Review of the 1993 Veterinary Drug Bioequivalence Workshop

Is the standard dose of amoxicillin-clavulanic acid sufficient?

Background

The pharmacodynamic (PD) efficacy target of amoxicillin is 40% time above the minimal inhibition concentration (40%T > MIC). Recent studies of other antibiotics have shown that PD-efficacy targets are not always reached. The aim of this study was to evaluate the percentage of hospitalised patients, using amoxicillin/clavulanic acid intravenously (iv), that reach the pharmacodynamic efficacy target 40%T > MIC. Additionally, the association of demographic anthropomorphic and clinical parameters with the pharmacokinetics and pharmacodynamics of amoxicillin were determined.

Methods

In serum of 57 hospitalised patients amoxicillin concentrations were measured using high performance liquid chromatography. Patients were older than 18 years and most patients had an abdominal infection. The standard amoxicillin/clavulanic acid dose was 4 times a day 1000/200 mg iv. Pharmacokinetic parameters were calculated with maximum a posteriori Bayesian estimation (MW\Pharm 3.60). A one-compartment open model was used. Individual dosing simulations were performed with MW\Pharm.

Results

In our study population, the mean (±SD) age was 67 (±16) years and the mean clearance corrected for bodyweight was 0.17 (±0.07) L/h/kg. Only, 65% of the patients reached the proposed amoxicillin 40%T > MIC with amoxicillin/clavulanic acid for bacterial MICs of 8 mg/L. A computer simulated increase of the standard dose to 6 times daily, increased this percentage to 95%. In this small study group 40%T > MIC was not associated with clinical or microbiological cure.

Conclusion

A substantial proportion of the hospitalised patients did not reach the 40%T > MIC with the standard dose amoxicillin/clavulanic acid for a bacterial MIC of 8 mg/L. Therefore, we suggest increasing the standard dose of amoxicillin/clavulanic acid to 6 times a day in patients with severe Enterobacteriaceae infections.

Trial registration

Trial registration number: NTR1725 16^th march 2009.

Microanalysis of amoxicillin, flucloxacillin, and rifampicin in neonatal plasma

Simple and rapid reversed-phase high-performance liquid chromatographic assays with ultraviolet detection have been developed and validated for the determination of amoxicillin, flucloxacillin and rifampicin in neonatal plasma. Plasma samples were either precipitated with perchloric acid (amoxicillin) or methanol (rifampicin) or extracted with methylene chloride (flucloxacillin). Precision coefficients of variation and inaccuracy were less than 15% for all three assays. Only small sample volumes (20-40 microL) were required, making the assays suitable for therapeutic drug monitoring and pharmacokinetic studies in preterm and term neonates. The assays have successfully been applied to analysis of amoxicillin, flucloxacillin and rifampicin in previously published pharmacokinetic studies in neonates.

Challenges associated with the evaluation of veterinary product bioequivalence: an AAVPT perspective

The Generic Animal Drug Patent Term Restoration Act (GADPTRA) enacted in 1988 provided the same benefits to animal drug products that were granted to human generic products. It has been over 13 years since the GADPTRA was enacted, and veterinary drug sponsors and regulators have gained enormous insight and experience into some of the unique challenges associated with the determination of product bioequivalence for veterinary dosage forms. Moreover, advances in information and technology have opened both new issues that must be addressed and new mechanisms for demonstrating product bioequivalence. While many aspects of the existing Center for Veterinary Medicine Bioequivalence Guidance continue to provide invaluable guidance to the animal drug industry, there are also aspects of this guidance that are being called into question. Therefore, during the 2001 annual meeting of the American Academy of Veterinary Pharmacology and Therapeutics, participants were asked to address issues and concerns associated with the evaluation of veterinary product bioequivalence. This manuscript provides a summary of the concerns and discussions that transpired.

Potential and problems of developing transdermal patches for veterinary applications

A new frontier in the administration of therapeutic drugs to veterinary species is transdermal drug delivery. The primary challenge in developing these systems is rooted in the wide differences in skin structure and function seen in species ranging from cats to cows. The efficacy of a transdermal system is primarily dependent upon the barrier properties of the targeted species skin, as well as the ratio of the area of the transdermal patch to the species total body mass needed to achieve effective systemic drug concentrations. A drug must have sufficient lipid solubility to traverse the epidermal barrier to be considered for delivery for this route. A number of insecticides have been developed in liquid "pour-on" formulations that illustrate the efficacy of this route of administration for veterinary species. The human transdermal fentanyl patch has been successfully used in cats and dogs for post-operative analgesia. The future development of transdermal drug delivery systems for veterinary species will be drug and species specific. With efficient experimental designs and available transdermal patch technology, there are no obvious hurdles to the development of effective systems in many veterinary species.

Pharmacokinetics and bioequivalence of parenterally administered doramectin in cattle

Plasma concentrations of doramectin in 40 cattle dosed by subcutaneous (sc) or intramuscular (i.m.) injection (200 micrograms/kg) were compared to assess the bioequivalence of the two routes of administration. Peak concentration (Cmax), and areas under the concentration curve (AUC0-infinity) were determined from plasma concentrations. Animals treated by the sc route showed a mean AUC0-infinity of 457 +/- 66 ng.day/mL (+/- SD) and a mean Cmax of 27.8 +/- 7.9 ng/mL. Results from the i.m. treatment group showed a mean AUC0-infinity of 475 +/- 82 ng.day/mL and a mean Cmax of 33.1 +/- 9.0 ng/mL. Absorption constants (ka) determined by modelling were 0.542 +/- 0.336 day-1 after sc administration and 0.710 +/- 0.357 day-1 after i.m. administration. The 90% confidence limits on the difference between mean AUC0-infinity values for the sc and i.m. groups fell within 20% of the mean value for the subcutaneous group. Cmax was somewhat greater for the i.m. route. The 90% confidence limits on the difference in mean In(Tmax +1) also fell within 20% of the mean sc value. Based on this analysis, bioequivalence of the sc and i.m. formulation has been established.

Pharmacokinetics, intramuscular bio-availability, and bioequivalence of amoxycillin in donkeys

The disposition kinetics of intravenously (i.v.) administered amoxycillin sodium (10 mg/kg) was determined in four adult donkeys. The elimination half-life (t1/2 beta) of 47.3 +/- 5.1 min, the apparent volume of distribution (Varea) of 0.325 +/- 0.093 l/kg and the total body clearance (ClB) of 4.76 +/- 1.33 ml/min.kg were very close to the corresponding values reported for the horse injected i.v. with amoxycillin sodium. It was evident that because of the rapid rate of drug elimination, limited distribution volume, and high clearance values, the i.v. injected amoxycillin sodium (10-20 mg/kg) was likely to result in potentially therapeutic tissue concentrations for a short time (2-3 h) only. Three formulations of 15% amoxycillin trihydrate suspension in oil were injected intramuscularly (i.m.) to each donkey at 10 mg/kg. Drug absorption was rapid and the elimination half-life (t1/2el) ranged between 6 and 10 h. Mean peak serum amoxycillin concentrations (Cmax) were, however, rather low (0.81-1.68 micrograms/ml) and the i.m. bioavailability was 25.8-45.1% for the different formulations. Although the three formulations were considered to be intramuscularly bio-equivalent and appeared to be well tolerated, it was estimated that multiple SID (once daily) treatments at 10-20 mg/kg could result in tissue concentrations of potential therapeutic value for the treatment of infections caused by very susceptible pathogens only.