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Bor S, Kalkan İH, Savarino E, Rao S, Tack J, Pasricha J, Cangemi D, Schol J, Karunaratne T, Ghisa M, Ahuja NK, Lacy B. Prokinetics-safety and efficacy: The European Society of Neurogastroenterology and Motility/The American Neurogastroenterology and Motility Society expert review. Neurogastroenterol Motil 2024; 36:e14774. [PMID: 38462678 DOI: 10.1111/nmo.14774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 02/02/2024] [Accepted: 02/13/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Prokinetics are a class of pharmacological drugs designed to improve gastrointestinal (GI) motility, either regionally or across the whole gut. Each drug has its merits and drawbacks, and based on current evidence as high-quality studies are limited, we have no clear recommendation on one class or other. However, there remains a large unmet need for both regionally selective and/or globally acting prokinetic drugs that work primarily intraluminally and are safe and without systemic side effects. PURPOSE Here, we describe the strengths and weaknesses of six classes of prokinetic drugs, including their pharmacokinetic properties, efficacy, safety and tolerability and potential indications.
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Affiliation(s)
- Serhat Bor
- Division of Gastroenterology, School of Medicine & Ege Reflux Study Group, Ege University, Izmir, Turkey
| | - İsmail H Kalkan
- Department of Gastroenterology, School of Medicine, TOBB University of Economics and Technology, Ankara, Turkey
| | - Edoardo Savarino
- Gastroenterology Unit, Azienda Ospedale Università di Padova (AOUP), Padua, Italy
| | - Satish Rao
- Division of Gastroenterology and Hepatology, Digestive Health Center, Augusta University, Augusta, Georgia, USA
| | - Jan Tack
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
| | - Jay Pasricha
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - David Cangemi
- Division of Gastroenterology & Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Jolien Schol
- Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - Tennekon Karunaratne
- Division of Gastroenterology/Hepatology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Matteo Ghisa
- Digestive Endoscopy Unit, Division of Gastroenterology, Padua University Hospital, Padua, Italy
| | - Nitin K Ahuja
- Division of Gastroenterology, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Brian Lacy
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
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2
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Arun S, Xin L, Gaonkar O, Neppolian B, Zhang G, Chakraborty P. Antibiotics in sewage treatment plants, receiving water bodies and groundwater of Chennai city and the suburb, South India: Occurrence, removal efficiencies, and risk assessment. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 851:158195. [PMID: 35995170 DOI: 10.1016/j.scitotenv.2022.158195] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 06/15/2023]
Abstract
The presence of antibiotics in the aqueous environment can alter the water microbiome, inducing antimicrobial resistance genes. Hence, the occurrence of 18 antibiotics belonging to sulfonamides, fluoroquinolones, tetracyclines, phenicols, and macrolides classes were investigated in surface water, groundwater, and sewage treatment plants in Chennai city and the suburbs. Fluoroquinolones had the maximum detection frequency in both influent and effluent samples of urban and suburban STPs, with ofloxacin and ciprofloxacin showing the highest influent concentrations. Erythromycin was the predominant antibiotic in surface water samples with an average concentration of 194.4 ng/L. All the detected antibiotic concentrations were higher in the Buckingham Canal compared to those in Adyar and Cooum rivers, possibly due to direct sewer outfalls in the canal. In groundwater samples, ciprofloxacin showed the highest levels with an average of 20.48 ng/L and the concentrations were comparable to those of surface water. The average sulfamethazine concentration in groundwater (5.2 ng/L) was found to be slightly higher than that of the surface water and much higher than the STP influent concentrations. High levels of ciprofloxacin and sulfamethazine in groundwater may be because of their high solubility and wide use. Moreover, erythromycin was completely removed after treatment in urban STPs; FQs showed relatively lesser removal efficiency (2.4-54%) in urban STPs and (8-44%) in suburban STP. Tetracyclines and phenicols were not detected in any of the samples. Ciprofloxacin and azithromycin in surface water pose a high risk in terms of estimated antibiotic resistance. This study revealed that the measured surface water concentration of antibiotics were 500 times higher for some compounds than the predicted calculated concentrations from STP effluents. Therefore, we suspect the direct sewage outlets or open drains might play an important role in contaminating surface water bodies in Chennai city.
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Affiliation(s)
- Sija Arun
- Department of Civil Engineering, SRM Institute of Science and Technology, Kattankulathur 603 203, Tamil Nadu, India
| | - Liu Xin
- Guangzhou Institute of Geochemistry, Chinese Academy of Sciences, Guangzhou 510640, China
| | | | - B Neppolian
- Department of Chemistry, SRM Institute of Science and Technology, Kattankulathur 603 203, Tamil Nadu, India
| | - Gan Zhang
- Guangzhou Institute of Geochemistry, Chinese Academy of Sciences, Guangzhou 510640, China
| | - Paromita Chakraborty
- Environmental Science and Technology Laboratory, Department of Chemical Engineering, SRM Institute of Science and Technology, Kattankulathur 603 203, Tamil Nadu, India.
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3
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Leclerc QJ, Lindsay JA, Knight GM. Modelling the synergistic effect of bacteriophage and antibiotics on bacteria: Killers and drivers of resistance evolution. PLoS Comput Biol 2022; 18:e1010746. [PMID: 36449520 PMCID: PMC9744316 DOI: 10.1371/journal.pcbi.1010746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 12/12/2022] [Accepted: 11/17/2022] [Indexed: 12/05/2022] Open
Abstract
Bacteriophage (phage) are bacterial predators that can also spread antimicrobial resistance (AMR) genes between bacteria by generalised transduction. Phage are often present alongside antibiotics in the environment, yet evidence of their joint killing effect on bacteria is conflicted, and the dynamics of transduction in such systems are unknown. Here, we combine in vitro data and mathematical modelling to identify conditions where phage and antibiotics act in synergy to remove bacteria or drive AMR evolution. We adapt a published model of phage-bacteria dynamics, including transduction, to add the pharmacodynamics of erythromycin and tetracycline, parameterised from new in vitro data. We simulate a system where two strains of Staphylococcus aureus are present at stationary phase, each carrying either an erythromycin or tetracycline resistance gene, and where multidrug-resistant bacteria can be generated by transduction only. We determine rates of bacterial clearance and multidrug-resistant bacteria appearance, when either or both antibiotics and phage are present at varying timings and concentrations. Although phage and antibiotics act in synergy to kill bacteria, by reducing bacterial growth antibiotics reduce phage production. A low concentration of phage introduced shortly after antibiotics fails to replicate and exert a strong killing pressure on bacteria, instead generating multidrug-resistant bacteria by transduction which are then selected for by the antibiotics. Multidrug-resistant bacteria numbers were highest when antibiotics and phage were introduced simultaneously. The interaction between phage and antibiotics leads to a trade-off between a slower clearing rate of bacteria (if antibiotics are added before phage), and a higher risk of multidrug-resistance evolution (if phage are added before antibiotics), exacerbated by low concentrations of phage or antibiotics. Our results form hypotheses to guide future experimental and clinical work on the impact of phage on AMR evolution, notably for studies of phage therapy which should investigate varying timings and concentrations of phage and antibiotics.
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Affiliation(s)
- Quentin J. Leclerc
- Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Antimicrobial Resistance Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Institute for Infection & Immunity, St George’s University of London, London, United Kingdom
- * E-mail: ,
| | - Jodi A. Lindsay
- Institute for Infection & Immunity, St George’s University of London, London, United Kingdom
| | - Gwenan M. Knight
- Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Antimicrobial Resistance Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Zang R, Barth A, Wong H, Marik J, Shen J, Lade J, Grove K, Durk MR, Parrott N, Rudewicz PJ, Zhao S, Wang T, Yan Z, Zhang D. Design and Measurement of Drug Tissue Concentration Asymmetry and Tissue Exposure-Effect (Tissue PK-PD) Evaluation. J Med Chem 2022; 65:8713-8734. [PMID: 35790118 DOI: 10.1021/acs.jmedchem.2c00502] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The "free drug hypothesis" assumes that, in the absence of transporters, the steady state free plasma concentrations equal to that at the site of action that elicit pharmacologic effects. While it is important to utilize the free drug hypothesis, exceptions exist that the free plasma exposures, either at Cmax, Ctrough, and Caverage, or at other time points, cannot represent the corresponding free tissue concentrations. This "drug concentration asymmetry" in both total and free form can influence drug disposition and pharmacological effects. In this review, we first discuss options to assess total and free drug concentrations in tissues. Then various drug design strategies to achieve concentration asymmetry are presented. Last, the utilities of tissue concentrations in understanding exposure-effect relationships and translational projections to humans are discussed for several therapeutic areas and modalities. A thorough understanding in plasma and tissue exposures correlation with pharmacologic effects can provide insightful guidance to aid drug discovery.
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Affiliation(s)
- Richard Zang
- IDEAYA Biosciences, South San Francisco, California 94080, United States
| | - Aline Barth
- Global Blood Therapeutics, South San Francisco, California 94080, United States
| | - Harvey Wong
- The University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Jan Marik
- Genentech, South San Francisco, California 98080, United States
| | - Jie Shen
- AbbVie, Irvine, California 92612, United States
| | - Julie Lade
- Amgen Inc., South San Francisco, California 94080, United States
| | - Kerri Grove
- Novartis, Emeryville, California 94608, United States
| | - Matthew R Durk
- Genentech, South San Francisco, California 98080, United States
| | - Neil Parrott
- Roche Innovation Centre, Basel CH-4070, Switzerland
| | | | | | - Tao Wang
- Coherus BioSciences, Redwood City, California 94605, United States
| | - Zhengyin Yan
- Genentech, South San Francisco, California 98080, United States
| | - Donglu Zhang
- Genentech, South San Francisco, California 98080, United States
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Delaunois A, Abernathy M, Anderson WD, Beattie KA, Chaudhary KW, Coulot J, Gryshkova V, Hebeisen S, Holbrook M, Kramer J, Kuryshev Y, Leishman D, Lushbough I, Passini E, Redfern WS, Rodriguez B, Rossman EI, Trovato C, Wu C, Valentin J. Applying the CiPA approach to evaluate cardiac proarrhythmia risk of some antimalarials used off-label in the first wave of COVID-19. Clin Transl Sci 2021; 14:1133-1146. [PMID: 33620150 PMCID: PMC8014548 DOI: 10.1111/cts.13011] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/20/2021] [Accepted: 01/23/2021] [Indexed: 12/13/2022] Open
Abstract
We applied a set of in silico and in vitro assays, compliant with the Comprehensive In Vitro Proarrhythmia Assay (CiPA) paradigm, to assess the risk of chloroquine (CLQ) or hydroxychloroquine (OH-CLQ)-mediated QT prolongation and Torsades de Pointes (TdP), alone and combined with erythromycin (ERT) and azithromycin (AZI), drugs repurposed during the first wave of coronavirus disease 2019 (COVID-19). Each drug or drug combination was tested in patch clamp assays on seven cardiac ion channels, in in silico models of human ventricular electrophysiology (Virtual Assay) using control (healthy) or high-risk cell populations, and in human-induced pluripotent stem cell (hiPSC)-derived cardiomyocytes. In each assay, concentration-response curves encompassing and exceeding therapeutic free plasma levels were generated. Both CLQ and OH-CLQ showed blocking activity against some potassium, sodium, and calcium currents. CLQ and OH-CLQ inhibited IKr (half-maximal inhibitory concentration [IC50 ]: 1 µM and 3-7 µM, respectively) and IK1 currents (IC50 : 5 and 44 µM, respectively). When combining OH-CLQ with AZI, no synergistic effects were observed. The two macrolides had no or very weak effects on the ion currents (IC50 > 300-1000 µM). Using Virtual Assay, both antimalarials affected several TdP indicators, CLQ being more potent than OH-CLQ. Effects were more pronounced in the high-risk cell population. In hiPSC-derived cardiomyocytes, all drugs showed early after-depolarizations, except AZI. Combining CLQ or OH-CLQ with a macrolide did not aggravate their effects. In conclusion, our integrated nonclinical CiPA dataset confirmed that, at therapeutic plasma concentrations relevant for malaria or off-label use in COVID-19, CLQ and OH-CLQ use is associated with a proarrhythmia risk, which is higher in populations carrying predisposing factors but not worsened with macrolide combination.
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Affiliation(s)
| | | | - Warren D. Anderson
- Center for Public Health GenomicsUniversity of VirginiaCharlottesvilleVirginiaUSA
| | | | | | | | | | | | | | | | | | - Derek Leishman
- Eli Lilly and CompanyLilly Corporate CenterIndianapolisIndianaUSA
| | | | - Elisa Passini
- Department of Computer ScienceUniversity of OxfordOxfordUK
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Effects of Acute and Chronic Exposure to Residual Level Erythromycin on Human Intestinal Epithelium Cell Permeability and Cytotoxicity. Microorganisms 2019; 7:microorganisms7090325. [PMID: 31489925 PMCID: PMC6780317 DOI: 10.3390/microorganisms7090325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 08/11/2019] [Accepted: 08/31/2019] [Indexed: 12/16/2022] Open
Abstract
Residual concentrations of erythromycin in food could result in gastrointestinal tract exposure that potentially poses a health-hazard to the consumer, affecting intestinal epithelial permeability, barrier function, microbiota composition, and antimicrobial resistance. We investigated the effects of erythromycin after acute (48 h single treatment with 0.03 μg/mL to 300 μg/mL) or chronic (repeated treatment with 0.3 µg/mL and 300 µg/mL erythromycin for five days) exposures on the permeability of human colonic epithelial cells, a model that mimics a susceptible intestinal surface devoid of commensal microbiota. Transepithelial electrical resistance (TER) measurements indicated that erythromycin above 0.3 µg/mL may compromise the epithelial barrier. Acute exposure increased cytotoxicity, while chronic exposure decreased the cytotoxicity. Quantitative PCR analysis revealed that only ICAM1 (intercellular adhesion molecule 1) was up-regulated during 0.3 μg/mL acute-exposure, while ICAM1, JAM3 (junctional adhesion molecule 3), and ITGA8 (integrin alpha 8), were over-expressed in the 300 μg/mL acute treatment group. However, during chronic exposure, no change in the mRNA expression was observed at 0.3 μg/mL, and only ICAM2 was significantly up-regulated after 300 μg/mL. ICAM1 and ICAM2 are known to be involved in the formation of extracellular matrices. These gene expression changes may be related to the immunoregulatory activity of erythromycin, or a compensatory mechanism of the epithelial cells to overcome the distress caused by erythromycin due to increased permeability.
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7
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Rubirola A, Boleda MR, Galceran MT, Moyano E. Formation of new disinfection by-products of priority substances (Directive 2013/39/UE and Watch List) in drinking water treatment. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:28270-28283. [PMID: 31368066 DOI: 10.1007/s11356-019-06018-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/22/2019] [Indexed: 06/10/2023]
Abstract
The degradation of priority substances (Directive 2013/39/UE and Watch List) by chlorine dioxide (ClO2) and the formation of disinfection by-products (DBPs) in a drinking water treatment plant (DWTP) located near Barcelona (NE Spain) were investigated. For the first time, the reactivity with ClO2 of several compounds frequently found at the entrance of the DWTP such as erythromycin, clarithromycin, chlorpyrifos, and imidacloprid was evaluated in both simulated and real conditions. To identify potential DBPs, experiments were performed at laboratory scale by simulating the operational disinfection conditions in the DWTP. Liquid chromatography coupled with high-resolution mass spectrometry (LC-HRMS) working in full scan and target-MS/HRMS modes was used for the identification of the generated DBPs. Several new DBPs were found, three from erythromycin, one from clarithromycin, two from chlorpyrifos, and one from imidacloprid. Then, the presence and behavior through DWTP treatment of priority substances and their DBPs were investigated in order to evaluate their generation in real working conditions. Two of the potential DBPs, anhydroerythromycin, and N-desmethyl clarithromycin were already identified in the raw water of DWTP, but N-desmethyl clarithromycin was also generated after the chlorine dioxide treatment step. Both compounds were eliminated by the treatments applied in the DWTP; anhydroerythromycin was eliminated after ozonation in the upgraded conventional treatment and after reverse osmosis in the advanced treatment while N-desmethyl clarithromycin is recalcitrant in the upgraded conventional treatment, but it was eliminated by reverse osmosis.
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Affiliation(s)
- Adrià Rubirola
- Aigües de Barcelona, Empresa Metropolitana de Gestió del Cicle Integral de l'Aigua, S.A., General Batet 1-7, 08028, Barcelona, Spain
| | - Mª Rosa Boleda
- Aigües de Barcelona, Empresa Metropolitana de Gestió del Cicle Integral de l'Aigua, S.A., General Batet 1-7, 08028, Barcelona, Spain
| | - Mª Teresa Galceran
- Department of Chemical Engineering and Analytical Chemistry, University of Barcelona, Diagonal 645, 08028, Barcelona, Spain
| | - Encarnación Moyano
- Department of Chemical Engineering and Analytical Chemistry, University of Barcelona, Diagonal 645, 08028, Barcelona, Spain.
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8
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Yi X, Lin C, Ong EJL, Wang M, Zhou Z. Occurrence and distribution of trace levels of antibiotics in surface waters and soils driven by non-point source pollution and anthropogenic pressure. CHEMOSPHERE 2019; 216:213-223. [PMID: 30368086 DOI: 10.1016/j.chemosphere.2018.10.087] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/09/2018] [Accepted: 10/14/2018] [Indexed: 06/08/2023]
Abstract
Antibiotics in surface waters and soils are growing public health concerns and treated wastewater has often been identified as the main source of antibiotics. However, few studies have been conducted to evaluate the occurrence and concentrations of antibiotics in coastal cities without direct impact of wastewater discharge. In this study, the occurrence of 14 antibiotics including four macrolides, three sulfonamides, three β-lactams, lincomycin, chloramphenicol, furazolidon, and monensin in surface waters and soils in Singapore were analyzed with SPE-LC-ESI-MS/MS. The detected concentrations of antibiotics were all below 82.5 ng/L in surface waters and below 80.6 ng/g dry wt in soils. These concentrations were significantly lower than other cities that were under the impact of treated wastewater discharge, suggesting that reduction of treated wastewater discharge reduces occurrence of antibiotics in the environment. However, the wide occurrence of trace levels of antibiotics suggest that other factors may have contributed to detected environmental antibiotics. Population density was positively correlated with concentrations of clarithromycin, lincomycin, azithromycin, and sulfamethoxazole in surface waters, suggesting that non-point source pollution due to anthropogenic pressure may contribute to the wide detection of trace levels of antibiotics. The potential impact of antibiotic use, natural production, and half-lives of antibiotics were further discussed. Further studies are needed to evaluate how anthropogenic activities other than wastewater discharge may contribute to the occurrence of trace level antibiotics and their associated health risks in urban environments.
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Affiliation(s)
- Xinzhu Yi
- School of Life Sciences, South China Normal University, Guangzhou, Guangdong, 510631, China
| | - Chenghui Lin
- Department of Civil and Environmental Engineering, National University of Singapore, 117411, Singapore
| | - Eugene Jie Li Ong
- Department of Civil and Environmental Engineering, National University of Singapore, 117411, Singapore
| | - Mian Wang
- Lyles School of Civil Engineering and Division of Environmental and Ecological Engineering, Purdue University, 550 Stadium Mall Drive, West Lafayette, IN, 47907, United States
| | - Zhi Zhou
- Lyles School of Civil Engineering and Division of Environmental and Ecological Engineering, Purdue University, 550 Stadium Mall Drive, West Lafayette, IN, 47907, United States.
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9
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Pea F. Intracellular Pharmacokinetics of Antibacterials and Their Clinical Implications. Clin Pharmacokinet 2017. [DOI: 10.1007/s40262-017-0572-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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10
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Kiang TKL, Häfeli UO, Ensom MHH. A comprehensive review on the pharmacokinetics of antibiotics in interstitial fluid spaces in humans: implications on dosing and clinical pharmacokinetic monitoring. Clin Pharmacokinet 2015; 53:695-730. [PMID: 24972859 DOI: 10.1007/s40262-014-0152-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The objective of the current review was to provide an updated and comprehensive summary on pharmacokinetic data describing the distribution of antimicrobials into interstitial fluid (ISF) by comparing drug concentration versus time profiles between ISF and blood/plasma in healthy individuals and/or diseased populations. An extensive literature search identified 55 studies detailing 87 individual comparisons. For each antibiotic (antibacterial) (or antibiotic class), we comment on dosing implications based on tissue ISF distribution characteristics and determine the suitability of conducting clinical pharmacokinetic monitoring (CPM) using a previously published scoring algorithm. Using piperacillin as an example, there is evidence supporting different degrees of drug penetration into the ISF of different tissues. A higher dose of piperacillin may be required to achieve an adequate ISF concentration in soft tissue infections. To achieve these higher doses, alternative administration regimens such as intravenous infusions may be utilized. Data also suggest that piperacillin can be categorized as a 'likely suitable' agent for CPM in ISF. Regression analyses of data from the published studies, including protein binding, molecular weight, and predicted partition coefficient (using XlogP3) as dependent variables, indicated that protein binding was the only significant predictor for the extent of drug distribution as determined by ratios of the area under the concentration-time curve between muscle ISF/total plasma (R (2) = 0.65, p < 0.001) and adipose ISF/total plasma (R (2) = 0.48, p < 0.004). Although recurrent limitations (i.e., small sample size, lack of statistical comparisons, lack of steady-state conditions, high individual variability) were identified in many studies, these data are still valuable and allowed us to generate general dosing guidelines and assess the suitability of using ISF for CPM.
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Affiliation(s)
- Tony K L Kiang
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada
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11
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Importance of relating efficacy measures to unbound drug concentrations for anti-infective agents. Clin Microbiol Rev 2013; 26:274-88. [PMID: 23554417 DOI: 10.1128/cmr.00092-12] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
For the optimization of dosing regimens of anti-infective agents, it is imperative to have a good understanding of pharmacokinetics (PK) and pharmacodynamics (PD). Whenever possible, drug efficacy needs to be related to unbound concentrations at the site of action. For anti-infective drugs, the infection site is typically located outside plasma, and a drug must diffuse through capillary membranes to reach its target. Disease- and drug-related factors can contribute to differential tissue distribution. As a result, the assumption that the plasma concentration of drugs represents a suitable surrogate of tissue concentrations may lead to erroneous conclusions. Quantifying drug exposure in tissues represents an opportunity to relate the pharmacologically active concentrations to an observed pharmacodynamic parameter, such as the MIC. Selection of an appropriate specimen to sample and the advantages and limitations of the available sampling techniques require careful consideration. Ultimately, the goal will be to assess the appropriateness of a drug and dosing regimen for a specific pathogen and infection.
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12
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Blood, tissue, and intracellular concentrations of azithromycin during and after end of therapy. Antimicrob Agents Chemother 2013; 57:1736-42. [PMID: 23357769 DOI: 10.1128/aac.02011-12] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Although azithromycin is extensively used in the treatment of respiratory tract infections as well as skin and skin-related infections, pharmacokinetics of azithromycin in extracellular space fluid of soft tissues, i.e., one of its therapeutic target sites, are not yet fully elucidated. In this study, azithromycin concentration-time profiles in extracellular space of muscle and subcutaneous adipose tissue, but also in plasma and white blood cells, were determined at days 1 and 3 of treatment as well as 2 and 7 days after the end of treatment. Of all compartments, azithromycin concentrations were highest in white blood cells, attesting for intracellular accumulation. However, azithromycin concentrations in both soft tissues were markedly lower than in plasma both during and after treatment. Calculation of the area under the concentration-time curve from 0 to 24 h (AUC(0-24))/MIC(90) ratios for selected pathogens suggests that azithromycin concentrations measured in the present study are subinhibitory at all time points in both soft tissues and at the large majority of observed time points in plasma. Hence, it might be speculated that azithromycin's clinical efficacy relies not only on elevated intracellular concentrations but possibly also on its known pleotropic effects, including immunomodulation and influence on bacterial virulence factors. However, prolonged subinhibitory azithromycin concentrations at the target site, as observed in the present study, might favor the emergence of bacterial resistance and should therefore be considered with concern. In conclusion, this study has added important information to the pharmacokinetic profile of the widely used antibiotic drug azithromycin and evidentiates the need for further research on its potential for induction of bacterial resistance.
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Zarogoulidis P, Darwiche K, Tsakiridis K, Teschler H, Yarmus L, Zarogoulidis K, Freitag L. Learning from the Cardiologists and Developing Eluting Stents Targeting the Mtor Pathway for Pulmonary Application; A Future Concept for Tracheal Stenosis. J Mol Genet Med 2013; 7:65. [PMID: 24454525 PMCID: PMC3896392 DOI: 10.4172/1747-0862.1000065] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Tracheal stenosis due to either benign or malignant disease is a situation that the pulmonary physicians and thoracic surgeons have to cope in their everyday clinical practice. In the case where tracheal stenosis is caused due to malignancy mini-interventional interventions with laser, apc, cryoprobe, balloon dilation or with combination of more than one equipment and technique can be used. On the other hand, in the case of a benign disease such as; tracheomalacia the clinician can immediately upon diagnosis proceed to the stent placement. In both situations however; it has been observed that the stents induce formation of granuloma tissue in both or one end of the stent. Therefore a frequent evaluation of the patient is necessary, taking also into account the nature of the primary disease. Evaluation methodologies identifying different types and extent of the trachea stenosis have been previously published. However; we still do not have an effective adjuvant therapy to prevent granuloma tissue formation or prolong already treated granuloma lesions. There have been proposed many mechanisms which induce the abnormal growth of the local tissue, such as; local pressure, local stress, inflammation and vascular endothelial growth factor overexpression. Immunomodulatory agents inhibiting the mTOR pathway are capable of inhibiting the inflammatory cascade locally. In the current mini-review we will try to present the current knowledge of drug eluting stents inhibiting the mTOR pathway and propose a future application of these stents as a local anti-proliferative treatment.
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Affiliation(s)
- Paul Zarogoulidis
- Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; Department of Interventional Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Kaid Darwiche
- Department of Interventional Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Kosmas Tsakiridis
- Cardiothoracic Surgery Department, "Saint Luke" Private Hospital of Health Excellence, Panorama, Thessaloniki, Greece
| | - Helmut Teschler
- Pulmonary Department, Ruhrlandklinik, West German Lung Center, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Lonny Yarmus
- Division of Pulmonary and Critical Care Medicine, Sheikh Zayed Cardiovascular & Critical Care Tower, Johns Hopkins University, Baltimore, USA
| | - Konstantinos Zarogoulidis
- Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lutz Freitag
- Department of Interventional Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital, University Duisburg-Essen, Essen, Germany
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