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Hanna RM, Sun SF, Gaynor P. A Case of Ertapenem Neurotoxicity Resulting in Vocal Tremor and Altered Mentation in a Dialysis Dependent Liver Transplant Patient. Antibiotics (Basel) 2018; 8:antibiotics8010001. [PMID: 30583507 PMCID: PMC6466552 DOI: 10.3390/antibiotics8010001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 12/14/2018] [Accepted: 12/18/2018] [Indexed: 11/16/2022] Open
Abstract
Carbapenem agents are advanced derivatives of cephalosporins that are active against bacteria that produce extended spectrum beta lactamases (ESBL). These antibiotics are resistant to enzymatic cleavage, and have good central nervous system penetration. Given this fact, it is not surprising that these drugs have been reported to cause neurological side effects like seizures and encephalopathy. We report a case of a patient on hemodialytic support who had a notable change in mentation and vocal tremor. This was at first attributed to calcineurin toxicity, but after the finding of a normal tacrolimus level, ertapenem neurotoxicity was suspected. After discontinuation of the offending agent, the patient’s vocal tremor, cognition, and neurological function returned to baseline levels.
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Affiliation(s)
- Ramy M Hanna
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 700 Tiverton Ave., Los Angeles, CA 90095, USA.
| | - Shih-Fan Sun
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 700 Tiverton Ave., Los Angeles, CA 90095, USA.
| | - Pryce Gaynor
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 700 Tiverton Ave., Los Angeles, CA 90095, USA.
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2
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Tahri A, Ksouda K, Kallel R, Daoud S, Boudawara T, Zeghal KM, Sahnoun Z. A carbapenem antibiotic imipenem/cilastatin induces an oxidative stress-status and gonadotoxic effects in « wistar » rats. Biomed Pharmacother 2017; 95:308-316. [DOI: 10.1016/j.biopha.2017.08.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/30/2017] [Accepted: 08/07/2017] [Indexed: 10/18/2022] Open
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3
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Reversible encephalopathy with photoparoxysmal response during imipenem/cilastatin treatment. J Neurol Sci 2016; 360:23-4. [DOI: 10.1016/j.jns.2015.11.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 11/06/2015] [Accepted: 11/19/2015] [Indexed: 11/21/2022]
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Golchin L, Golchin L, Vahidi AA, Shabani M. Hippocampus and cerebellum function following imipenem treatment in male and female rats: evaluation of sex differences during developmental stage. Pak J Biol Sci 2013; 16:151-159. [PMID: 24171262 DOI: 10.3923/pjbs.2013.151.159] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The B-Lactam antibiotics have been suggested to have some degree of neurotoxicity in experimental animals as well as in clinical situations. This study has been elucidated the alteration in hippocampal and cerebellum function following adolescent imipenem exposure in male and female rats. Hippocampus and cerebellum related behavioral dysfunction in imipenem -treated [intraperitoneally, 40 and 80 mg/kg/day for one week from 23-day-old] rats were analyzed using explorative, motor function, learning and memory tasks [grasping, rotarod, open field shuttle box and Morris water maze tests]. Exposure to imipenem especially in high dosage impaired the motor coordination in male and female rats. There weren't any differences in grasping time in male and female rats. When the rearing and grooming frequency of their recorded in open field test, both males and females were dramatically affected by exposure to imipenem. Compared to the saline, male and female rats trained one week after imipenem injection showed significant memory deficits in the shuttle box and Morris water maze tests. Results in this study suggested that animals treated with imipenem suffer from motor activity and cognitive impairment. However, hippocampal and cerebellum functions of male and female rats were profoundly affected by exposure to imipenem while no sex-differences in the most variable were evident.
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Affiliation(s)
- Leila Golchin
- Physiology Research Center, Kerman University of Medical Sciences, Kerman, Iran
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5
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Yoshizawa K, Ikawa K, Ikeda K, Kumon H, Ohge H, Morikawa N. Optimisation of imipenem regimens in patients with impaired renal function by pharmacokinetic-pharmacodynamic target attainment analysis of plasma and urinary concentration data. Int J Antimicrob Agents 2012; 40:427-33. [DOI: 10.1016/j.ijantimicag.2012.06.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 06/21/2012] [Accepted: 06/25/2012] [Indexed: 10/28/2022]
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6
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Marchand S, Dahyot C, Lamarche I, Plan E, Mimoz O, Couet W. Lack of effect of experimental hypovolemia on imipenem muscle distribution in rats assessed by microdialysis. Antimicrob Agents Chemother 2006; 49:4974-9. [PMID: 16304160 PMCID: PMC1315960 DOI: 10.1128/aac.49.12.4974-4979.2005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to investigate the influence of hypovolemia on the distribution of imipenem in muscle extracellular fluid determined by microdialysis in awake rats. Microdialysis probes were inserted into the jugular vein and hind leg muscle. Imipenem recoveries in muscle and blood were determined in each rat by retrodialysis by drug before drug administration. Hypovolemia was induced by removing 40% of the initial blood volume over 30 min. Imipenem was infused intravenously at a dose of 70 mg . kg(-1) over 30 min, and microdialysis samples were collected for 120 min from hypovolemic (n = 8) and control (n = 8) rats. The decay of the free concentrations in blood and muscle with time were monoexponential, and the concentration profiles in muscle and blood were virtually superimposed in both groups. Accordingly, the ratios of the area under the concentration-time curve (AUC) for tissue (muscle) to the AUC for blood were always virtually equal to 1. Hypovolemia induced a 23% decrease in the clearance (P < 0.05) of imipenem, with no statistically significant alteration of its volume of distribution. This study showed that imipenem elimination was altered in hypovolemic rats, probably due to decreased renal blood flow, but its distribution characteristics were not. In particular, free imipenem concentrations in blood and muscle were always virtually identical.
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Affiliation(s)
- Sandrine Marchand
- EA 3809, Faculté de Médecine et de Pharmacie, BP 199, Poitiers Cedex, France
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7
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Marchand S, Dahyot C, Lamarche I, Mimoz O, Couet W. Microdialysis study of imipenem distribution in skeletal muscle and lung extracellular fluids of noninfected rats. Antimicrob Agents Chemother 2005; 49:2356-61. [PMID: 15917533 PMCID: PMC1140500 DOI: 10.1128/aac.49.6.2356-2361.2005] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to investigate the imipenem distribution in muscle and lung interstitial fluids by microdialysis in rats and to compare the free concentrations in tissue with the free concentrations in blood. Microdialysis probes were inserted into the jugular vein, hind leg muscle, and lung. Imipenem recoveries in these three media were determined in each rat by retrodialysis by drug period before drug administration. Imipenem was infused intravenously at a dose of 120 mg . kg-1 over 30 min, and microdialysis samples were collected for 150 min. The whole study was conducted with nonhydrated rats (n=4) and hydrated rats (n=6) while the animals were under isoflurane anesthesia. The decay of free concentrations in blood, muscle, and lung with time were monoexponential; and the concentration profiles in these three media were virtually superimposed in both groups. Accordingly, the ratios of the area under the curve (AUC) for tissue (muscle or lung) to the AUC for blood were always virtually equal to 1. Compared to values previously determined with awake rats, clearance was reduced by 2 and 1.5 in nonhydrated and hydrated rats, respectively, but the volume of distribution was unchanged. By combining microdialysis in blood and tissues, it was possible to demonstrate that free imipenem concentrations were virtually identical in blood, muscle, and lung.
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Affiliation(s)
- Sandrine Marchand
- EA 3809, Faculté de Médecine et de Pharmacie, Poitiers Cedex, France
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Chenel M, Marchand S, Dupuis A, Lamarche I, Paquereau J, Pariat C, Couet W. Simultaneous central nervous system distribution and pharmacokinetic-pharmacodynamic modelling of the electroencephalogram effect of norfloxacin administered at a convulsant dose in rats. Br J Pharmacol 2004; 142:323-30. [PMID: 15155539 PMCID: PMC1574943 DOI: 10.1038/sj.bjp.0705748] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The objective of this study was to investigate the contribution of norfloxacin blood-brain barrier (BBB) transport to its delayed electroencephalogram (EEG) effect in rats. Norfloxacin was injected as a bolus dose of 150 mg kg(-1). Blood samples were collected for total norfloxacin plasma concentration measurements. The corresponding unbound levels were determined in brain extracellular fluid (ECF) using microdialysis. Quantitative EEG recording was conducted during 9 h post-dose. Brain ECF norfloxacin concentrations were much lower than plasma levels (AUC ratio=9.7+/-2.8%) but peaked very early, and concentration versus time profiles were parallel in both biological fluids. The best pharmacokinetic (PK) modelling was obtained by considering that ECF concentrations were part of the central compartment, with a proportionality factor. The peak of EEG effect was delayed and the effect versus plasma concentration curves exhibited a dramatic hysteresis. A PK-pharmacodynamic (PD) effect compartment model with a spline function to describe the relationship between effect and concentration at the effect site successfully described the data. Comparisons of PK-PD parameters estimated from plasma and ECF concentrations show that most of the delayed norfloxacin EEG effect is not due to BBB transport, but also that PD parameters derived from plasma data must be carefully interpreted when drug distribution at the effect site is restricted, as may often be the case for centrally acting drugs.
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Affiliation(s)
- Marylore Chenel
- EE Médicaments anti-infectieux et barrière hémato-encéphalique, PBS, Faculté de Médecine & Pharmacie, 40 avenue du Recteur Pineau, 86022 Poitiers Cedex, France
- Laboratoire de Pharmacocinétique, PBS, CHU La Milétrie, 86022 Poitiers Cedex, France
| | - Sandrine Marchand
- EE Médicaments anti-infectieux et barrière hémato-encéphalique, PBS, Faculté de Médecine & Pharmacie, 40 avenue du Recteur Pineau, 86022 Poitiers Cedex, France
| | - Antoine Dupuis
- EE Médicaments anti-infectieux et barrière hémato-encéphalique, PBS, Faculté de Médecine & Pharmacie, 40 avenue du Recteur Pineau, 86022 Poitiers Cedex, France
- Pharmacie Centrale, CHU La Milétrie, 86022 Poitiers Cedex, France
| | - Isabelle Lamarche
- EE Médicaments anti-infectieux et barrière hémato-encéphalique, PBS, Faculté de Médecine & Pharmacie, 40 avenue du Recteur Pineau, 86022 Poitiers Cedex, France
| | - Joël Paquereau
- Equipe Sommeil: Attention et Respiration, PBS, Faculté de Médecine & Pharmacie, 86022 Poitiers Cedex, France
| | - Claudine Pariat
- EE Médicaments anti-infectieux et barrière hémato-encéphalique, PBS, Faculté de Médecine & Pharmacie, 40 avenue du Recteur Pineau, 86022 Poitiers Cedex, France
| | - William Couet
- EE Médicaments anti-infectieux et barrière hémato-encéphalique, PBS, Faculté de Médecine & Pharmacie, 40 avenue du Recteur Pineau, 86022 Poitiers Cedex, France
- Author for correspondence: .
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9
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Brochot C, Marchand S, Couet W, Gelman A, Bois FY. Extension of the isobolographic approach to interactions studies between more than two drugs: illustration with the convulsant interaction between pefloxacin, norfloxacin, and theophylline in rats. J Pharm Sci 2004; 93:553-62. [PMID: 14762894 DOI: 10.1002/jps.10574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This work proposes a model to characterize the additivity or the nonadditivity of combinations of more than two agents. Using a Bayesian framework, we modeled the variability between experimental subjects, the errors that occurred during data collection, and the relationship between effects and concentrations of agents at the effect site. The model was used to characterize the additivity (or non-additivity) of norfloxacin, pefloxacin, and theophylline in causing maximal seizures in male Sprague Dawley rats. Animals received the drugs separately or in various combinations. Drug infusion was stopped at the onset of maximal seizures, and cerebrospinal fluid samples were collected for determination of drug concentration by high-performance liquid chromatography. The model was fitted to concentration data using Markov Chain Monte Carlo techniques. Results showed that induction of seizures by mixtures of theophylline and pefloxacin were additive. Seizure induction by mixtures of norfloxacin and pefloxacin or norfloxacin and theophylline were not additive and, given the model, these drugs interacted negatively. There was no triple interaction effect between the drugs. This study demonstrates the ease with which mixtures of more than two drugs can be analyzed with the proposed model.
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Affiliation(s)
- Céline Brochot
- Institut National de l'Environnement Industriel et des Risques, Unité de Toxicologie Expérimentale, Parc Alata, BP2, 60550 Verneuil-En-Halatte, France
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Chenel M, Limosin A, Marchand S, Paquereau J, Mimoz O, Couet W. Norfloxacin-induced electroencephalogram alteration and seizures in rats are not triggered by enhanced levels of intracerebral glutamate. Antimicrob Agents Chemother 2004; 47:3660-2. [PMID: 14576142 PMCID: PMC253770 DOI: 10.1128/aac.47.11.3660-3662.2003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Pharmacokinetic-pharmacodynamic modeling of the electroencephalogram (EEG) effect was combined with intracerebral glutamate determinations using microdialysis for rats receiving norfloxacin intravenously (150 mg/kg of body weight). The EEG effect (accompanied by tremors and seizures) was consistently observed without glutamate level modifications. Therefore, norfloxacin-inducted seizures are not triggered by intracerebral glutamate level enhancement.
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Affiliation(s)
- Marylore Chenel
- Equipe Médicaments anti-infectieux et barrière hémato-encéphalique, PBS, Faculté de Médecine & Pharmacie, and Laboratoire de Pharmacocinétique, PBS, CHU La Milétrie, 86022 Poitiers Cedex, France
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11
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Liu Q, Rand K, Derendorf H. Impact of tazobactam pharmacokinetics on the antimicrobial effect of piperacillin–tazobactam combinations. Int J Antimicrob Agents 2004; 23:494-7. [PMID: 15120729 DOI: 10.1016/j.ijantimicag.2003.10.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2003] [Accepted: 10/29/2003] [Indexed: 10/26/2022]
Abstract
Pharmacokinetic-pharmacodynamic (PK-PD) modelling was used to study the impact of the pharmacokinetics of tazobactam on the antimicrobial effect of piperacillin-tazobactam combinations. An in vitro experiment using a novel dilution system was performed to compare the effects of two conditions of the combination therapy against Escherichia coli ATCC35218, a beta-lactamase producing bacterium. Both conditions simulated the same initial concentrations of piperacillin and tazobactam, but different elimination half-lives for tazobactam. The killing and regrowth kinetics of E. coli clearly indicated that there is a difference in the antimicrobial effects when there is a difference in the pharmacokinetics of tazobactam in the combination therapy. The results show that for equal piperacillin exposure, different tazobactam half-lives will have a significant effect on antimicrobial outcome.
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Affiliation(s)
- Q Liu
- Department of Pharmaceutics, College of Pharmacy, University of Florida, 1600 SW Archer Road, P.O. Box 100494, Gainesville, FL 32610, USA
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Fernández-Torre JL, Velasco M, Gutiérrez R, Fernández-Sampedro M. Encephalopathy secondary to imipenem therapy. Clin EEG Neurosci 2004; 35:100-3. [PMID: 15164819 DOI: 10.1177/155005940403500210] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We describe the case of an 84-year-old woman who developed a confusional state and suffered from a generalized tonic-clonic seizure while she was treated with imipenem, a beta-lactam antibiotic. Focal and generalized epileptiform discharges and a photoparoxysmal response were prominent with transient changes on the EEG.
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Affiliation(s)
- J L Fernández-Torre
- Department of Clinical Neurophysiology, Hospital Universitario "Marqués de Valdecilla", Santander, Cantabria, Spain.
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Chenel M, Barbot A, Dupuis A, Mimoz O, Paquereau J, Bouquet S, Couet W. Pharmacokinetic-pharmacodynamic modeling of the electroencephalogram effect of norfloxacin in rats. Antimicrob Agents Chemother 2003; 47:1952-7. [PMID: 12760873 PMCID: PMC155845 DOI: 10.1128/aac.47.6.1952-1957.2003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A previously developed pharmacokinetic-pharmacodynamic (PK-PD) modeling approach was used to investigate the epileptogenic activity of norfloxacin as a representative antibiotic with concentration-dependent antimicrobial activity. Rats received an intravenous infusion of norfloxacin at a rate of 5 mg kg of body weight(-1) min(-1) over 30 min. Blood samples were collected for drug assay, and an electroencephalogram (EEG) was recorded during infusion and postinfusion. An important delay was observed between concentrations of norfloxacin in plasma and the EEG effect. Indirect effect models failed to describe these data, which were successfully fitted by using an effect compartment model with a spline function to describe the relationship between effect and concentration at the effect site, as previously observed with imipenem. The robustness of the PK-PD model was then assessed by keeping the dose constant but increasing the duration of infusion to 120 and 240 min. Although this was accompanied by PK modifications, PD parameters did not vary significantly, and the PK-PD model still applied. In conclusion, the successful PK-PD modeling of the norfloxacin EEG effect in rats should be considered to predict and reduce the epileptogenic risk associated with this antibiotic as a representative fluoroquinolone (E. Fuseau and L. B. Sheiner, Clin. Pharmacol. Ther. 35:733-741, 1984).
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Affiliation(s)
- Marylore Chenel
- EE Médicaments Anti-Infectieux et Barrière Hémato-Encéphalique, PBS, Faculté de Médecine & Pharmacie, 86022 Poitiers Cedex, France
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Dupuis A, Limosin A, Paquereau J, Mimoz O, Couet W, Bouquet S. Pharmacokinetic-pharmacodynamic modeling of electroencephalogram effect of imipenem in rats with acute renal failure. Antimicrob Agents Chemother 2001; 45:3607-9. [PMID: 11709350 PMCID: PMC90879 DOI: 10.1128/aac.45.12.3607-3609.2001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The epileptogenic activity of imipenem was investigated in rats with experimental renal failure induced by uranyl nitrate injection by using electroencephalogram (EEG) recording and a pharmacokinetic-pharmacodynamic model including an effect compartment. Results previously obtained with healthy rats were used to estimate the dose of imipenem required to induce an observable but nonlethal EEG effect on the assumption that only the pharmacokinetic parameters of the model would be affected by renal failure. Good agreement was observed between the predicted and observed effects.
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Affiliation(s)
- A Dupuis
- Laboratoire de Biopharmacie, Faculté de Médecine & Pharmacie, Poitiers, France
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