1
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Vogelaar T, Szostak SM, Lund R. Coacervation in Slow Motion: Kinetics of Complex Micelle Formation Induced by the Hydrolysis of an Antibiotic Prodrug. Mol Pharm 2024; 21:4157-4168. [PMID: 39011839 PMCID: PMC11304390 DOI: 10.1021/acs.molpharmaceut.4c00579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 07/04/2024] [Accepted: 07/05/2024] [Indexed: 07/17/2024]
Abstract
Colistin methanesulfonate (CMS) is the less-toxic prodrug of highly nephrotoxic colistin. To develop and understand highly necessary new antibiotic formulations, the hydrolysis of CMS to colistin must be better understood. Herein, with the addition of poly(ethylene oxide)-b-poly(methacrylic acid) (PEO-b-PMAA) to CMS, we show that we can follow the hydrolysis kinetics, employing small-angle X-ray scattering (SAXS) through complex coacervation. During this hydrolysis, hydroxy methanesulfonate (HMS) groups from CMS are cleaved, while the newly formed cationic amino groups complex with the anionic charge from the PMAA block. As the hydrolysis of HMS groups is slow, we can follow the complex coacervation process by the gradual formation of complex micelles containing activated antibiotics. Combining mass spectrometry (MS) with SAXS, we quantify the hydrolysis as a function of pH. Upon modeling the kinetic pathways, we found that complexation only happens after complete hydrolysis into colistin and that the process is accelerated under acidic conditions. At pH = 5.0, effective charge switching was identified as the slowest step in the CMS conversion, constituting the rate-limiting step in colistin formation.
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Affiliation(s)
- Thomas
D. Vogelaar
- Department
of Chemistry, University of Oslo, P.O. Box 1033 Blindern, Oslo NO-0315, Norway
| | - Szymon M. Szostak
- Department
of Chemistry, University of Oslo, P.O. Box 1033 Blindern, Oslo NO-0315, Norway
| | - Reidar Lund
- Department
of Chemistry, University of Oslo, P.O. Box 1033 Blindern, Oslo NO-0315, Norway
- Hylleraas
Centre for Quantum Molecular Sciences, University
of Oslo, Oslo NO-0315, Norway
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2
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Kaya TB, Sürmeli Onay Ö, Aydemir Ö, Tekin AN. Ten-year Single Center Experience With Colistin Therapy in NICU. Pediatr Infect Dis J 2024; 43:165-169. [PMID: 37820257 DOI: 10.1097/inf.0000000000004130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
BACKGROUND Colistin, a cationic polypeptide antibiotic of the polymyxin class has come back into use due to its potent antimicrobial activity against multidrug-resistant Gram-negative bacteria and the lack of new antibiotics. The purpose of this study was to assess the critically ill infants treated with colistin in our neonatal intensive care unit and to identify predisposing factors for the emergence of acute kidney injury (AKI) following colistin treatment. METHODS This was a retrospective case-control study that included infants with proven or suspected nosocomial infections in the neonatal intensive care unit of a University Hospital between January 2012 and March 2022. Over the same time period, the clinical and laboratory characteristics and outcomes of patients who received antibiotic combination with colistin were compared to patients who received antibiotic combination without colistin. RESULTS A total of 77 patients were in the colistin group (ColG) and 77 patients were in the control group. The demographic and clinical characteristics of the study groups were similar. In the ColG compared to the control group, hyponatremia, hypokalemia, hypophosphatemia, hypomagnesia and AKI were all more prevalent ( P < 0.05). The most important finding in our study was the higher incidence of AKI and mortality in ColG, as well as the increasing nephrotoxic effect of other medications when used in conjunction with colistin. CONCLUSION During colistin therapy, newborn infants must be closely monitored for AKI. Clinicians should be aware of an increased incidence of hyponatremia, hypokalemia, hypophosphatemia, hypomagnesia, AKI and its consequences in infants given colistin. As awareness increases, harmful effects will decrease.
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Affiliation(s)
- Tuğba Barsan Kaya
- From the Department of Neonatology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
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3
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Karpuz M, Temel A, Ozgenc E, Tekintas Y, Erel-Akbaba G, Senyigit Z, Atlihan-Gundogdu E. 99mTc-Labeled, Colistin Encapsulated, Theranostic Liposomes for Pseudomonas aeruginosa Infection. AAPS PharmSciTech 2023; 24:77. [PMID: 36899198 DOI: 10.1208/s12249-023-02533-8] [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: 10/20/2022] [Accepted: 02/12/2023] [Indexed: 03/12/2023] Open
Abstract
Infectious diseases are still the major issue not only due to antibiotic resistance but also causing deaths if not diagnosed at early-stages. Different approaches including nanosized drug delivery systems and theranostics are researched to overcome antibiotic resistance, decrease the side effects of antibiotics, improve the treatment response, and early diagnose. Therefore, in the present study, nanosized, radiolabeled with 99mTc, colistin encapsulated, neutral and cationic liposome formulations were prepared as the theranostic agent for Pseudomonas aeruginosa infections. Liposomes exhibited appropriate physicochemical properties thanks to their nano-particle size (between 173 and 217 nm), neutral zeta potential value (about - 6.5 and 2.8 mV), as well as encapsulation efficiency of about 75%. All liposome formulations were radiolabeled with over 90% efficiency, and the concentration of stannous chloride was found as 1 mg.mL-1 to obtain maximum radiolabeling efficiency. In alamar blue analysis, neutral liposome formulations were found more biocompatible compared with the cationic formulations. Neutral colistin encapsulated liposomes were found to be more effective against P. aeruginosa strain according to their time-dependent antibacterial effect, in addition to their highest bacterial binding capacity. As conclusion, theranostic, nanosized, colistin encapsulated, neutral liposome formulations were found as promising agents for the imaging and treating of P. aeruginosa infections.
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Affiliation(s)
- Merve Karpuz
- Department of Radiopharmacy, Faculty of Pharmacy, Izmir Katip Celebi University, Izmir, Turkey.
| | - Aybala Temel
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Izmir Katip Celebi University, Izmir, Turkey
| | - Emre Ozgenc
- Department of Radiopharmacy, Faculty of Pharmacy, Ege University, Izmir, Turkey
| | - Yamac Tekintas
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Izmir Katip Celebi University, Izmir, Turkey
| | - Gulsah Erel-Akbaba
- Department of Pharmaceutical Biotechnology, Faculty of Pharmacy, Izmir Katip Celebi University, Izmir, Turkey
| | - Zeynep Senyigit
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Izmir Katip Celebi University, Izmir, Turkey
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4
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Krishnakumar RT, Asok A, Mohamed ZU, Padma UD, Sathyapalan DT, Moni M, Balachandran S, Kumar AV, Nair R, Sudhindran S, Singh SK. Colistin (Polymyxin E) Use in Abdominal Solid Organ. J Pharm Pract 2022:8971900221074967. [PMID: 35201947 DOI: 10.1177/08971900221074967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Amrita Asok
- Department of Pharmacy Practice, Amrita School of Pharmacy, Cochin, India
| | - Zubair U Mohamed
- Department of Anaesthesia and Critical Care, 29286Amrita Institute of Medical Sciences, Cochin, India
| | - Uma D Padma
- Department of Pharmacology, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, Cochin, India
| | - Dipu T Sathyapalan
- Division of Infectious Diseases, Department of General Medicine, 29286Amrita Institute of Medical Sciences, Cochin, India
| | - Merlin Moni
- Division of Infectious Diseases, Department of General Medicine, 29286Amrita Institute of Medical Sciences, Cochin, India
| | - Sabarish Balachandran
- Department of Emergency Medicine and Critical Care, 29286Amrita Institute of Medical Sciences, Cochin, India
| | - Anil V Kumar
- Department of Microbiology, 29286Amrita Institute of Medical Sciences, Cochin, India
| | - Rajesh Nair
- Department of Nephrology, 29286Amrita Institute of Medical Sciences, Cochin, India
| | - Surendran Sudhindran
- Department of Gastro-intestinal Surgery and Transplantation, 29286Amrita Institute of Medical Sciences, Cochin, India
| | - Sanjeev K Singh
- Medical Superintendent, 29286Amrita Institute of Medical Sciences, Cochin, India
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5
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Population Pharmacokinetics of Colistin Methanesulfonate Sodium and Colistin in Critically Ill Patients: A Systematic Review. Pharmaceuticals (Basel) 2021; 14:ph14090903. [PMID: 34577603 PMCID: PMC8472798 DOI: 10.3390/ph14090903] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/01/2021] [Accepted: 09/01/2021] [Indexed: 02/06/2023] Open
Abstract
Understanding the pharmacokinetics parameter of colistin methanesulfonate sodium (CMS) and colistin is needed to optimize the dosage regimen in critically ill patients. However, there is a scarcity of pharmacokinetics parameters in this population. This review provides a comprehensive understanding of CMS and colistin pharmacokinetics parameters in this population. The relevant studies published in English that reported on the pharmacokinetics of CMS and colistin from 2000 until 2020 were systematically searched using the PubMed and Scopus electronic databases. Reference lists of articles were reviewed to identify additional studies. A total of 252 citation titles were identified, of which 101 potentially relevant abstracts were screened, and 25 full-text articles were selected for detailed analysis. Of those, 15 studies were included for the review. This review has demonstrated vast inter-study discrepancies in colistin plasma concentration and the pharmacokinetics parameter estimates. The discrepancies might be due to complex pathophysiological changes in the population studied, differences in CMS brand used, methodology, and study protocol. Application of loading dose of CMS and an additional dose of CMS after dialysis session was recommended by some studies. In view of inter-patient and intra-patient variability in colistin plasma concentration and pharmacokinetics parameters, personalized colistin dosing for this population is recommended.
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6
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Feng JY, Lee YT, Pan SW, Yang KY, Chen YM, Yen DHT, Li SY, Wang FD. Comparison of colistin-induced nephrotoxicity between two different formulations of colistin in critically ill patients: a retrospective cohort study. Antimicrob Resist Infect Control 2021; 10:111. [PMID: 34330333 PMCID: PMC8323087 DOI: 10.1186/s13756-021-00977-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/08/2021] [Indexed: 12/22/2022] Open
Abstract
Background Colistin is widely used in the treatment of nosocomial infections caused by carbapenem-resistant gram-negative bacilli (CR-GNB). Colistin-induced nephrotoxicity is one of the major adverse reactions during colistin treatment. Comparisons of colistin-induced nephrotoxicity between different formulations of colistin are rarely reported. Methods In this retrospective cohort study, we enrolled intensive care unit–admitted patients if they had culture isolates of CR-GNB and underwent intravenous treatment with colistin. The occurrence of acute kidney injury (AKI) during intravenous treatment with colistin was recorded. The occurrence of colistin-induced nephrotoxicity was compared between two formulations of colistin, Locolin®, and Colimycin®. Treatment outcomes associated with the occurrence of colistin-induced nephrotoxicity were also investigated. Results Among 195 patients, 95 who were treated with Locolin® and 100 who were treated with Colimycin® were included for analysis. Patients treated with Locolin® had a higher rate of occurrence of stage 2 (46.3% vs. 32%, p = 0.040) and stage 3 (29.5% vs. 13%, p = 0.005) AKI than did those treated with Colimycin®. In multivariate analysis, the presence of septic shock (adjusted odds ratio [aOR] 2.17, 95% confidence interval [CI] 1.10–4.26) and inappropriate colistin dosage (aOR 2.52, 95% CI 1.00–6.33) were clinical factors associated with colistin-induced nephrotoxicity. Treatment with Colimycin® was an independent factor associated with a lower risk of colistin-induced nephrotoxicity (aOR 0.37, 95% CI 0.18–0.77). The mortality rate was comparable between patients with and without colistin-induced nephrotoxicity. Conclusions The risk of colistin-induced nephrotoxicity significantly varied in different formulations of colistin in critically ill patients. Colistin-induced nephrotoxicity was not associated with increased mortality rate. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-021-00977-w.
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Affiliation(s)
- Jia-Yih Feng
- Department of Chest Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei, Taiwan.,Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei, Taiwan
| | - Yi-Tzu Lee
- School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei, Taiwan.,Department of Emergency Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Taipei, Taiwan
| | - Sheng-Wei Pan
- Department of Chest Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei, Taiwan.,Institute of Public Health, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei, Taiwan
| | - Kuang-Yao Yang
- Department of Chest Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Taipei, Taiwan.,Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei, Taiwan
| | - Yuh-Min Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei, Taiwan
| | - David Hung-Tsang Yen
- Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei, Taiwan.,Department of Emergency Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Taipei, Taiwan
| | - Szu-Yuan Li
- School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei, Taiwan.,Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Taipei, Taiwan
| | - Fu-Der Wang
- School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei, Taiwan. .,Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Taipei, 11217, Taiwan.
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7
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Chiron E, Varache M, Stokniene J, Thomas DW, Ferguson EL. A physicochemical assessment of the thermal stability of dextrin-colistin conjugates. Sci Rep 2021; 11:10600. [PMID: 34011987 PMCID: PMC8134461 DOI: 10.1038/s41598-021-89946-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/04/2021] [Indexed: 11/25/2022] Open
Abstract
Attachment of polysaccharide carriers is increasingly being used to achieve precision delivery and improved effectiveness of protein and peptide drugs. Although it is clear that their clinical effectiveness relies on the purity and integrity of the conjugate in storage, as well as following administration, instability of polysaccharide-based conjugates can reduce the protective efficacy of the polymer, which may adversely affect the bioactive's potency. As a model, these studies used dextrin-colistin conjugates, with varying degrees of polymer modification (1, 2.5 and 7.5 mol% succinoylation) to assess the effect of storage temperature (- 20, 4, 21 and 37 °C) and duration (up to 12 months) on saccharide and colistin release and antimicrobial activity. Estimation of the proportion of saccharide release (by comparison of area under the curve from size exclusion chromatograms) was more pronounced at higher temperatures (up to 3 and 35% at - 20 °C and 37 °C, respectively after 12 months), however, repeated freeze-thaw did not produce any measurable release of saccharides, while addition of amylase (20, 100, 500 IU/L) caused rapid release of saccharides (> 70% total within 24 h). At all temperatures, conjugates containing the lowest degree of succinoylation released the highest proportion of free colistin, which increased with storage temperature, however no trend in saccharide release was observed. Despite the clear physical effects of prolonged storage, antimicrobial activity of all samples was only altered after storage at 37 °C for 12 months (> threefold decreased activity). These results demonstrate significant release of saccharides from dextrin-colistin conjugates during prolonged storage in buffered solution, especially at elevated temperature, which, in most cases, did not affect antimicrobial activity. These findings provide vital information about the structure-activity relationship of dextrin-colistin conjugates, prior to full-scale commercial development, which can subsequently be applied to other polysaccharide-protein and -peptide conjugates.
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Affiliation(s)
- Emilie Chiron
- Advanced Therapies Group, Oral and Biomedical Sciences, School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Heath Park, Cardiff, CF14 4XY, UK
| | - Mathieu Varache
- Advanced Therapies Group, Oral and Biomedical Sciences, School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Heath Park, Cardiff, CF14 4XY, UK
- CNRS, Ingénierie Des Matériaux Polymères, IMP UMR CNRS 5223, Université de Lyon, Université Claude Bernard Lyon 1, 15 bd A. Latarjet, 69622, Villeurbanne, France
| | - Joana Stokniene
- Advanced Therapies Group, Oral and Biomedical Sciences, School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Heath Park, Cardiff, CF14 4XY, UK
| | - David W Thomas
- Advanced Therapies Group, Oral and Biomedical Sciences, School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Heath Park, Cardiff, CF14 4XY, UK
| | - Elaine L Ferguson
- Advanced Therapies Group, Oral and Biomedical Sciences, School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Heath Park, Cardiff, CF14 4XY, UK.
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8
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Desgrouas M, Ehrmann S. Inhaled antibiotics during mechanical ventilation-why it will work. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:598. [PMID: 33987296 DOI: 10.21037/atm-20-3686] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Inhaled antibiotics are a common therapy among patients suffering recurrent or chronic pulmonary infections. Their use is less frequent in acutely ill patients despite a strong theoretical rationale and growing evidence of their efficiency, safety and beneficial effect on reducing bacterial resistance emergence. Clinical trials of inhaled antibiotics have shown contradictory results among mechanically ventilated patients. The optimal nebulization setup, not always implemented in all trials, the difficulty to identify the population most likely to benefit and the testing of various therapeutic strategies such as adjunctive versus alternative to systemic antibiotics may explain the disparity in trial results. The present review first presents the reasons why inhaled antibiotics have to be developed and the benefits to be expected of inhaled anti-infectious therapy among mechanically ventilated patients. A second part develops the constraints of aerosolized therapies that one has to be aware of and the simple actions required during nebulization to ensure optimal delivery to the distal lung parenchyma. Positive and negative studies concerning inhaled antibiotics are compared to understand the discrepancies of their findings and conclusions. The last part presents current developments and perspective which will likely turn it into a fully successful therapeutic modality, and makes the link between inhaled antibiotics and inhaled anti-infectious therapy.
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Affiliation(s)
- Maxime Desgrouas
- CHRU Tours, Médecine Intensive Réanimation, Tours, France.,CHR Orléans, Médecine Intensive Réanimation, Orléans, France.,INSERM, Centre d'étude des pathologies respiratoires, U1100, Université de Tours, Tours, France
| | - Stephan Ehrmann
- CHRU Tours, Médecine Intensive Réanimation, Tours, France.,INSERM, Centre d'étude des pathologies respiratoires, U1100, Université de Tours, Tours, France
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9
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Eronmosele JE, Olurishe TO, Olorukooba AB. Investigation of treatment-time differences in colistin-induced nephrotoxicity in Wistar rats. Chronobiol Int 2020; 38:224-233. [PMID: 33108904 DOI: 10.1080/07420528.2020.1838535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Colistin-induced nephrotoxicity (CIN) occurs in up to 60% of patients, and this has restricted its clinical use. In view of its efficacy amidst the rising challenge of infections caused by multidrug-resistant bacteria, current studies are focusing on ways to ameliorate colistin-induced nephrotoxicity. This study investigated treatment-time differences in colistin-induced nephrotoxicity in Wistar rats. A dose of 600,000 IU/Kg/day of colistimethate sodium (CMS) was administered to male Wistar rats to induce nephrotoxicity; the rats tolerated the higher dose for the treatment duration with higher mean values of serum creatinine, urea, and malondialdehyde compared to the group that received 450,000 IU/Kg/day CMS (p ≤ 0.05). Four groups (n = 8/group) of rats received intraperitoneal (i.p.) injections of 600,000 IU/Kg/day CMS each at four equally spaced circadian times (00:00, 06:00, 12:00, and 18:00 h) to determine the time of administration with least renal toxicity. Biomarkers of oxidative stress and renal toxicity were measured and kidney histology studied after the treatments. The results showed a 24-h pattern in nephrotoxicity from CIN, and that treatment during the activity time period (dark phase) caused lowest CIN. Histological findings supported this finding, with photomicrographs consistently showing more pronounced features of CIN in the groups treated during time frame that coincided with the rest phase in rats (12:00 and 18:00).
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Affiliation(s)
| | - T O Olurishe
- Department of Pharmacology and Toxicology, Ahmadu Bello University , Zaria, Nigeria
| | - A B Olorukooba
- Department of Pharmacology and Toxicology, Ahmadu Bello University , Zaria, Nigeria
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10
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Benítez-Cano A, de Antonio-Cuscó M, Luque S, Sorlí L, Carazo J, Ramos I, Bermejo S, Campillo N, Horcajada JP, Samsó E, Grau S. Systemic pharmacokinetics and safety of high doses of nebulized colistimethate sodium in critically ill patients with hospital-acquired and ventilator-associated pneumonia. J Antimicrob Chemother 2020; 74:3268-3273. [PMID: 31495877 DOI: 10.1093/jac/dkz356] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/16/2019] [Accepted: 07/16/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To assess the pharmacokinetics of formed colistin in plasma and the safety of two different high doses of colistimethate sodium administered via nebulization in critically ill surgical patients with hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP). PATIENTS AND METHODS Formed colistin plasma concentrations were measured in critically ill surgical patients with pneumonia treated with two different doses of nebulized colistimethate sodium (3 MIU/8 h versus 5 MIU/8 h). Adverse events possibly related to nebulized colistimethate sodium were recorded. RESULTS Twenty-seven patients (15 in the 3 MIU/8 h group and 12 in the 5 MIU/8 h group) were included. Colistin plasma concentrations were unquantifiable (<0.1 mg/L) in eight (53.3%) patients in the 3 MIU/8 h group and in seven patients (58.3%) in the 5 MIU/8 h group. Median (IQR) quantifiable colistin plasma concentrations before nebulization and at 1, 4 and 8 h were 0.17 (0.12-0.33), 0.20 (0.11-0.24), 0.17 (0.12-0.23) and 0.17 (0.11-0.32) mg/L, respectively, in the 3 MIU/8 h group and 0.20 (0.11-0.35), 0.24 (0.12-0.44), 0.24 (0.10-0.49) and 0.23 (0.11-0.44) mg/L, respectively, in the 5 MIU/8 h group, with no differences between the two groups at any time. Renal impairment during nebulized treatment was observed in three patients in each group, but was unlikely to be related to colistimethate sodium treatment. Nebulized colistimethate sodium therapy was well tolerated and no bronchospasms or neurotoxicity events were observed. CONCLUSIONS In this limited observational case series of critically ill patients with HAP or VAP treated with high doses of nebulized colistimethate sodium, systemic exposure was minimal and the treatment was well tolerated.
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Affiliation(s)
- Adela Benítez-Cano
- Department of Anaesthesiology and Surgical Intensive Care, Hospital del Mar, IMIM (Hospital del Mar Research Institute), Paseo Marítimo 25-29, Barcelona, Spain
| | - Marta de Antonio-Cuscó
- Department of Pharmacy, Hospital del Mar, IMIM (Hospital del Mar Research Institute), Paseo Marítimo 25-29, Barcelona, Spain
| | - Sonia Luque
- Department of Pharmacy, Hospital del Mar, IMIM (Hospital del Mar Research Institute), Universitat Autònoma de Barcelona, Paseo Marítimo 25-29, Barcelona, Spain
| | - Luisa Sorlí
- Department of Infectious Diseases, Hospital del Mar, IMIM (Hospital del Mar Research Institute), Universitat Autònoma de Barcelona, Paseo Marítimo 25-29, Barcelona, Spain
| | - Jesús Carazo
- Department of Anaesthesiology and Surgical Intensive Care, Hospital del Mar, IMIM (Hospital del Mar Research Institute), Paseo Marítimo 25-29, Barcelona, Spain
| | - Isabel Ramos
- Department of Anaesthesiology and Surgical Intensive Care, Hospital del Mar, IMIM (Hospital del Mar Research Institute), Paseo Marítimo 25-29, Barcelona, Spain
| | - Silvia Bermejo
- Department of Anaesthesiology and Surgical Intensive Care, Hospital del Mar, IMIM (Hospital del Mar Research Institute), Paseo Marítimo 25-29, Barcelona, Spain
| | - Nuria Campillo
- Department of Pharmacy, Hospital del Mar, IMIM (Hospital del Mar Research Institute), Paseo Marítimo 25-29, Barcelona, Spain
| | - Juan P Horcajada
- Department of Infectious Diseases, Hospital del Mar, IMIM (Hospital del Mar Research Institute), Universitat Autònoma de Barcelona, Paseo Marítimo 25-29, Barcelona, Spain
| | - Enric Samsó
- Department of Anaesthesiology and Surgical Intensive Care, Hospital del Mar, IMIM (Hospital del Mar Research Institute), Universitat Pompeu Fabra, Paseo Marítimo 25-29, Barcelona, Spain
| | - Santiago Grau
- Department of Pharmacy, Hospital del Mar, IMIM (Hospital del Mar Research Institute), Universitat Autònoma de Barcelona, Paseo Marítimo 25-29, Barcelona, Spain
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11
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McKinzie CJ, Chen L, Ehlert K, Grisso AG, Linafelter A, Lubsch L, O'Brien CE, Pan AC, Wright BA, Elson EC. Off-label use of intravenous antimicrobials for inhalation in patients with cystic fibrosis. Pediatr Pulmonol 2019; 54 Suppl 3:S27-S45. [PMID: 31715085 DOI: 10.1002/ppul.24511] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 08/19/2019] [Indexed: 11/12/2022]
Abstract
Management of infections in patients with cystic fibrosis (CF) presents challenges for healthcare providers, including the eradication of initial acquisition, treatment of acute exacerbations, and chronic infection with suppressive therapy. Inhaled antimicrobial therapy for infections in patients with CF has been used in these capacities, often in an effort to achieve optimal concentrations in sputum for antimicrobial efficacy while mitigating potential toxicities associated with systemic therapy. Unfortunately, there are few commercially available products formulated for inhalation, resulting in the off-label use of other formulations, such as intravenous products, administered via nebulization. This review aims to examine the evidence supporting the efficacy of these off-label formulations for management of acute and chronic infections associated with CF, as well as adverse effects associated with their use.
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Affiliation(s)
- Cameron J McKinzie
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, North Carolina
| | - Lori Chen
- Department of Pharmacy, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kim Ehlert
- Department of Pharmacy, Fairview Health Services, Minneapolis, Minnesota
| | - Alison G Grisso
- Department of Pharmacy, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Alaina Linafelter
- Department of Pharmacy, Children's Mercy Kansas City, Kansas City, Missouri
| | - Lisa Lubsch
- Department of Pharmacy, Practice, Southern Illinois University Edwardsville School of Pharmacy, Edwardsville, Missouri.,Department of Pharmacy, Cardinal Glennon Children's Hospital, St Louis, Missouri
| | - Catherine E O'Brien
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences College of Pharmacy, Little Rock, Arkansas
| | - Alice C Pan
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Brittany A Wright
- Department of Pharmaceutical Care, University of Iowa Health Care, Iowa City, Iowa
| | - E Claire Elson
- Department of Pharmacy, Children's Mercy Kansas City, Kansas City, Missouri
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12
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Bihan K, Zahr N, Becquemin MH, Lu X, Bertholon JF, Vezinet C, Arbelot C, Monsel A, Rouby JJ, Langeron O, Lu Q. Influence of diluent volume of colistimethate sodium on aerosol characteristics and pharmacokinetics in ventilator-associated pneumonia caused by MDR bacteria. J Antimicrob Chemother 2019; 73:1639-1646. [PMID: 29506194 DOI: 10.1093/jac/dky044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 01/23/2018] [Indexed: 11/12/2022] Open
Abstract
Objectives Nebulized colistimethate sodium (CMS) can be used to treat ventilator-associated pneumonia caused by MDR bacteria. The influence of the diluent volume of CMS on aerosol delivery has never been studied. The main objectives of the study were to compare aerosol particle characteristics and plasma and urine pharmacokinetics between two diluent volumes in patients treated with nebulized CMS. Methods A crossover study was conducted in eight patients receiving nebulized CMS every 8 h. After inclusion, nebulization started with 4 million international units (MIU) of CMS diluted either in 6 mL (experimental dilution) or in 12 mL (recommended dilution) of normal saline in a random order. For each diluent volume, CMS aerosol particle sizes were measured and plasma and urine samples were collected every 2 h. Nebulization time and stability of colistin in normal saline were assessed. Results The mass median aerodynamic diameters were 1.4 ± 0.2 versus 0.9 ± 0.2 μm (P < 0.001) for 6 and 12 mL diluent volumes, respectively. The plasma area under the concentration-time curve from 0 to 8 h (AUC0-8) of colistinA+B was 6.6 (4.3-17.0) versus 6.7 (3.6-14.0) μg·h/mL (P = 0.461) for each dilution. The total amount of colistin and CMS eliminated in the urine represented, respectively, 17% and 13% of the CMS initially placed in the nebulizer chamber for 6 and 12 mL diluent volumes (P = 0.4). Nebulization time was shorter [66 (58-75) versus 93 (69-136) min, P = 0.042] and colistin stability was better with the 6 mL diluent volume. Conclusions Nebulization with a higher concentration of CMS in saline (4 MIU in 6 mL) decreases nebulization time and improves colistin stability without changing plasma and urine pharmacokinetics or aerosol particle characteristics for lung deposition.
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Affiliation(s)
- Kevin Bihan
- Department of Pharmacology and CIC-1421, F-75013, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Noël Zahr
- Department of Pharmacology and CIC-1421, F-75013, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Marie-Hélène Becquemin
- Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Xiao Lu
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France.,Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Jean-François Bertholon
- Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Corinne Vezinet
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Charlotte Arbelot
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Antoine Monsel
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Jean-Jacques Rouby
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Olivier Langeron
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Qin Lu
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
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13
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Liu CY, Ko HK, Fink JB, Wan GH, Huang CC, Chen YC, Lin HL. Size Distribution of Colistin Delivery by Different Type Nebulizers and Concentrations During Mechanical Ventilation. Pharmaceutics 2019; 11:pharmaceutics11090459. [PMID: 31491870 PMCID: PMC6781281 DOI: 10.3390/pharmaceutics11090459] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 08/27/2019] [Accepted: 09/03/2019] [Indexed: 02/02/2023] Open
Abstract
Although aerosol delivery through mechanical ventilators has been used to administer various medications, little is known of administration with colistin. This in vitro evaluation aimed to evaluate size distribution of colistin delivery by different types of nebulizers and concentrations during mechanical ventilation. Colistin methanesulfonate (colistin) for injection was dissolved in 6 mL of distilled water to produce a low concentration (L; 156 mg) and a high concentration (H; 312 mg). A dose volume of 6 mL was placed in a vibrating mesh nebulizer (VMN) and a jet nebulizer (JN). The inhaled mass (mean ± SD) of the VMN-L (53.80 ± 14.79 mg) was greater than both the JN-L (19.82 ± 3.34 mg, P = 0.001) and JN-H (31.72 ± 4.48 mg, P = 0.017). The nebulization time of the VMN-L (42.35 ± 2.30 min) was two times longer than the JN-L (21.12 ± 0.8 min) or JN-H (21.65 ± 0.42 min; P < 0.001). The mass median aerodynamic distal to the endotracheal tube was within a similar range at 2.03 to 2.26 μm (P = 0.434), independent of neb or formulation concentration. In conclusion, the VMN-L yields greater inhaled mass than the JN with either concentration. Therefore, a standard nominal dose of colistin results in a higher delivered dose during mechanical ventilation with a VMN compared with a JN and may be considered the preferred device. If JN must be used, multiple doses of low concentration colistin may compensate for poor delivery performance.
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Affiliation(s)
- Ching-Yi Liu
- Department of Respiratory Therapy, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
- Division of Respiratory therapy, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
| | - Hsin-Kuo Ko
- Division of Respiratory therapy, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
- School of Medicine, National Yang-Ming University, Taipei 11217, Taiwan.
| | | | - Gwo-Hwa Wan
- Department of Respiratory Therapy, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
- Department of Respiratory Therapy, Chang Gung University of Science and Technology, Chiayi 61301, Taiwan.
- Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital-Linko, Taoyuan 33301, Taiwan.
| | - Chung-Chi Huang
- Department of Respiratory Therapy, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
- Division of Thoracic Medicine, Chang Gung Memorial Hospital-Linko, Taoyuan 33301, Taiwan.
| | - Yu-Chun Chen
- Division of Respiratory therapy, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
| | - Hui-Ling Lin
- Department of Respiratory Therapy, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
- Department of Respiratory Therapy, Chang Gung University of Science and Technology, Chiayi 61301, Taiwan.
- Department of Respiratory Therapy, Chiayi Chang Gung Memorial Hospital, Chiayi 61301, Taiwan.
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15
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Varache M, Powell LC, Aarstad OA, Williams TL, Wenzel MN, Thomas DW, Ferguson EL. Polymer Masked-Unmasked Protein Therapy: Identification of the Active Species after Amylase Activation of Dextrin-Colistin Conjugates. Mol Pharm 2019; 16:3199-3207. [PMID: 31125239 PMCID: PMC6779022 DOI: 10.1021/acs.molpharmaceut.9b00393] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
![]()
Polymer
masked–unmasked protein therapy (PUMPT) uses conjugation
of a biodegradable polymer, such as dextrin, hyaluronic acid, or poly(l-glutamic acid), to mask a protein or peptide’s activity;
subsequent locally triggered degradation of the polymer at the target
site regenerates bioactivity in a controllable fashion. Although the
concept of PUMPT is well established, the relationship between protein
unmasking and reinstatement of bioactivity is unclear. Here, we used
dextrin–colistin conjugates to study the relationship between
the molecular structure (degree of unmasking) and biological activity.
Size exclusion chromatography was employed to collect fractions of
differentially degraded conjugates and ultraperformance liquid chromatography–mass
spectrometry (UPLC–MS) employed to characterize the corresponding
structures. Antimicrobial activity was studied using a minimum inhibitory
concentration (MIC) assay and confocal laser scanning microscopy of
LIVE/DEAD-stained biofilms with COMSTAT analysis. In vitro toxicity
of the degraded conjugate was assessed using an 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl
tetrazolium bromide assay. UPLC–MS revealed that the fully
“unmasked” dextrin–colistin conjugate composed
of colistin bound to at least one linker, whereas larger species were
composed of colistin with varying lengths of glucose units attached.
Increasing the degree of dextrin modification by succinoylation typically
led to a greater number of linkers bound to colistin. Greater antimicrobial
and antibiofilm activity were observed for the fully “unmasked”
conjugate compared to the partially degraded species (MIC = 0.25 and
2–8 μg/mL, respectively), whereas dextrin conjugation
reduced colistin’s in vitro toxicity toward kidney cells, even
after complete unmasking. This study highlights the importance of
defining the structure–antimicrobial activity relationship
for novel antibiotic derivatives and demonstrates the suitability
of LC–MS to aid the design of biodegradable polymer–antibiotic
conjugates.
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Affiliation(s)
- Mathieu Varache
- Advanced Therapies Group, Oral and Biomedical Sciences, School of Dentistry, College of Biomedical and Life Sciences , Cardiff University , Heath Park , Cardiff CF14 4XY , U.K
| | - Lydia C Powell
- Advanced Therapies Group, Oral and Biomedical Sciences, School of Dentistry, College of Biomedical and Life Sciences , Cardiff University , Heath Park , Cardiff CF14 4XY , U.K
| | - Olav A Aarstad
- Department of Biotechnology and Food Sciences , Norwegian University of Science and Technology , Trondheim 7491 , Norway
| | - Thomas L Williams
- School of Chemistry , Cardiff University , Main Building, Park Place , Cardiff CF10 3AT , U.K
| | - Margot N Wenzel
- School of Chemistry , Cardiff University , Main Building, Park Place , Cardiff CF10 3AT , U.K
| | - David W Thomas
- Advanced Therapies Group, Oral and Biomedical Sciences, School of Dentistry, College of Biomedical and Life Sciences , Cardiff University , Heath Park , Cardiff CF14 4XY , U.K
| | - Elaine L Ferguson
- Advanced Therapies Group, Oral and Biomedical Sciences, School of Dentistry, College of Biomedical and Life Sciences , Cardiff University , Heath Park , Cardiff CF14 4XY , U.K
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Spencer S, Ipema H, Hartke P, Krueger C, Rodriguez R, Gross AE, Gabay M. Intravenous Push Administration of Antibiotics: Literature and Considerations. Hosp Pharm 2018; 53:157-169. [PMID: 30147136 PMCID: PMC6102793 DOI: 10.1177/0018578718760257] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Intravenous (IV) push administration can provide clinical and practical advantages over longer IV infusions in multiple clinical scenarios, including in the emergency department, in fluid-restricted patients, and when supplies of diluents are limited. In these settings, conversion to IV push administration may provide a solution. This review compiles available data on IV push administration of antibiotics in adults, including preparation, stability, and administration instructions. Prescribing information, multiple tertiary drug resources, and primary literature were consulted to compile relevant data. Several antibiotics are Food and Drug Administration-approved for IV push administration, including many beta-lactams. In addition, cefepime, ceftriaxone, ertapenem, gentamicin, and tobramycin have primary literature data to support IV push administration. While amikacin, ciprofloxacin, imipenem/cilastatin, and metronidazole have limited primary literature data on IV push administration, available data do not support that route. In addition, a discussion on practical considerations, such as IV push best practices and pharmacodynamic considerations, is provided.
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Affiliation(s)
| | - Heather Ipema
- College of Pharmacy, University of Illinois at
Chicago, USA
| | | | | | - Ryan Rodriguez
- College of Pharmacy, University of Illinois at
Chicago, USA
| | - Alan E. Gross
- College of Pharmacy, University of Illinois at
Chicago, USA
| | - Michael Gabay
- College of Pharmacy, University of Illinois at
Chicago, USA
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17
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Bakthavatchalam YD, Pragasam AK, Biswas I, Veeraraghavan B. Polymyxin susceptibility testing, interpretative breakpoints and resistance mechanisms: An update. J Glob Antimicrob Resist 2018; 12:124-136. [DOI: 10.1016/j.jgar.2017.09.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 07/25/2017] [Accepted: 09/19/2017] [Indexed: 12/12/2022] Open
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18
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Determination of Colistin and Colistimethate Levels in Human Plasma and Urine by High-Performance Liquid Chromatography-Tandem Mass Spectrometry. Ther Drug Monit 2017; 38:796-803. [PMID: 27684296 DOI: 10.1097/ftd.0000000000000345] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Colistin is a polypeptide antibiotic from the polymyxin E group used for the treatment of infections caused by multidrug-resistant gram-negative bacteria. The main constituents, accounting for approximately 85% of this mixture, are colistin A (polymyxin E1) and colistin B (polymyxin E2). The aim of this study was to develop and validate new and fast methods of quantification of colistin A and B and its precursors [colistin methanesulfonate sodium (CMS) A and B] by ultraperformance liquid chromatography-tandem mass spectrometry in plasma and urine with short pretreatment and run times. METHODS Chromatography was performed on an Acquity UPLC-MS/MS system (WATERS) with a WATERS Acquity UPLC C18 column (4.6 × 150 mm, 3.5 μm particle size). The pretreatment of samples consists of precipitation and extraction into microcolumns plate and HLB 96-well plate 30 μm-30 mg (OASIS) with a Positive Pressure-96 (WATERS). RESULTS Quantification was performed using a multiple reaction monitoring of the following transitions: m/z 390.9 → 385.1 for colistin A, m/z 386.2 → 101.0 for colistin B, and m/z 602.4 → 241.1 for polymyxin B1 sulfate. In plasma and urine, calibration curves were linear from 30 to 6000 ng/mL for colistin A and from 15 to 3000 ng/mL for colistin B. With an acceptable accuracy and precision, the lower limit of quantification were set at 24.0 ng/mL and 12.0 ng/mL for colistin A and B in plasma, and at 18.0 ng/mL and 9.0 ng/mL for colistin A and B in urine. CONCLUSIONS These LC-MS/MS methods of quantification for colistin A and B and its precursors (CMS A and B) in plasma and urine are fast, simple, specific, sensitive, accurate, precise, and reliable. Furthermore, they are linear and repeatable. These procedures were successfully applied to a pharmacokinetic study of a critically ill patient suffering from ventilator-associated pneumonia, who was treated with nebulized CMS.
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19
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Polymyxins: Antibacterial Activity, Susceptibility Testing, and Resistance Mechanisms Encoded by Plasmids or Chromosomes. Clin Microbiol Rev 2017; 30:557-596. [PMID: 28275006 DOI: 10.1128/cmr.00064-16] [Citation(s) in RCA: 918] [Impact Index Per Article: 131.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Polymyxins are well-established antibiotics that have recently regained significant interest as a consequence of the increasing incidence of infections due to multidrug-resistant Gram-negative bacteria. Colistin and polymyxin B are being seriously reconsidered as last-resort antibiotics in many areas where multidrug resistance is observed in clinical medicine. In parallel, the heavy use of polymyxins in veterinary medicine is currently being reconsidered due to increased reports of polymyxin-resistant bacteria. Susceptibility testing is challenging with polymyxins, and currently available techniques are presented here. Genotypic and phenotypic methods that provide relevant information for diagnostic laboratories are presented. This review also presents recent works in relation to recently identified mechanisms of polymyxin resistance, including chromosomally encoded resistance traits as well as the recently identified plasmid-encoded polymyxin resistance determinant MCR-1. Epidemiological features summarizing the current knowledge in that field are presented.
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20
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Nebulized antibiotics in mechanically ventilated patients: a challenge for translational research from technology to clinical care. Ann Intensive Care 2017; 7:78. [PMID: 28766281 PMCID: PMC5539056 DOI: 10.1186/s13613-017-0301-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 07/17/2017] [Indexed: 01/20/2023] Open
Abstract
Nebulized antibiotic therapy directly targets airways and lung parenchyma resulting in high local concentrations and potentially lower systemic toxicities. Experimental and clinical studies have provided evidence for elevated lung concentrations and rapid bacterial killing following the administration of nebulized antibiotics during mechanical ventilation. Delivery of high concentrations of antibiotics to infected lung regions is the key to achieving efficient nebulized antibiotic therapy. However, current non-standardized clinical practice, the difficulties with implementing optimal nebulization techniques and the lack of robust clinical data have limited its widespread adoption. The present review summarizes the techniques and clinical constraints for optimal delivery of nebulized antibiotics to lung parenchyma during invasive mechanical ventilation. Pulmonary pharmacokinetics and pharmacodynamics of nebulized antibiotic therapy to treat ventilator-associated pneumonia are discussed and put into perspective. Experimental and clinical pharmacokinetics and pharmacodynamics support the use of nebulized antibiotics. However, its clinical benefits compared to intravenous therapy remain to be proved. Future investigations should focus on continuous improvement of nebulization practices and techniques. Before expanding its clinical use, careful design of large phase III randomized trials implementing adequate therapeutic strategies in targeted populations is required to demonstrate the clinical effectiveness of nebulized antibiotics in terms of patient outcomes and reduction in the emergence of antibiotic resistance.
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Grégoire N, Aranzana-Climent V, Magréault S, Marchand S, Couet W. Clinical Pharmacokinetics and Pharmacodynamics of Colistin. Clin Pharmacokinet 2017; 56:1441-1460. [DOI: 10.1007/s40262-017-0561-1] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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22
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Post TE, Kamerling IMC, van Rossen RCJM, Burggraaf J, Stevens J, Dijkmans AC, Heijerman HGM, Touw DJ, van Velzen AJ, Wilms EB. Colistin methanesulfonate infusion solutions are stable over time and suitable for home administration. Eur J Hosp Pharm 2017; 25:337-339. [PMID: 31157054 DOI: 10.1136/ejhpharm-2016-001128] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 02/08/2017] [Accepted: 02/20/2017] [Indexed: 11/03/2022] Open
Abstract
The stability of colistin methanesulfonate (CMS) was determined in quadruplicate in elastomeric home infusion pumps containing 1, 2 or 3 MU CMS and in infusion bags with 2 MU CMS all in 100 mL normal saline. Infusions were stored at room temperature (20°C-24°C) with or without exposure to natural light or refrigerated (4°C-8°C) and protected from light up to 2 weeks. In the initial solution of 2 MU CMS in 100 mL saline sampled immediately after reconstitution and dilution, 1.5% of CMS was hydrolysed to colistin. When stored at room temperature and exposed to natural light, colistin concentration in elastomeric infusion pumps increased to 2.6% in 8 days and to 2.1% when stored at 4°C. CMS stability increases at lower temperatures and higher concentrations. Based on the current data, chemical stability of CMS infusion solution is sufficient for a shelf life of 7 days refrigerated plus 1 day at room temperature.
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Affiliation(s)
- Titiaan E Post
- The Hague Hospital Pharmacy, The Hague, The Netherlands
- Centre for Human Drug Research, Leiden, The Netherlands
| | | | | | | | | | - Anneke C Dijkmans
- Centre for Human Drug Research, Leiden, The Netherlands
- Department of Medical Microbiology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Harry G M Heijerman
- Department of Pulmonology and Cystic Fibrosis, Haga Teaching Hospital, The Hague, The Netherlands
| | - Daan J Touw
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Erik B Wilms
- The Hague Hospital Pharmacy, The Hague, The Netherlands
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Population Pharmacokinetics of Colistin Methanesulfonate and Colistin in Critically Ill Patients with Acute Renal Failure Requiring Intermittent Hemodialysis. Antimicrob Agents Chemother 2016; 60:1788-93. [PMID: 26729492 DOI: 10.1128/aac.01868-15] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 12/30/2015] [Indexed: 11/20/2022] Open
Abstract
Colistin is increasingly used as a last option for the treatment of severe infections due to Gram-negative bacteria in critically ill patients requiring intermittent hemodialysis (HD) for acute renal failure. Our objective was to characterize the pharmacokinetics (PK) of colistin and its prodrug colistin methanesulfonate (CMS) in this population and to suggest dosing regimen recommendations. Eight intensive care unit (ICU) patients who were under intermittent HD and who were treated by CMS (Colimycine) were included. Blood samples were collected between two consecutive HD sessions. CMS and colistin concentrations were measured by a specific chromatographic assay and were analyzed using a PK population approach (Monolix software). Monte Carlo simulations were conducted to predict the probability of target attainment (PTA). CMS nonrenal clearance was increased in ICU-HD patients. Compared with that of ICU patients included in the same clinical trial but with preserved renal function, colistin exposure was increased by 3-fold in ICU-HD patients. This is probably because a greater fraction of the CMS converted into colistin. To maintain colistin plasma concentrations high enough (>3 mg/liter) for high PTA values (area under the concentration-time curve for the free, unbound fraction of a drug [fAUC]/MIC of >10 and fAUC/MIC of >50 for systemic and lung infections, respectively), at least for MICs lower than 1.5 mg/liter (nonpulmonary infection) or 0.5 mg/liter (pulmonary infection), the dosing regimen of CMS should be 1.5 million international units (MIU) twice daily on non-HD days. HD should be conducted at the end of a dosing interval, and a supplemental dose of 1.5 MIU should be administered after the HD session (i.e., total of 4.5 MIU for HD days). This study has confirmed and complemented previously published data and suggests an a priori clear and easy to follow dosing strategy for CMS in ICU-HD patients.
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Abstract
Polymyxin B and colistin (polymyxin E) are polypeptide antibiotics that were developed in the 1940s, but fell into disfavor due to their high toxicity rates. These two antibiotics were previously regarded to be largely equivalent, due to similarities in their chemical structure and spectrum of activity. In recent years, several pertinent differences, especially in terms of potency and disposition, have been revealed between polymyxin B and colistin. These differences are mainly attributed to the fact that polymyxin B is administered parenterally in its active form, while colistin is administered parenterally as an inactive pro-drug, colistimethate. In this review, we summarize the similarities and differences between polymyxin B and colistin. We also discuss the potential clinical implications of these findings, and provide our perspectives on how polymyxins should be employed to preserve their utility in this era of multi-drug resistance.
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Affiliation(s)
- Yiying Cai
- a 1 Department of Pharmacy, Singapore General Hospital, Outram Rd 169608, Singapore.,c 3 Department of Pharmacy, National University of Singapore, 21 Lower Kent Ridge Rd 119077, Singapore
| | - Winnie Lee
- a 1 Department of Pharmacy, Singapore General Hospital, Outram Rd 169608, Singapore
| | - Andrea L Kwa
- a 1 Department of Pharmacy, Singapore General Hospital, Outram Rd 169608, Singapore.,b 2 Emerging Infectious Diseases, Duke-NUS Graduate Medical School, 8 College Rd 169857, Singapore.,c 3 Department of Pharmacy, National University of Singapore, 21 Lower Kent Ridge Rd 119077, Singapore
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Mucin Binding Reduces Colistin Antimicrobial Activity. Antimicrob Agents Chemother 2015; 59:5925-31. [PMID: 26169405 DOI: 10.1128/aac.00808-15] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 07/04/2015] [Indexed: 11/20/2022] Open
Abstract
Colistin has found increasing use in treating drug-resistant bacterial lung infections, but potential interactions with pulmonary biomolecules have not been investigated. We postulated that colistin, like aminoglycoside antibiotics, may bind to secretory mucin in sputum or epithelial mucin that lines airways, reducing free drug levels. To test this hypothesis, we measured binding of colistin and other antibiotics to porcine mucin, a family of densely glycosylated proteins used as a surrogate for human sputum and airway mucin. Antibiotics were incubated in dialysis tubing with or without mucin, and concentrations of unbound antibiotics able to penetrate the dialysis tubing were measured over time using liquid chromatography-tandem mass spectrometry (LC-MS/MS). The percentage of antibiotic measured in the dialysate after 4 h in the presence of mucin, relative to the amount without mucin, was 15% for colistin, 16% for polymyxin B, 19% for tobramycin, 52% for ciprofloxacin, and 78% for daptomycin. Antibiotics with the strongest mucin binding had an overall polybasic positive charge, whereas those with comparatively little binding were less basic. When comparing MICs measured with or without added mucin, colistin and polymyxin B showed >100-fold increases in MICs for multiple Gram-negative bacteria. Preclinical evaluation of mucin binding should become a standard procedure when considering the potential pulmonary use of new or existing antibiotics, particularly those with a polybasic overall charge. In the airways, mucin binding may reduce the antibacterial efficacy of inhaled or intravenously administered colistin, and the presence of sub-MIC effective antibiotic concentrations could result in the development of antibiotic resistance.
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Velkov T, Abdul Rahim N, Zhou Q(T, Chan HK, Li J. Inhaled anti-infective chemotherapy for respiratory tract infections: successes, challenges and the road ahead. Adv Drug Deliv Rev 2015; 85:65-82. [PMID: 25446140 PMCID: PMC4429008 DOI: 10.1016/j.addr.2014.11.004] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 11/04/2014] [Accepted: 11/05/2014] [Indexed: 12/31/2022]
Abstract
One of the most common causes of illnesses in humans is from respiratory tract infections caused by bacterial, viral or fungal pathogens. Inhaled anti-infective drugs are crucial for the prophylaxis and treatment of respiratory tract infections. The benefit of anti-infective drug delivery via inhalation is that it affords delivery of sufficient therapeutic dosages directly to the primary site of infection, while minimizing the risks of systemic toxicity or avoiding potential suboptimal pharmacokinetics/pharmacodynamics associated with systemic drug exposure. This review provides an up-to-date treatise of approved and novel developmental inhaled anti-infective agents, with particular attention to effective strategies for their use, pulmonary pharmacokinetic properties and safety.
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Abdulla A, van Leeuwen RWF, de Vries Schultink AHM, Koch BCP. Stability of colistimethate sodium in a disposable elastomeric infusion device. Int J Pharm 2015; 486:367-9. [PMID: 25863116 DOI: 10.1016/j.ijpharm.2015.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 04/02/2015] [Accepted: 04/06/2015] [Indexed: 10/23/2022]
Abstract
Infections of the respiratory tract with Pseudomonas aeruginosa in cystic fibrosis patients are frequently treated with colistimethate sodium (CMS). For the intravenous administration of CMS a disposable elastomeric pump is a convenient option. To date, there are no data available on the chemical stability of CMS solutions stored in elastomeric pumps. We evaluated the chemical stability of 0.8 mg/mL solutions of CMS by measuring the degradation over a period of 7 days. Test samples were prepared by diluting CMS with saline solution (0.9%). The preparations were transferred to 100-mL elastomeric pumps and stored at 4 °C. The chemical stability was measured by a high-performance liquid chromatography method with UV detection. There was no degradation of CMS (<0.5% of CMS present as colistin) for at least 3 day at 4 °C, and after 7 days all test samples remained chemically stable (<5% of CMS present as colistin). Since colistin formed in pharmacy-compounded CMS solutions prior to administration may cause toxicity, we advise that the solution should be used before the hydrolysis of CMS occurs. Therefore, we recommend that the 0.8 mg/mL solution of CMS can be stored for up to 3 days at 4 °C in an elastomeric pump.
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Affiliation(s)
- Alan Abdulla
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Roelof W F van Leeuwen
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Birgit C P Koch
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands
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Pulmonary and systemic pharmacokinetics of inhaled and intravenous colistin methanesulfonate in cystic fibrosis patients: targeting advantage of inhalational administration. Antimicrob Agents Chemother 2014; 58:2570-9. [PMID: 24550334 DOI: 10.1128/aac.01705-13] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The purpose of this study was to define the pulmonary and systemic pharmacokinetics of colistin methanesulfonate (CMS) and formed colistin following intravenous (i.v.) and inhaled administration in cystic fibrosis (CF) patients. Six CF subjects were administered nebulized CMS doses of 2 and 4 million IU and an i.v. CMS infusion of 150 mg of colistin base activity. Blood plasma, sputum, and urine samples were collected for 12 to 24 h postdose. To assess the tolerability of the drug, lung function tests, blood serum creatinine concentrations, and adverse effect reports were recorded. All doses were well tolerated in the subjects. The pharmacokinetic parameters for CMS following i.v. delivery were consistent with previously reported values. Sputum concentrations of formed colistin were maintained at <1.0 mg/liter for 12 h postdose. Nebulization of CMS resulted in relatively high sputum concentrations of CMS and formed colistin compared to those resulting from i.v. administration. The systemic availability of CMS was low following nebulization of 2 and 4 million IU (7.93% ± 4.26% and 5.37% ± 1.36%, respectively), and the plasma colistin concentrations were below the limit of quantification. Less than 2 to 3% of the nebulized CMS dose was recovered in the urine samples in 24 h. The therapeutic availability and drug targeting index for CMS and colistin following inhalation compared to i.v. delivery were significantly greater than 1. Inhalation of CMS is an effective means of targeting CMS and formed colistin for delivery to the lungs, as high lung exposure and minimal systemic exposure were achieved in CF subjects.
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Population pharmacokinetics of colistin methanesulfonate in rats: achieving sustained lung concentrations of colistin for targeting respiratory infections. Antimicrob Agents Chemother 2013; 57:5087-95. [PMID: 23917323 DOI: 10.1128/aac.01127-13] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Colistin methanesulfonate (CMS), the inactive prodrug of colistin, is administered by inhalation for the management of respiratory infections. However, limited pharmacokinetic data are available for CMS and colistin following pulmonary delivery. This study investigates the pharmacokinetics of CMS and colistin following intravenous (i.v.) and intratracheal (i.t.) administration in rats and determines the targeting advantage after direct delivery into the lungs. In addition to plasma, bronchoalveolar lavage (BAL) fluid was collected to quantify drug concentrations in lung epithelial lining fluid (ELF). The resulting data were analyzed using a population modeling approach in S-ADAPT. A three-compartment model described the disposition of both compounds in plasma following i.v. administration. The estimated mean clearance from the central compartment was 0.122 liters/h for CMS and 0.0657 liters/h for colistin. Conversion of CMS to colistin from all three compartments was required to fit the plasma data. The fraction of the i.v. dose converted to colistin in the systemic circulation was 0.0255. Two BAL fluid compartments were required to reflect drug kinetics in the ELF after i.t. dosing. A slow conversion of CMS (mean conversion time [MCTCMS] = 3.48 h) in the lungs contributed to high and sustained concentrations of colistin in ELF. The fraction of the CMS dose converted to colistin in ELF (fm,ELF = 0.226) was higher than the corresponding fractional conversion in plasma after i.v. administration. In conclusion, pulmonary administration of CMS achieves high and sustained exposures of colistin in lungs for targeting respiratory infections.
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He H, Li JC, Nation RL, Jacob J, Chen G, Lee HJ, Tsuji BT, Thompson PE, Roberts K, Velkov T, Li J. Pharmacokinetics of four different brands of colistimethate and formed colistin in rats. J Antimicrob Chemother 2013; 68:2311-7. [PMID: 23749953 DOI: 10.1093/jac/dkt207] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Very different labelling conventions are employed by different products of colistimethate (CMS), an inactive prodrug of colistin that is used as a last-line defence against Gram-negative 'superbugs'. This study examined the chemical composition and pharmacokinetics in rats of four commercial parenteral products of CMS. METHODS Contents per vial of four brands of CMS from three different continents were weighed (n = 3). Elemental analysis and HPLC examination were conducted. The pharmacokinetics of CMS and formed colistin were investigated for each product after intravenous administration in rats (28.1 mg/kg CMS; n = 4). Blood was collected over 180 min, and concentrations of CMS and colistin were measured followed by pharmacokinetic analysis. RESULTS X-GEN, Paddock and Atlantic products, labelled with 150 mg 'colistin base activity', contained 366.8 ± 0.80, 340.6 ± 0.08 and 380.0 ± 5.97 mg CMS (sodium) per vial, respectively; while the Forest product (labelled with 2 000 000 IU) contained 159.3 ± 1.75 mg CMS (sodium). The elemental compositions of the four products were similar; however, the HPLC profile of the Atlantic CMS was different from those of the other three products. The pharmacokinetics of CMS were generally comparable across brands; however, the molar ratios (%) of the AUC0-180min of colistin to CMS (1.68% ± 0.35% to 3.29% ± 0.43%) were significantly different (P = 0.0157). CONCLUSION This is the first study to demonstrate that although different brands of CMS from various parts of the world have similar elemental compositions, they lead to different exposures to the microbiologically active formed colistin. The study has significant implications for the interpretation of pharmacological studies of CMS conducted in different parts of the world.
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Affiliation(s)
- Hui He
- Drug Delivery, Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
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Abstract
Colistimethate sodium, increasingly used to treat multidrug-resistant Gram-negative infections, spontaneously hydrolyzes to form colistin A (polymyxin E1) and B (polymyxin E2/B) when mixed with water. High levels of these active breakdown products at the time of administration have been associated with nephrotoxicity and even death. In this study, reconstituted colistimethate sodium was shown to be stable (<1.0% colistin A/B formation) for up to 24 h when stored at 21, 0, -20, and -70°C.
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Bergen PJ, Landersdorfer CB, Zhang J, Zhao M, Lee HJ, Nation RL, Li J. Pharmacokinetics and pharmacodynamics of 'old' polymyxins: what is new? Diagn Microbiol Infect Dis 2012; 74:213-23. [PMID: 22959816 DOI: 10.1016/j.diagmicrobio.2012.07.010] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 07/12/2012] [Accepted: 07/23/2012] [Indexed: 12/21/2022]
Abstract
'Old' colistin and polymyxin B are increasingly used as last-line therapy against multidrug-resistant Gram-negative bacteria Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae. For intravenous administration, colistin is dosed as its inactive prodrug colistin methanesulfonate (sodium), while polymyxin B is used as its sulfate (active antibacterial). Over the last decade, significant progress has been made in understanding their chemistry, pharmacokinetics (PK), and pharmacodynamics (PD). The first scientifically based dosing suggestions are now available for colistin methanesulfonate to generate a desired target steady-state plasma concentration of formed colistin in various categories of critically ill patients. As simply increasing polymyxin dosage regimens is not an option for optimizing their PK/PD due to nephrotoxicity, combination therapy with other antibiotics has great potential to maximize the efficacy of polymyxins while minimizing emergence of resistance. We must pursue rational approaches to the use of polymyxins and other existing antibiotics through the application of PK/PD principles.
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Affiliation(s)
- Phillip J Bergen
- Drug Delivery, Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria 3052, Australia
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Wallace SJ, Li J, Nation RL, Prankerd RJ, Boyd BJ. Interaction of colistin and colistin methanesulfonate with liposomes: colloidal aspects and implications for formulation. J Pharm Sci 2012; 101:3347-59. [PMID: 22623044 DOI: 10.1002/jps.23203] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 03/23/2012] [Accepted: 04/01/2012] [Indexed: 12/30/2022]
Abstract
Interaction of colistin and colistin methanesulfonate (CMS) with liposomes has been studied with the view to understanding the limitations to the use of liposomes as a more effective delivery system for pulmonary inhalation of this important class of antibiotic. Thus, in this study, liposomes containing colistin or CMS were prepared and characterized with respect to colloidal behavior and drug encapsulation and release. Association of anionic CMS with liposomes induced negative charge on the particles. However, degradation of the CMS to form cationic colistin over time was directly correlated with charge reversal and particle aggregation. The rate of degradation of CMS was significantly more rapid when associated with the liposome bilayer than when compared with the same concentration in aqueous solution. Colistin liposomes carried positive charge and were stable. Encapsulation efficiency for colistin was approximately 50%, decreasing with increasing concentration of colistin. Colistin was rapidly released from liposomes on dilution. Although the studies indicate limited utility of colistin or CMS liposomes for long duration controlled-release applications, colistin liposomes were highly stable and may present a potential opportunity for coformulation of colistin with a second antibiotic to colocalize the two drugs after pulmonary delivery.
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Affiliation(s)
- Stephanie J Wallace
- Drug Delivery, Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria 3052, Australia
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Wallace SJ, Li J, Nation RL, Boyd BJ. Drug release from nanomedicines: Selection of appropriate encapsulation and release methodology. Drug Deliv Transl Res 2012; 2:284-92. [PMID: 23110256 DOI: 10.1007/s13346-012-0064-4] [Citation(s) in RCA: 126] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The characterization of encapsulation efficiency and in vitro drug release from nanoparticle-based formulations often requires the separation of nanoparticles from unencapsulated drug. Inefficient separation of nanoparticles from the medium in which they are dispersed can lead to inaccurate estimates of encapsulation efficiency and drug release. This study establishes dynamic light scattering as a simple method for substantiation of the effectiveness of the separation process. Colistin-loaded liposomes, as an exemplar nano-sized delivery particle, were diluted to construct a calibration curve relating the amount of light scattering to liposome concentration. Dynamic light scattering revealed that, in the case of ultracentrifugation and centrifugal ultrafiltration, approximately 2.9% of the total liposomes remained in supernatants or filtrates, respectively. In comparison, filtrates obtained using pressure ultrafiltration contained less than 0.002% of the total liposomes from the formulation. Subsequent release studies using dialysis misleadingly implied a slow release of colistin over >48 h. In contrast, pressure ultrafiltration revealed immediate equilibration to the equilibrium distribution of colistin between the liposome and aqueous phases upon dilution. Pressure ultrafiltration is therefore recommended as the optimal method of choice for studying release kinetics of drug from nanomedicine carriers.
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Affiliation(s)
- Stephanie J Wallace
- Drug Delivery, Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Melbourne, Victoria 3052, Australia
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Yahav D, Farbman L, Leibovici L, Paul M. Colistin: new lessons on an old antibiotic. Clin Microbiol Infect 2012; 18:18-29. [DOI: 10.1111/j.1469-0691.2011.03734.x] [Citation(s) in RCA: 171] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Srinivas NR. The rationality for using prodrug approach in drug discovery programs for new xenobiotics: opportunities and challenges. Eur J Drug Metab Pharmacokinet 2011; 36:49-59. [PMID: 21404122 DOI: 10.1007/s13318-011-0035-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 03/07/2011] [Indexed: 10/18/2022]
Abstract
The concept of prodrugs has been successfully executed for life cycle management options of several approved drugs and drugs in development. In addition to imparting ideal biopharmaceutical properties, such as solubility, permeability and lipophilicity, some prodrug concepts have also enabled site-specific drug delivery, prolonged the duration of therapeutic effect and improved therapeutic index. The strategic inclusion of prodrug concept during drug discovery and early development process brings in some unique challenges. The communication provides balanced perspectives on the rational use and challenges of prodrug concept during the drug discovery and development process.
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Cheng C, Liu S, Xiao D, Hollembaek J, Yao L, Lin J, Hansel S. LC–MS/MS method development and validation for the determination of polymyxins and vancomycin in rat plasma. J Chromatogr B Analyt Technol Biomed Life Sci 2010; 878:2831-8. [DOI: 10.1016/j.jchromb.2010.08.037] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Revised: 08/23/2010] [Accepted: 08/23/2010] [Indexed: 10/19/2022]
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Wallace SJ, Li J, Nation RL, Prankerd RJ, Velkov T, Boyd BJ. Self-assembly behavior of colistin and its prodrug colistin methanesulfonate: implications for solution stability and solubilization. J Phys Chem B 2010; 114:4836-40. [PMID: 20302384 DOI: 10.1021/jp100458x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Colistin is an amphiphilic antibiotic that has re-emerged into clinical use due to the increasing prevalence of difficult-to-treat Gram-negative infections. The existence of self-assembling colloids in solutions of colistin and its derivative prodrug, colistin methanesulfonate (CMS), was investigated. Colistin and CMS reduced the air-water interfacial tension, and dynamic light scattering (DLS) studies showed the existence of 2.07 +/- 0.3 nm aggregates above 1.5 mM for colistin and of 1.98 +/- 0.36 nm aggregates for CMS above 3.5 mM (mean +/- SD). Above the respective critical micelle concentrations (CMC) the solubility of azithromycin, a hydrophobic antibiotic, increased approximately linearly with increasing surfactant concentration (5:1 mol ratio colistin:azithromycin), suggestive of hydrophobic domains within the micellar cores. Rapid conversion of CMS to colistin occurred below the CMC (60% over 48 h), while conversion above the CMC was less than 1%. The formation of colistin and CMS micelles demonstrated in this study is the proposed mechanism for solubilization of azithromycin and the concentration-dependent stability of CMS.
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Affiliation(s)
- Stephanie J Wallace
- Facility for Anti-Infective Drug Development and Innovation, Monash Institute of Pharmaceutical Sciences, Parkville, Melbourne, Victoria 3052, Australia
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Dudhani RV, Nation RL, Li J. Evaluating the stability of colistin and colistin methanesulphonate in human plasma under different conditions of storage. J Antimicrob Chemother 2010; 65:1412-5. [PMID: 20413406 DOI: 10.1093/jac/dkq134] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The purpose of this study was to assess the stability of colistin and colistin methanesulphonate (CMS) in human plasma under storage conditions typically used in clinical pharmacokinetic (PK) and PK/pharmacodynamic (PD) investigations. METHODS Human plasma (pH adjusted to 7.4) containing colistin (2 mg/L) or CMS (2 or 30 mg/L) was stored at -20, -70 or -80 degrees C for 6-12 months. At periodic intervals, the concentrations of colistin in colistin-spiked samples, and of CMS and formed colistin in CMS-spiked samples, were analysed (n = 3 replicates at each time) by HPLC. RESULTS The time course of colistin concentrations in colistin-spiked plasma showed a substantially better stability at -80 and -70 degrees C than at -20 degrees C. With regard to CMS-spiked plasma of 2 and 30 mg/L stored at -80 and -70 degrees C, no quantifiable colistin formed over a 4 month period. However, the plasma spiked to 2 mg/L stored at -20 degrees C showed a substantial concentration of colistin ( approximately 0.4 mg/L) within 2 months. At all three storage temperatures, the stability of CMS was substantially better for the plasma spiked to contain 30 mg/L as compared with 2 mg/L. CONCLUSIONS The results of our long-term stability study have significant implications for those involved in conducting clinical PK and PK/PD studies with CMS/colistin.
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Affiliation(s)
- Rajesh V Dudhani
- Facility for Anti-infective Drug Development and Innovation, Drug Delivery, Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, Australia
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Abstract
PURPOSE OF REVIEW Colistin is a 50-year-old antibiotic that is being used increasingly as a 'last-line' therapy to treat infections caused by multidrug-resistant Gram-negative bacteria, when essentially no other options are available. Despite its age, or because of its age, there has been a dearth of knowledge on its pharmacological and microbiological properties. This review focuses on recent studies aimed at optimizing the clinical use of this old antibiotic. RECENT FINDINGS A number of factors, including the diversity in the pharmaceutical products available, have hindered the optimal use of colistin. Recent advances in understanding of the pharmacokinetics and pharmacodynamics of colistin, and the emerging knowledge on the relationship between the pharmacokinetics and pharmacodynamics, provide a solid base for optimization of dosage regimens. The potential for nephrotoxicity has been a lingering concern, but recent studies provide useful new information on the incidence, severity and reversibility of this adverse effect. Recent approaches to the use of other antibiotics in combination with colistin hold promise for increased antibacterial efficacy with less potential for emergence of resistance. SUMMARY Because few, if any, new antibiotics with activity against multidrug-resistant Gram-negative bacteria will be available within the next several years, it is essential that colistin is used in ways that maximize its antibacterial efficacy and minimize toxicity and development of resistance. Recent developments have improved use of colistin in the 21st century.
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