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Vossen MG, Pferschy S, Milacek C, Haidinger M, Karolyi M, Vass Z, Burgmann H, Maier-Salamon A, Wicha SG, Jäger W, Zeitlinger M, Stimpfl T, Wittek T, Thalhammer F. In vivo / in vitro Correlation of Pharmacokinetics of Gentamicin, Vancomycin, Teicoplanin and Doripenem in a Bovine Blood Hemodialysis Model. Front Pharmacol 2021; 12:702455. [PMID: 34248646 PMCID: PMC8264131 DOI: 10.3389/fphar.2021.702455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Elimination of a drug during renal replacement therapy is not only dependent on flow rates, molecular size and protein binding, but is often influenced by difficult to predict drug membrane interactions. In vitro models allow for extensive profiling of drug clearance using a wide array of hemofilters and flow rates. We present a bovine blood based in vitro pharmacokinetic model for intermittent renal replacement therapy. Methods: Four different drugs were analyzed: gentamicin, doripenem, vancomicin and teicoplanin. The investigated drug was added to a bovine blood reservoir connected to a hemodialysis circuit. In total seven hemofilter models were analyzed using commonly employed flow rates. Pre-filter, post-filter and dialysate samples were drawn, plasmaseparated and analyzed using turbidimetric assays or HPLC. Protein binding of doripenem and vancomycin was measured in bovine plasma and compared to previously published values for human plasma. Results: Clearance values were heavily impacted by choice of membrane material and surface as well as by dialysis parameters such as blood flow rate. Gentamicin clearance ranged from a minimum of 90.12 ml/min in a Baxter CAHP-170 diacetate hemofilter up to a maximum of 187.90 ml/min in a Fresenius medical company Fx80 polysulfone model (blood flow rate 400 ml/min, dialysate flow rate 800 ml/min). Clearance of Gentamicin vs Vancomicin over the F80s hemofilter model using the same flow rates was 137.62 mL vs 103.25 ml/min. Doripenem clearance with the Fx80 was 141.25 ml/min. Conclusion: Clearance values corresponded very well to previously published data from clinical pharmacokinetic trials. In conjunction with in silico pharmacometric models. This model will allow precise dosing recommendations without the need of large scale clinical trials.
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Affiliation(s)
- M G Vossen
- Clinical Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - S Pferschy
- Clinical Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - C Milacek
- Clinical Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - M Haidinger
- Department of Internal and Emergency Medicine, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Mario Karolyi
- Department for Infectious Diseases, Sozialmedizinisches Zentrum Sued Kaiser-Franz-Josef-Spital, Wien, Austria
| | - Zoltan Vass
- Clinical Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Heinz Burgmann
- Clinical Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Alexandra Maier-Salamon
- Department of Pharmaceutical Chemistry, Division of Clinical Pharmacy and Diagnostics, University of Vienna, Vienna, Austria
| | - S G Wicha
- Department of Clinical Pharmacy, Institute of Pharmacy, University of Hamburg, Hamburg, Germany
| | - W Jäger
- Department of Pharmaceutical Chemistry, Division of Clinical Pharmacy and Diagnostics, University of Vienna, Vienna, Austria
| | - M Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - T Stimpfl
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - T Wittek
- University Clinic for Ruminants, University of Veterinary Medicine Vienna, Vienna, Austria
| | - F Thalhammer
- Clinical Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
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De Schuyter K, Colin PJ, Vanommeslaeghe F, Delanghe S, De Cock P, Veys N, De Paepe P, Van Biesen W, Eloot S. Optimizing Amoxicillin/Clavulanic Acid Dosing Regimens in Patients on Maintenance High-Flux Hemodialysis. Am J Kidney Dis 2021; 78:153-156. [PMID: 33460691 DOI: 10.1053/j.ajkd.2020.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/28/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Kelly De Schuyter
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium.
| | - Pieter J Colin
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Sigurd Delanghe
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Pieter De Cock
- Department of Pharmacy, Ghent University Hospital, Ghent, Belgium; Heymans Institute of Pharmacology, Ghent University Hospital, Ghent, Belgium
| | - Nic Veys
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Peter De Paepe
- Heymans Institute of Pharmacology, Ghent University Hospital, Ghent, Belgium
| | - Wim Van Biesen
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Sunny Eloot
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
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3
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Hui K, Patel K, Kong DC, Kirkpatrick CM. Impact of high-flux haemodialysis on the probability of target attainment for oral amoxicillin/clavulanic acid combination therapy. Int J Antimicrob Agents 2017; 50:110-113. [DOI: 10.1016/j.ijantimicag.2017.02.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 02/16/2017] [Accepted: 02/22/2017] [Indexed: 10/19/2022]
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Abstract
Hemodialysis is a life-sustaining chronic therapy for individuals with end stage renal disease (ESRD). It is also frequently used for days to weeks for patients with acute renal failure who are awaiting the recovery of their kidneys from the acute toxic or traumatic event. Both populations of patients often require complex pharmacotherapeutic regimens, and it is not uncommon for them to be receiving 10 or more concomitant medications. Optimization of care for these patients is dependent on the selection of the most appropriate drug as well as dosage regimen design, which accounts for the influence of hemodialysis therapy on drug disposition. During the last 10 to 15 years there have been several significant changes in the prescribed dose of dialysis and the composition and size of dialyzers available for use. Furthermore, reuse of dialyzers, which was rare in the early 1980s, is now common; it is employed with over 70% of patients with ESRD. The new synthetic dialyzers, which are now used for over 60% of ESRD patients in the United States, are uniformly associated with dramatic improvements in drug removal; dialysis clearance increases of 3 to 10 fold were common for the few drugs evaluated. The influence of these changes in hemodialysis therapy on drug disposition are discussed in a quantitative fashion, and a conceptual framework for drug therapy regimen decision making is presented. For the majority of the drugs reviewed, however, there were no data in the literature regarding dialyzability with currently available dialyzers. The generation of dialyzability data for old and new pharmacotherapeutic agents with state of the art dialysis procedures is clearly needed.
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Affiliation(s)
- Gary R. Matzke
- Department of Pharmacy and Therapeutics, School of Pharmacy, Division of Renal-Electrolyte Medicine at the School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania,
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Bruyère F, Dihn A, Sotto A. Intérêt de l’association amoxicilline–acide clavulanique en urologie : mise au point. Prog Urol 2016; 26:437-41. [DOI: 10.1016/j.purol.2016.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 05/19/2016] [Indexed: 11/15/2022]
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6
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Ball P, Geddes A, Rolinson G. Amoxycillin clavulanate: an assessment after 15 years of clinical application. J Chemother 1997; 9:167-98. [PMID: 9210001 DOI: 10.1179/joc.1997.9.3.167] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- P Ball
- University of St. Andrews, Fife, UK
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7
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Gladziwa U, Koltz U. Pharmacokinetic optimisation of the treatment of peptic ulcer in patients with renal failure. Clin Pharmacokinet 1994; 27:393-408. [PMID: 7851056 DOI: 10.2165/00003088-199427050-00006] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The pathogenesis of peptic ulceration is not yet clear. It could be due to an imbalance between acid secretion and mucosal defensive and/or protective mechanisms, but the association between Helicobacter pylori and peptic ulceration has questioned this hypothesis. Therefore, drugs inhibiting acid secretion and/or eradicating H. pylori are of major interest. Peptic ulcer disease is often associated with renal failure. For the selection of the proper dosage of these agents their pharmacokinetic properties and alterations in pharmacokinetics in various disease states, including renal failure, should be known. As histamine H2-receptor antagonists and pirenzepine are mainly eliminated by the renal route their elimination is dependent on creatinine clearance. Consequently, their elimination will be impaired in patients with renal insufficiency, which makes dosage reduction mandatory in these patients. No dosage supplementation is necessary after any type of dialysis because the drugs are removed in insignificant amounts by the various blood purification procedures. Misoprostol and proton pump inhibitors, such as omeprazole, lansoprazole and pantoprazole, are primarily eliminated by nonrenal routes. Therefore no dosage adjustments are necessary in patients with renal insufficiency. Bismuth salts, sucralfate and antacids should be avoided in patients with renal failure because of the accumulation of their cations and the associated risk of toxic reactions. For most agents more long term experience from comparative and double-blinded studies is needed to define better their clinical efficacy and tolerability in patients with renal failure.
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Affiliation(s)
- U Gladziwa
- Department of Internal Medicine II, Technical University, Aachen, Germany
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St Peter WL, Redic-Kill KA, Halstenson CE. Clinical pharmacokinetics of antibiotics in patients with impaired renal function. Clin Pharmacokinet 1992; 22:169-210. [PMID: 1559311 DOI: 10.2165/00003088-199222030-00002] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Many antibiotics are eliminated renally and dosage adjustments are commonly made in patients with renal insufficiency. This is a critical review of antibiotic pharmacokinetics in patients with various degrees of renal function. Detailed information regarding pharmacokinetic alterations with specific antibiotics or antibiotic classes has been compiled and tabulated. From pharmacokinetic evidence, recommendations for dosage adjustments of antibiotics are supplied. The criteria used for assigning rating levels to specific pharmacokinetic articles as well as the grading system for dosage adjustments are outlined. In addition, a basic review of pharmacokinetic alterations in renal failure and factors affecting the removal of drugs by haemodialysis is included.
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Affiliation(s)
- W L St Peter
- Drug Evaluation Unit, Hennepin County Medical Center, Minneapolis, Minnesota
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9
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Fillastre JP, Singlas E. Pharmacokinetics of newer drugs in patients with renal impairment (Part I). Clin Pharmacokinet 1991; 20:293-310. [PMID: 2036748 DOI: 10.2165/00003088-199120040-00004] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Many drugs are eliminated via the renal route and the usual dose must be modified in patients with severe renal impairment. This review is an attempt to supply physicians with the more recent data on pharmacokinetic studies of new drugs administered in uraemic patients. The review is in 2 parts: the first indicates the results of studies on the pharmacokinetics of antibiotic agents, antifungal, antiviral and antiulcer drugs, and nonsteroidal anti-inflammatory drugs. Special mention is made of epoetin (recombinant human erythropoietin). It was not possible to give all the information collected from the recent literature: since mild renal failure has little effect on the fate of a drug, pharmacokinetic data obtained in patients with a creatinine clearance (CLCR) of more than 50 ml/min has been omitted. Both the text and tables give recommendations for treating patients with moderate renal insufficiency (CLCR of about 50 ml/min), more severe renal impairment (CLCR between 10 and 50 ml/min) and end-stage renal failure with a very low creatinine clearance (below 10 ml/min). It was not possible to give uniform recommendations (i.e. reducing the dose while maintaining the same interval, or giving the same dose and prolonging the interval). This article follows the recommendations of the authors, which may vary for drugs in similar classes.
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Affiliation(s)
- J P Fillastre
- Department of Nephrology, School of Medicine, Rouen, France
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Todd PA, Benfield P. Amoxicillin/clavulanic acid. An update of its antibacterial activity, pharmacokinetic properties and therapeutic use. Drugs 1990; 39:264-307. [PMID: 2184003 DOI: 10.2165/00003495-199039020-00008] [Citation(s) in RCA: 119] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Clavulanic acid enhances the antibacterial spectrum of amoxicillin by rendering most beta-lactamase-producing isolates susceptible to the drug. In clinical trials amoxicillin/clavulanic acid is clinically and bacteriologically superior to amoxicillin alone and at least as effective as numerous other comparative agents, such as orally administered cephalosporins, cotrimoxazole, doxycycline and bacampicillin, in the treatment of adults and children with the most common forms of infection encountered in general practice, i.e. urinary tract infections, upper and lower respiratory tract infections, otorhinolaryngological infections, and skin and soft tissue infections. It may also provide effective treatment for uncomplicated gonorrhoea, chancroid and gynaecological infections as well as acting as a prophylactic agent against surgical infection. Thus, in general practice environments where beta-lactamase production has restricted the effectiveness of amoxicillin, the combination of clavulanic acid with amoxicillin has clearly extended the usefulness of a tried and proven first-line antibacterial agent.
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Affiliation(s)
- P A Todd
- ADIS Drug Information Services, Auckland, New Zealand
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