology and Visual Science (Crowell, Koduri, Groat, Lee), McGovern Medical School at The University of Texas Health Science Center at Houston, and the Robert Cizik Eye Clinic (Crowell, Groat, Lee), Houston, Texas, USA
| | - David A Lee
- From the Ruiz Department of Ophthalmology and Visual Science (Crowell, Koduri, Groat, Lee), McGovern Medical School at The University of Texas Health Science Center at Houston, and the Robert Cizik Eye Clinic (Crowell, Groat, Lee), Houston, Texas, USA.
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Bhalerao H, Koteshwara KB, Chandran S. Levofloxacin Hemihydrate In Situ Gelling Ophthalmic Solution: Formulation Optimization and In Vitro and In Vivo Evaluation. AAPS PharmSciTech 2019; 20:272. [PMID: 31372767 DOI: 10.1208/s12249-019-1489-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 07/19/2019] [Indexed: 11/30/2022] Open
Abstract
Bacterial conjunctivitis is a leading cause of ocular infections requiring short-term therapeutic treatment with frequent administration of drugs on daily basis. Topical dosage forms available in the market for the treatment of bacterial conjunctivitis such as simple drug solutions and suspensions are rapidly eliminated from the precorneal space upon instillation due to tear turn over and nasolacrimal drainage, limiting intraocular bioavailability of drug to less than 10% of the administered dose. To overcome issues related to conventional drop, an effort was made to design and evaluate prolong release ophthalmic solution of levofloxacin hemihydrate (LFH) using ion-sensitive in situ gelling polymer. Gellan gum was used as the in situ gelling agent. Formulations were screened based on in vitro gelation time, in vitro drug release, and stability towards sol to gel conversion upon storage. The prototype formulations exhibiting quick in vitro gelling time (< 15 s), prolonged in vitro drug release (18-24 h), and stability for at least 6 months at 25°C/40% relative humidity (RH) and 40°C/25% RH were evaluated for pharmacokinetic studies using healthy New Zealand white rabbits. Tested formulations were found to be well-tolerated and showed significant increase in AUC0-24 (22,660.39 h ng/mL) and mean residence time (MRT 12 h) as compared with commercially available solution Levotop PF® (Ajanta Pharma Ltd., India)(AUC0-24 6414.63 h ng/mL and MRT 4 h). Thus, solution formulations containing in situ gelling polymer may serve as improved drug delivery system providing superior therapeutic efficacy and better patient compliance for the treatment of bacterial conjunctivitis.
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Alhusban AA, Tarawneh OA, Dawabsheh SO, Alhusban AA, Abumhareb FW. Liquid chromatography–tandem mass spectrometry for rapid and selective simultaneous determination of fluoroquinolones level in human aqueous humor. J Pharmacol Toxicol Methods 2019; 97:36-43. [DOI: 10.1016/j.vascn.2019.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/23/2018] [Accepted: 03/14/2019] [Indexed: 11/30/2022]
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Abdel-Meguid AAE, Gabr AF, Said MM, Nassef MAEH, Elmenofy TMI. Comparative Study Between Topical Gatifloxacin 0.5% and Moxifloxacin 0.5% as a Prophylactic Measure Before Intraocular Surgery. J Ocul Pharmacol Ther 2019; 35:315-318. [PMID: 30950680 DOI: 10.1089/jop.2018.0088] [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] [Indexed: 11/12/2022] Open
Abstract
Purpose: To compare equal concentrations (0.5%) of moxifloxacin and gatifloxacin ophthalmic solutions with regard to conjunctival bacterial reduction as well as anterior chamber penetration. Methods: One hundred patients were divided into 2 groups. Group A received moxifloxacin 0.5% ophthalmic solution and group B received gatifloxacin 0.5% ophthalmic solution 4 times a day for 3 days before surgery and 5 times with 30 min intervals on the day of surgery. Two conjunctival swabs were obtained: one before instillation of antibiotic and the second 30 min after instillation of the last antibiotic drop. Specimens were sent for culture and susceptibility testing. At the time of surgery, 0.1 mL of aqueous fluid was aspired, and aqueous concentration of fluoroquinolones was identified using reverse-phase high-pressure liquid chromatography assay technique. Results: The most common flora isolated was coagulase-negative Staphylococcus (32.9%), followed by Staphylococcus aureus (24.8%) and Corynebacterium diphtheria (19.1%). Moxifloxacin aqueous concentration was higher compared with gatifloxacin [1.75 ± 0.98 standard deviation (SD) and 0.75 ± 0.22 SD, respectively]. This 2.3-fold difference in aqueous humor antibiotic concentrations was statistically significant (P ≤ 0.001). There was significant difference between the means of conjunctival colony-forming unit after antibiotic administration in both the study groups (2.17 ± 1.54 SD in group A and 1.56 ± 1.09 SD in group B). Conclusions: Moxifloxacin 0.5% was found to penetrate anterior chamber more than gatifloxacin 0.5%, enforcing its use for prophylaxis before intraocular surgeries. However, gatifloxacin 0.5% eye drops were able to reduce conjunctival bacterial load, more supporting its use before extraocular and refractive surgeries.
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Affiliation(s)
- Asser Ahmed Ehsan Abdel-Meguid
- 1 Department of Ophthalmology, Fayoum University Faculty of Medicine, Fayoum, Egypt.,2 Department of Ophthalmology, Cairo University Kasr Alaini Faculty of Medicine, Cairo, Egypt
| | - Ahmed Fathy Gabr
- 3 Department of Ophthalmology, Aswan University Faculty of Medicine, Aswan, Egypt
| | - Mohamed Mostafa Said
- 1 Department of Ophthalmology, Fayoum University Faculty of Medicine, Fayoum, Egypt
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Current Strategies for Prevention and Treatment of Postoperative Endophthalmitis. CURRENT OPHTHALMOLOGY REPORTS 2018. [DOI: 10.1007/s40135-018-0171-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Domingos LC, Moreira MVL, Keller KM, Viana FAB, Melo MM, Soto-Blanco B. Simultaneous quantification of gatifloxacin, moxifloxacin, and besifloxacin concentrations in cornea and aqueous humor by LC-QTOF/MS after topical ocular dosing. J Pharmacol Toxicol Methods 2017; 83:87-93. [DOI: 10.1016/j.vascn.2016.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 08/27/2016] [Accepted: 09/22/2016] [Indexed: 10/21/2022]
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Oh LJ, Nguyen CL, Wang SS, Francis IC. Has the Time Come for All to Routinely Use Intracameral Antibiotic Prophylaxis at the Time of Cataract Surgery? Am J Ophthalmol 2016; 171:152-153. [PMID: 27666492 DOI: 10.1016/j.ajo.2016.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 08/10/2016] [Indexed: 10/21/2022]
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Kim ES, Lyseng-Williamson KA. Levofloxacin hydrate 1.5 % ophthalmic solution in external ocular infections and intraocular surgery: a guide to its use. DRUGS & THERAPY PERSPECTIVES 2016. [DOI: 10.1007/s40267-016-0351-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Postoperative endophthalmitis incidence after intravitreal therapy: a comparison of two different preoperative antibiotic prophylaxis. Int Ophthalmol 2016; 37:787-794. [DOI: 10.1007/s10792-016-0307-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 07/25/2016] [Indexed: 11/30/2022]
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Prieto-Borja L, García-Coca M, Ustratova I, Alejandre Alba N. Keratitis due to Nocardia nova after cataract surgery. Enferm Infecc Microbiol Clin 2016; 35:57-58. [PMID: 27448807 DOI: 10.1016/j.eimc.2016.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/01/2016] [Accepted: 06/03/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Laura Prieto-Borja
- Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz, Avda. Reyes Católicos 2, 28040 Madrid, Spain.
| | - Marta García-Coca
- Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz, Avda. Reyes Católicos 2, 28040 Madrid, Spain
| | - Iuliia Ustratova
- Department of Ophthalmology, IIS-Fundación Jiménez Díaz, Avda. Reyes Católicos 2, 28040 Madrid, Spain
| | - Nicolás Alejandre Alba
- Department of Ophthalmology, IIS-Fundación Jiménez Díaz, Avda. Reyes Católicos 2, 28040 Madrid, Spain
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Olson RJ. Has the Time Come for All to Routinely Use Intracameral Antibiotic Prophylaxis at the Time of Cataract Surgery? Am J Ophthalmol 2016; 166:xii-xiv. [PMID: 27178744 DOI: 10.1016/j.ajo.2016.04.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 04/19/2016] [Accepted: 04/20/2016] [Indexed: 11/27/2022]
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Klaus R, Jin C, Maier-Salamon A, Jäger W, Knopf C, Zeitlinger M, Richter-Müksch S, Schmidl D, Schmetterer L, Garhöfer G. An Exploratory Microdialysis Study to Assess the Ocular Pharmacokinetics of Ciprofloxacin Eye Drops in Rabbits. J Ocul Pharmacol Ther 2016; 32:390-5. [PMID: 27115201 DOI: 10.1089/jop.2015.0131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Despite the high frequency of use, data regarding the ocular in vivo pharmacokinetics (PK) of topically applied antibiotics are sparse. This study seeks to investigate the PK of the widely used fluoroquinolone ciprofloxacin by means of in vivo microdialysis. METHODS Twelve New Zealand white rabbits were included in the experiments. Under general anesthesia, microdialysis probes were implanted in the anterior chamber and the posterior segment of the same eye. After a period of 90 min after implantation, one drop of ciprofloxacin was administered onto the ocular surface. Microdialysis samples of the anterior chamber and the vitreous were collected every 30 min for 6 h. Relative recovery was assessed by retrodialysis to calculate absolute concentration values. Samples were analyzed using HPLC. RESULTS In the anterior chamber, the maximum total drug concentration (Cmax) amounted to 0.373 ± 0.281 μg/mL and was reached (Tmax) after 116 ± 36 min. Calculated area under the concentration-time curve AUC(0-n) for ciprofloxacin in the anterior chamber was 78.8 ± 47.1 μg min/mL. For the vitreous, Cmax was 0.02 ± 0.03 μg/mL and maximum drug concentration was reached 107 ± 60 min after topical administration. AUC(0-n) for ciprofloxacin in the vitreous was 0.269 ± 0.370 μg min/mL. CONCLUSION Microdialysis is a suitable method to assess in vivo pharmacokinetic profiles in the anterior chamber and in the vitreous. In the anterior chamber, maximum drug concentration was reached ∼2 h after single drug administration. Although the drug concentration in the vitreous was considerably lower, time course of drug concentration was comparable.
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Affiliation(s)
- Robert Klaus
- 1 Department of Clinical Pharmacology, Medical University of Vienna , Vienna, Austria
- 2 Center for Medical Physics and Biomedical Engineering, Medical University of Vienna , Vienna, Austria
- 3 Christian Doppler Laboratory for Ocular Effects of Thiomers , Vienna, Austria
| | - Chen Jin
- 1 Department of Clinical Pharmacology, Medical University of Vienna , Vienna, Austria
| | | | - Walter Jäger
- 4 Department of Clinical Pharmacy and Diagnostics, University of Vienna , Vienna, Austria
| | - Corinna Knopf
- 2 Center for Medical Physics and Biomedical Engineering, Medical University of Vienna , Vienna, Austria
- 3 Christian Doppler Laboratory for Ocular Effects of Thiomers , Vienna, Austria
| | - Markus Zeitlinger
- 1 Department of Clinical Pharmacology, Medical University of Vienna , Vienna, Austria
| | - Sybilla Richter-Müksch
- 5 Hietzing Hospital , Vienna, Austria
- 6 Karl Landsteiner Institute for Process Optimization and Quality Management in Cataract Surgery , Vienna, Austria
| | - Doreen Schmidl
- 1 Department of Clinical Pharmacology, Medical University of Vienna , Vienna, Austria
- 2 Center for Medical Physics and Biomedical Engineering, Medical University of Vienna , Vienna, Austria
- 3 Christian Doppler Laboratory for Ocular Effects of Thiomers , Vienna, Austria
| | - Leopold Schmetterer
- 1 Department of Clinical Pharmacology, Medical University of Vienna , Vienna, Austria
- 2 Center for Medical Physics and Biomedical Engineering, Medical University of Vienna , Vienna, Austria
- 3 Christian Doppler Laboratory for Ocular Effects of Thiomers , Vienna, Austria
| | - Gerhard Garhöfer
- 1 Department of Clinical Pharmacology, Medical University of Vienna , Vienna, Austria
- 3 Christian Doppler Laboratory for Ocular Effects of Thiomers , Vienna, Austria
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Stringham JD, Flynn HW, Schimel AM, Banta JT. Dropless Cataract Surgery: What Are the Potential Downsides? Am J Ophthalmol 2016; 164:viii-x. [PMID: 26895602 DOI: 10.1016/j.ajo.2016.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 01/23/2016] [Accepted: 02/01/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Jack D Stringham
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
| | | | - James T Banta
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
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Suzuki T, Yamamoto T, Ohashi Y. The antibacterial activity of levofloxacin eye drops against staphylococci using an in vitro pharmacokinetic model in the bulbar conjunctiva. J Infect Chemother 2016; 22:360-5. [PMID: 27036073 DOI: 10.1016/j.jiac.2016.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 01/07/2016] [Accepted: 01/19/2016] [Indexed: 11/18/2022]
Abstract
The incidence of fluoroquinolone-resistant staphylococcal isolates from the conjunctival sac is increasing. We compared pharmacological effects of levofloxacin (LVFX) against Staphylococcus epidermidis using an in vitro pharmacokinetic (PK) model simulating the concentration in the bulbar conjunctiva after applying eye drops of 0.5% and 1.5% LVFX. We used S. epidermidis conjunctival sac isolates [minimum inhibitory concentrations (MICs) of LVFX, 0.125 μg/mL]. LVFX-resistant strains were obtained from parental strains after culture with LVFX. The in vitro PK model simulated the concentration in the bulbar conjunctiva following three topical applications of 0.5% or 1.5% LVFX ophthalmic solution (0, 4, and 8 h) to rabbit eyes. Parental and LVFX-resistant strains were exposed to LVFX in the in vitro PK model, and changes in viable bacterial counts were evaluated for 12 h. The MICs of LVFX for the resistant isolates were 2-32 times higher than the parental strain, and those with MICs ≥2 ug/mL had mutations in the quinolone resistance-determining region. The PK model simulation predicts that 1.5% LVFX exerts bactericidal and bacteriostatic effects against strains with MICs of 0.125-2 and 4 μg/mL, respectively, whereas 0.5% LVFX would only be effective against strains with MICs of 0.125-1 μg/mL. The PK model predicts that the 1.5% LVFX ophthalmic solution exhibits a stronger bactericidal effect against resistant staphylococci in the bulbar conjunctiva than the 0.5% LVFX ophthalmic solution.
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Affiliation(s)
- Takashi Suzuki
- Department of Ophthalmology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan.
| | - Toshihiro Yamamoto
- Department of Ophthalmology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Yuichi Ohashi
- Department of Ophthalmology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
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Besifloxacin: Efficacy and Safety in Treatment and Prevention of Ocular Bacterial Infections. Ophthalmol Ther 2016; 5:1-20. [PMID: 27010720 PMCID: PMC4909673 DOI: 10.1007/s40123-016-0046-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Indexed: 02/07/2023] Open
Abstract
This comprehensive review summarizes the mechanism
of action, pharmacokinetics, efficacy, and safety of besifloxacin ophthalmic suspension, 0.6% and examines its role in the treatment of ocular surface bacterial infections. Besifloxacin possesses balanced activity against bacterial topoisomerase II (also called DNA gyrase) and topoisomerase IV. It has shown a low potential to select for bacterial resistance in vitro and demonstrated strong in vitro activity against many Gram-positive, Gram-negative, and anaerobic organisms, including methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis (MRSA and MRSE, respectively). Ocular pharmacokinetic studies have shown that besifloxacin achieves high, sustained concentrations in the tear fluid and conjunctiva following topical administration, with negligible systemic exposure. Large randomized, controlled clinical trials have established the efficacy and safety of besifloxacin administered three times daily for 5 days for treatment of acute bacterial conjunctivitis in both adults and children, with high rates of clinical resolution (up to more than 70% by day 5) and bacterial eradication (more than 90% by day 5), and a low incidence of adverse events. Additionally, besifloxacin applied twice daily for 3 days demonstrated greater efficacy than vehicle in treating bacterial conjunctivitis. Case reports, a large retrospective chart review, and animal studies have provided supporting evidence for the efficacy of besifloxacin in the management of acute bacterial keratitis. There is some evidence to suggest that besifloxacin may provide an advantage over other current-generation fluoroquinolones in antimicrobial prophylaxis for ocular surgery. Besifloxacin is an appropriate option for treatment of bacterial conjunctivitis, and its use in the treatment of bacterial keratitis and lid disorders, as well as for surgical prophylaxis, appears promising and warrants further evaluation.
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Sharma C, Biswas NR, Ojha S, Velpandian T. Comprehensive evaluation of formulation factors for ocular penetration of fluoroquinolones in rabbits using cassette dosing technique. Drug Des Devel Ther 2016; 10:811-23. [PMID: 26955263 PMCID: PMC4769009 DOI: 10.2147/dddt.s95870] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Corneal permeability of drugs is an important factor used to assess the efficacy of topical preparations. Transcorneal penetration of drugs from aqueous formulation is governed by various physiological, physiochemical, and formulation factors. In the present study, we investigated the effect of formulation factors like concentration, pH, and volume of instillation across the cornea using cassette dosing technique for ophthalmic fluoroquinolones (FQs). MATERIALS AND METHODS Sterile cocktail formulations were prepared using four congeneric ophthalmic FQs (ofloxacin, sparfloxacin, pefloxacin mesylate, and gatifloxacin) at concentrations of 0.025%, 0.5%, and 0.1%. Each formulation was adjusted to different pH ranges (4.5, 7.0, and 8.0) and assessed for transcorneal penetration in vivo in rabbit's cornea (n=4 eyes) at three different volumes (12.5, 25, and 50 μL). Aqueous humor was aspirated through paracentesis after applying local anesthesia at 0, 5, 15, 30, 60, 120, and 240 minutes postdosing. The biosamples collected from a total of 27 groups were analyzed using liquid chromatography-tandem mass spectroscopy to determine transcorneal permeability of all four FQs individually. RESULTS Increase in concentration showed an increase in penetration up to 0.05%; thereafter, the effect of concentration was found to be dependent on volume of instillation as we observed a decrease in transcorneal penetration. The highest transcorneal penetration of all FQs was observed at pH 7.0 at concentration 0.05% followed by 0.025% at pH 4.5. Lastly, increasing the volume of instillation from 12.5 to 50 μL showed a significant fall in transcorneal penetration. CONCLUSION The study concludes that formulation factors showed discernible effect on transcorneal permeation; therefore, due emphasis should be given on drug development and design of ophthalmic formulation.
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Affiliation(s)
- Charu Sharma
- Department of Ocular Pharmacology and Pharmacy, All India Institute of Medical Sciences, New Delhi, India
- Department of Internal Medicine, United Arab Emirates University, Al Ain, UAE
| | - Nihar R Biswas
- Department of Ocular Pharmacology and Pharmacy, All India Institute of Medical Sciences, New Delhi, India
| | - Shreesh Ojha
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Thirumurthy Velpandian
- Department of Ocular Pharmacology and Pharmacy, All India Institute of Medical Sciences, New Delhi, India
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Tajima K, Miyake T, Koike N, Hattori T, Kumakura S, Yamaguchi T, Matsumoto T, Fujita K, Kuroda M, Ito N, Goto H. In vivo challenging of polymyxins and levofloxacin eye drop against multidrug-resistant Pseudomonas aeruginosa keratitis. J Infect Chemother 2014; 20:343-9. [DOI: 10.1016/j.jiac.2013.10.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 10/28/2013] [Accepted: 10/29/2013] [Indexed: 11/25/2022]
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Suzuki T, Tanaka H, Toriyama K, Okamoto S, Urabe K, Hashida M, Shinkai Y, Ohashi Y. Prospective clinical evaluation of 1.5% levofloxacin ophthalmic solution in ophthalmic perioperative disinfection. J Ocul Pharmacol Ther 2013; 29:887-92. [PMID: 24180629 DOI: 10.1089/jop.2013.0146] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Gram-positive cocci and Propionibacterium acnes are widely reported agents of infectious postoperative endophthalmitis. This multicenter study was conducted to evaluate the eradication effectiveness and safety profile of levofloxacin 1.5% ophthalmic solution (LVFX 1.5%) for use in perioperative disinfection. METHODS Patients who were scheduled for cataract surgery were enrolled. The perioperative regimen of LVFX 1.5% was administered 3 times daily as follows: preoperative 3 days; the day of surgery (in the morning, 1 h before surgery, and immediately after surgery); and postoperative 2 weeks. Conjunctival sac scrapings were collected 3 times in the observation period; before preoperative administration, before iodine eyewash on the day of surgery, and after completion of postoperative administration. Isolated and identified microbial strains were assessed for antibacterial susceptibility. RESULTS One hundred patients were enrolled and data obtained from 96 patients (mean age, 72.7 ± 8.9 years). The preoperative eradication rate was 86.7% in total microbes. In the case of gram-positive cocci, the preoperative eradication rate was 100%, even though there were LVFX-registrant methicillin-resistant Staphylococcus aureus and methicillin-resistant coagulase-negative Staphylococcus, which had a high minimum inhibitory concentration against LVFX, such as 32 μg/mL. On the other hand, that of P. acnes was 78.3%. No acquired drug resistance was suspected in all strains. Adverse drug reactions occurred in 4.2% patients, and all were slight. CONCLUSIONS For ophthalmic perioperative disinfection, the LVFX 1.5% ophthalmic solution showed a good safety profile, and critical eradication of gram-positive cocci, including the fluoroquinolone-resistant strains.
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Affiliation(s)
- Takashi Suzuki
- 1 Department of Ophthalmology, Ehime University Graduate School of Medicine , Ehime, Japan
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