Application of microbiological assay to determine pharmaceutical equivalence of generic intravenous antibiotics

Antimicrobial and Hemostatic Diatom Biosilica Composite Sponge

The 3D nanopatterned silica shells of diatoms have gained attention as drug delivery vehicles because of their high porosity, extensive surface area, and compatibility with living organisms. Tooth extraction may result in various complications, including impaired blood clotting, desiccation of the root canal, and infection. Therapeutic sponges that possess multiple properties, such as the ability to stop bleeding and kill bacteria, provide numerous advantages for the healing of the area where a tooth has been removed. This study involved the fabrication of a composite material with antibacterial and hemostatic properties for dental extraction sponges. We achieved this by utilizing the porous nature and hemostatic capabilities of diatom biosilica. The antibiotic used was doxycycline. The gelatin-based diatom biosilica composite with antibiotics had the ability to prevent bleeding and release the antibiotic over a longer time compared to gelatin sponge. These properties indicate its potential as a highly promising medical device for facilitating rapid healing following tooth extraction.

Pharmacokinetic/Pharmacodynamic Index Linked to In Vivo Efficacy of the Ampicillin-Ceftriaxone Combination against Enterococcus faecalis

Combination therapy with ampicillin plus ceftriaxone (AMP+CRO) is the first-line therapy for treating severe infections due to Enterococcus faecalis. However, the pharmacokinetic/pharmacodynamic (PK/PD) index linked to the in vivo efficacy of the combination is not yet defined, hindering dose optimization in the clinic. Because classical PK/PD indices are not directly applicable to antimicrobial combinations, two novel indices were tested in the optimized murine model of infection by E. faecalis to delineate the potentiation of AMP by CRO: the time above the CRO threshold (T_>threshold) and the time above the AMP instantaneous MIC (T_>MICi). The potential clinical relevance was evaluated by simulating human doses of AMP and CRO. Hill's equation fitted well the exposure-response data in terms of T_>threshold, with a CRO threshold of 1 mg/L. The required exposures were 46%, 49%, and 52% for stasis and 1- and 2-log₁₀ killing, respectively. Human ceftriaxone doses of 2 g every 12 h (q12h) would reach the target in >90% of strains with thresholds ≤64 mg/L. The AMP T_>MICi index also fitted well, and the required exposures were 37%, 41%, and 46% for stasis and 1- and 2-log₁₀ killing, respectively. In humans, the addition of CRO would allow use of lower AMP doses to reach the same T_>MICi and to treat strains with higher MICs. This is the first report of the PK/PD indices and required magnitudes linked to AMP+CRO against E. faecalis; these results can be used as the basis to guide the design of clinical trials to improve combined therapy against enterococci.

A simple and rapid HPLC-MS/MS method for therapeutic drug monitoring of amikacin in dried matrix spots

Individualized treatment of amikacin under the guidance of therapeutic drug monitoring (TDM) is important to reduce the occurrence of toxicity and improve clinical efficacy. In the present study, we developed and validated a simple and high-throughput liquid chromatography-tandem mass spectrometry (LC-MS/MS) method to determine the concentration of amikacin in dried matrix spots (DMS) which the matrix is serum. DMS samples were obtained by spotting volumetric blood onto Whatman 903® cards. Samples were punched into 3 mm diameter discs and extracted with 0.2 % formic acid in water. The HILIC column (2.1 mm × 100 mm, 3.0 µm) under gradient elution was applied, and the analysis time was 3 min per injection. The mass spectrometry transitions were m/z 586.3 → 163.0 for amikacin and m/z 591.4 → 163.1 for D5-amikacin. Full validation was conducted for DMS method, and the method was applied for the amikacin TDM and compared with serum method. The linearity was ranged from 0.5 to 100 mg/L. Both within-run and between-run accuracy and precision of DMS ranged from 91.8 % to 109.6 % and 3.6 % to 14.2 %, respectively. The matrix effect was 100.5 %-106.5 % of DMS method. Amikacin remained stable in DMS for at least 6 days at room temperature, 16 days at 4 °C, 86 days at -20 °C and -70 °C. A good agreement between the DMS method and serum method has been shown in Bland-Altman plots and Passing-Bablok regression. All of the results demonstrated that the DMS methods can be a favorable replacement for amikacin TDM.

Erythromycin Formulations—A Journey to Advanced Drug Delivery

Erythromycin (ERY) is a macrolide compound with a broad antimicrobial spectrum which is currently being used to treat a large number of bacterial infections affecting the skin, respiratory tract, intestines, bones and other systems, proving great value from a clinical point of view. It became popular immediately after its discovery in 1952, due to its therapeutic effect against pathogens resistant to other drugs. Despite this major advantage, ERY exhibits several drawbacks, raising serious clinical challenges. Among them, the very low solubility in water and instability under acidic conditions cause a limited efficacy and bioavailability. Apart from this, higher doses promote drug resistance and undesirable effects. In order to overcome these disadvantages, during the past decades, a large variety of ERY formulations, including nanoparticles, have emerged. Despite the interest in ERY-(nano)formulations, a review on them is lacking. Therefore, this work was aimed at reviewing all efforts made to encapsulate ERY in formulations of various chemical compositions, sizes and morphologies. In addition, their preparation/synthesis, physico-chemical properties and performances were carefully analysed. Limitations of these studies, particularly the quantification of ERY, are discussed as well.

Solidified Reverse Micellar Solution- (SRMS-) Based Microparticles for Enhanced Oral Bioavailability and Systemic Antifungal Efficacy of Miconazole Nitrate in Immunocompromised Mice

Purpose. To assess the improvement in oral bioavailability and efficacy in systemic candidiasis treatment of miconazole nitrate (MN) formulations in murine models of candidiasis. Methods. Selected formulations containing 5% of $\text{Softisan}+\text{Phospholipon}$ 90H lipid matrix with 3% of MN ( $A_1$ ), 5% of $\text{stearic}\text{acid}+\text{Phospholipon}$ 90H lipid matrix with 3% of MN ( $B_1$ ), and 5% $\text{Softisan}+\text{stearic}\text{acid}+\text{Phospholipon}$ 90H with 3% of MN ( $C_1$ ) from the in vitro investigation were used for the study. Their acute toxicity was assessed using Lorke’s method (with slight modification) while bioavailability was determined using the bioassay method. The optimized batch ( $A_1$ ) was tested in murine systemic candidiasis induced in cyclophosphamide-immunosuppressed mice. The mice were treated with a single oral dose (100 mg/kg) of the formulations for five days. Serum fungal counts (cfu/mL) were determined on days 1, 3, and 5 of the treatment period. Haematological assessments were done. Results. The lipid formulations were safer than MN powder with LD50 values of 3162.8 and 1118.3 mg/kg. Bioavailability determination revealed a higher area under the curve (AUC) value for formulations $A_1$ (6.11 μg/hr/mL) and $B_1$ (4.91 μg/hr/mL) while formulation $C_1$ (1.80 μg/hr/mL) had a lower AUC than MN (4.46 μg/hr/mL). Fungi were completely cleared from the blood of animals treated with the optimized formulation by day 3 as opposed to the controls (MN and Tween® 20) which still had fungi on day 5. No significant increase ( $p>0.05$ ) in haematological parameters was observed in mice treated with $A_1$ . Conclusion. Formulation $A_1$ successfully cleared Candida albicans from the blood within a shorter period than miconazole powder. This research has shown the potential of orally administered MN-loaded SRMS-based microparticles in combating systemic candidaemia.

Intensity of statin therapy and muscle symptoms: a network meta-analysis of 153 000 patients

OBJECTIVE

To estimate relative risk (RR) of statin-associated musculoskeletal symptoms by statin therapy intensity.

SETTING

Network meta-analysis assessing multicentre randomised controlled trials (RCTs) across several countries.

PARTICIPANTS

PubMed, Web of Science, Cochrane database and ClinicalTrials.gov were searched through January 2021 for doubled-blinded RCTs testing the effect of statin therapy on lipids with at least 1000 participants and 2 years of intended treatment. Two coders assessed articles for final inclusion, quality and outcomes. Treatment intensity was categorised according to American Heart Association definitions.

OUTCOMES

Pairwise and network meta-analysis (NMA) estimated RR and risk difference with random effects modelling. Heterogeneity was evaluated with the I² statistic. Outcomes included muscle symptoms (any, myalgia and attrition due to muscle symptoms), rhabdomyolysis and elevated creatine kinase (CK) (>10 × upper limit of normal).

RESULTS

Of 2919 RCTs, 24 (n=152 461) met inclusion criteria. NMA results indicated risk was significantly greater for high compared with moderate intensity statin therapy for any muscle problem (RR=1.04, 95% CI 1.00 to 1.07; I²=0%), myalgia (RR=1.04, 95% CI 1.00 to 1.08; I²=0%, number needed to harm (NNH)=173), attrition due to muscle problems (RR=1.37, 95% CI 1.09 to 1.73, I²=0%, NNH=218) and elevated CK (RR=4.69, 95% CI 2.50 to 8.80; I²=7%, NNH=527). Risk also was significantly higher for high intensity compared with placebo for any muscle problem (RR=1.05, 95% CI 1.01 to 1.09, I²=0%), myalgia (RR=1.13, 95% CI 1.05 to 1.23; I²=0%, NNH=182), attrition due to muscle problems (RR=1.55, 95% CI 1.15 to 2.08, I²=0%, NNH=187) and elevated CK (RR=5.37, 95% CI 2.48 to 11.61; I²=7%, NNH=589). Due to inconsistency of results across sensitivity analyses, estimates were inconclusive for rhabdomyolysis and CK. There were no significant differences in risk between moderate intensity therapy and placebo for all outcomes.

CONCLUSIONS

For approximately each 200 patients on high intensity statins, one additional patient may experience myalgia or discontinue therapy due to muscle problems compared with moderate intensity therapy.

TRIAL REGISTRATION NUMBER

CRD42019112758.

Potential Antibacterial Activity of Bioactive β-sitosterol from Root Bark of Rhizophora apiculata from Lampung Coastal

β-sitosterol is an essential bioactive phytosterol naturally present in plant cell membranes. It has a coincident structure with animal cholesterol. This investigation reported isolation, structure analysis, and an antimicrobial assay of β-sitosterol from the root bark of Bakau Minyak (Rhizophora apiculata) from Lampung coastal. The isolation of β-sitosterol was carried out through maceration using methanol, separation by vacuum liquid chromatography (VLC), and purification by column chromatography (CC) using ethyl acetate/n-hexane (2:8) as eluent. The structure of β-sitosterol was determined using spectroscopic analysis (UV-Vis, FT-IR, 13C-NMR, 1H-NMR, DEPT, and GC-MS). The pure β-sitosterol has 107.4 mg of white needle crystalline compound, the compound melting point about 140.7-141.2oC, the molecular mass confirmed by m/z 414, and UV absorption detected at λ 203.9 nm. The β-sitosterol antimicrobial bioactivity assay has shown potential activity to be developed as a lead compound against E. coli.

Development and application of a spectrophotometric method in quality evaluation of benzimidazole anthelminthics in Nairobi city county

Background

Neglected tropical diseases (NTDs) are a group of communicable diseases which are prevalent in the tropics affecting more than one billion people. Treatment and prevention of these infections is very costly to developing economies. Helminthiases are classified among NTDs. The communities afflicted are poor and have limited access to essential resources for their livelihood. Poor-quality drugs for NTDs may lead to death or prolonged treatment without achieving the desired results. The limited resources used in purchasing poor-quality drugs will therefore be wasted instead of being put to good use.

Most of the methods available for the analysis of benzimidazole anthelminthics utilize high-performance liquid chromatography. They are therefore time consuming, require sophisticated and expensive equipment, utilize rare and expensive reagents and solvents, and call for skilled personnel. A simple, rapid, and inexpensive ultraviolet spectrophotometric method of analysis would therefore come in handy especially in the analysis of many samples as occurs during post-authorization market surveillance for quality.

Results

The suitable solvent for the spectroscopic analysis was established as 0.1 M methanolic HCl. The wavelength of analysis was set at 294 nm. Upon validation, the method was found to have good linearity. The range over which linearity was established was way beyond the 80 to 120% of the working concentration specified by the ICH. The method exhibited good precision.

Out of 32 commercial samples analyzed, five (15.6%) did not comply with compendial specifications. Intra-brand batch variation was also observed. Out of three batches of product A002T analyzed, one did not comply with compendial specifications.

Conclusion

A major limitation in the analysis of benzimidazole anthelminthics is the lack of reliable, simple, rapid, and low-cost methods of analysis with high throughput. The developed method serves to fill this gap. It can be used in the analysis of raw materials and finished products. It can also be used in the establishment of the quality of products prior to registration. The method will prove very useful in post-market surveillance of quality of benzimidazole anthelminthics.

Turbidimetric Method: A New, Ecological, and Fast Way to Evaluate of Vancomycin Potency

Background

Vancomycin, an antimicrobial, has many microbiological methods in literature, but it was not found any that follows the green chemistry principles.

Objective

The aim of this work was to develop and validate a new microbiological analytical method with a green view to determine the vancomycin potency in lyophilized powder using less quantity of diluents and culture medium, minimizing the costs and reducing the time of analysis.

Methods

The objective will be achieved using the microbiological method by turbidimetry.

Results

Water was used as the diluent to prepare the vancomycin solution. BHI broth as used as culture media for the growth of the S. aureus ATCC 25923. The method was linear in the range of 30, 39 and 50.7 µg/mL. It was selective, with vancomycin reference and sample absorbance values very similar. The precision of the method was proved at intraday (RSD 4.42 %), interday (RSD 3.56 %) and intermediate levels (RSD 2.03%). It was accurate with mean recovery of 100.71 % and robust when changes were performed in three parameters of the method and analyzed by the F-Test and t-Test.

Conclusions

The method for evaluating the potency of vancomycin in pharmaceutical product was successfully developed and validated.

Highlights

The method can be applied to routine quality control of vancomycin product as an alternative that contemplates the green analytical chemistry and the current pharmaceutical analyzes.

A Status Update on Pharmaceutical Analytical Methods of Aminoglycoside Antibiotic: Amikacin

Amikacin (AMK) is one of the commonly used aminoglycoside antibiotics, introduced for clinical use in patients suffering from bacterial infections especially life-threatening gram-negative infections. Due to lack of chromophore in the molecule, the detection of AMK during analysis is a challenge. Thus, pre and post-column derivatization techniques are generally used for AMK estimation. This review focuses on different analytical methods used for detection and quantification of AMK in pure or fixed dose combination pharmaceutical formulations and biological samples. Various reported methods described in the literature include high-performance liquid chromatography techniques, pulsed electrochemical detection techniques, Chemiluminescence techniques, Capillary electrophoresis and immunological methods. High-performance-liquid-chromatography based methods with UV/Vis spectrophotometric, fluorescence and mass spectrometric detection are the most prevailing methods employed for the analysis of AMK. This review could be of significant importance in the area of future AMK analytical method development studies.

Analysis of the Antifungal Properties of Bacillus velezensis B-4 Through a Bioassay and Complete-Genome Sequencing

The strain B-4, isolated from a field in Changsha (China), presents strong antifungal activities, as identified by the Kirby–Bauer test, especially for pathogens that harm crops. Here, we obtained the complete genome sequence of the strain B-4 by Pacific Biosciences single-molecule real-time sequencing, making it well analyzed for understanding mechanisms and creating biological agents. Its 3,919-kb circular chromosome genome has 3,725 protein-coding genes [coding sequences (CDSs)] and 46.7% guanine–cytosine content. A comparative genome analysis of B-4 with other published strains (including Bacillus velezensis, Bacillus amyloliquefaciens, and Bacillus subtilis) revealed that the strain B-4 is a B. velezensis strain. These different strains have 2,889 CDSs in common, whereas 179 CDSs were found to be unique in the strain B-4, which is a far greater number than that in other strains. Regarding the antifungal activities of B-4, we were specifically concerned with the genes involved in the biosynthesis of secondary metabolites. In total, more than 19.56% of the genome was annotated to 12 gene clusters relating to synthesis of antimicrobial metabolites, which contained various enzyme-encoding operons for non-ribosomal peptide synthetases, polyketide synthases, and lantipeptide synthesis proteins. They were all considered to be related to the production of bacteriostatic substances or stimulation of induced systemic resistance by bacterial metabolites. These situations also present an advantage over those of other strains for biocontrol potential. We provide evidence that the biological control effect of the strain B-4, as demonstrated in antibacterial activity experiments and predicted from the complete genome sequence analysis, provides the basis for research promoting agricultural research on sustainable development, especially the contribution of biotechnology to agriculture.

Current Status of Vancomycin Analytical Methods

BACKGROUND

The glycopeptide antibiotics are a class of antimicrobial drugs that are an important alternative for cases of bacterial infections resistant to penicillins, besides being able to be used to treat infections in people allergic to pencilin. They have great activity against Gram-positive microorganisms, including methicillin-resistant Staphylococcus aureus (MRSA), by inhibiting the cell wall synthesis.

OBJECTIVE

There are many analytical methods in the literature for determination of antimicrobial glycopeptide vancomycin in different matrixes that are very effective; however, all of them use toxic solvents, contributing to the generation of waste, causing damage to the environment and to the operator, as well as increased costs of analysis.

RESULTS

The most prevailing method found was high performance liquid chromatography (HPLC), followed by microbiological assays and, in less quantity, spectrometric methods. The chromatographic methods use organic solvents that are toxic, such as acetonitrile and methanol, and buffer solutions, that can damage the equipment and the column. In the microbiological assays the disc diffusion methods are still in the majority. The spectrophotometric methods were based in the UV-Vis region using buffer solutions as a diluent.

CONCLUSIONS

All these methods can become greener, following green analytical chemistry principles, which could bring benefits both to the environment and the operator, and reduce costs.

HIGHLIGHTS

In this paper, a literature review regarding analytical methods for determination of vancomycin was carried out with a suggestion of greener alternatives.

Nontherapeutic equivalence of a generic product of imipenem-cilastatin is caused more by chemical instability of the active pharmaceutical ingredient (imipenem) than by its substandard amount of cilastatin

Background

We demonstrated therapeutic nonequivalence of “bioequivalent” generics for meropenem, but there is no data with generics of other carbapenems.

Methods

One generic product of imipenem-cilastatin was compared with the innovator in terms of in vitro susceptibility testing, pharmaceutical equivalence, pharmacokinetic (PK) and pharmacodynamic (PD) equivalence in the neutropenic mouse thigh, lung and brain infection models. Both pharmaceutical forms were then subjected to analytical chemistry assays (LC/MS).

Results and conclusion

The generic product had 30% lower concentration of cilastatin compared with the innovator of imipenem-cilastatin. Regarding the active pharmaceutical ingredient (imipenem), we found no differences in MIC, MBC, concentration or potency or AUC, confirming equivalence in terms of in vitro activity. However, the generic failed therapeutic equivalence in all three animal models. Its E_max against S. aureus in the thigh model was consistently lower, killing from 0.1 to 7.3 million less microorganisms per gram in 24 hours than the innovator (P = 0.003). Against K. pneumoniae in the lung model, the generic exhibited a conspicuous Eagle effect fitting a Gaussian equation instead of the expected sigmoid curve of the Hill model. In the brain infection model with P. aeruginosa, the generic failed when bacterial growth was >4 log₁₀ CFU/g in 24 hours, but not if it was less than 2.5 log₁₀ CFU/g. These large differences in the PD profile cannot be explained by the lower concentration of cilastatin, and rather suggested a failure attributable to the imipenem constituent of the generic product. Analytical chemistry assays confirmed that, besides having 30% less cilastatin, the generic imipenem was more acidic, less stable, and exhibited four different degradation masses that were absent in the innovator.

Serum trough level as a postmarketing quality measure of generic vancomycin products

BACKGROUND

The vancomycin trough level (VTL) is the most widely used pharmacokinetic parameter for monitoring its clinical efficacy. Whether the VTL is affected in patients receiving different vancomycin products has not previously been determined.

METHODS

From 2005 to 2015, five vancomycin products, including the innovator (designated as VAN-Lilly) and four generic versions (designated as VAN-A, VAN-B, VAN-C and VAN-D), were sequentially used in a teaching hospital. The initial VTLs were compared between patients who received different vancomycin products after propensity score (PS) weighting and matching for clinical covariates.

RESULTS

Among 8735 patients with initial VTL levels available for analysis, a significant association was identified between the VTL and different vancomycin products in children aged 1 month to 12 years (P < 0.0001). The PS weighting analysis in the paediatric group disclosed children on VAN-C had higher VTL compared to those on other four products (P = 0.0008). PS matching analysis revealed that children who received VAN-C had significantly higher VTLs than those who received VAN-Lily (P = 0.0001), VAN-A (P = 0.0008), VAN-B (P = 0.0002) or VAN-D (P = 0.0015). Furthermore, the coefficient of variation of the VTL was much greater in patients who received VAN-C than in those who received the other four versions, suggesting an unstable quality of this product.

CONCLUSION

A generic version of vancomycin generated significantly higher concentrations and greater variation of VTLs than the innovator and other generic vancomycin products in children. The VTL can serve as an indicator to monitor the quality of vancomycin products after marketing.

Methods of Rapid Microbiological Assay and Their Application to Pharmaceutical and Medical Device Fabrication

　There are several rapid microbiological methods becoming available that have useful applications in pharmaceutical and medical devices. They are ATP bioluminescence, fluorescent labeling, electrical resistance, and nucleic acid probes. In choosing to employ rapid methods, the microbiologist should examine their prospective performances against the specific requirements for that sector. Some methods may require expensive equipment and offer full automation, and others represent only a small investment. The regulatory view of these methods is changing and they still officially have not been approved in medical and pharmaceutical area, but it will still be up to the microbiologist to demonstrate that the method chosen is fit for the purpose intended.

A prospective, observational study comparing the PK/PD relationships of generic Meropenem (Mercide®) to the innovator brand in critically ill patients

Introduction

Clinicians’ skepticism, fueled by evidence of inferiority of some multisource generic antimicrobial products, results in the underutilization of more cost-effective generics, especially in critically ill patients. The aim of this observational study was to demonstrate equivalence between the generic or comparator brand of meropenem (Mercide^®) and the leading innovator brand (Meronem^®) by means of an ex vivo technique whereby antimicrobial activity is used to estimate plasma concentration of the active moiety.

Methods

Patients from different high care and intensive care units were recruited for observation when prescribed either of the meropenem brands under investigation. Blood samples were collected over 6 hours after a 30 minute infusion of the different brands. Meropenem concentration curves were established against United States Pharmacopeia standard meropenem (Sigma-Aldrich) by using standard laboratory techniques for culture of Klebsiella pneumoniae. Patients’ plasma samples were tested ex vivo, using a disc diffusion assay, to confirm antimicrobial activity and estimate plasma concentrations of the two brands.

Results

Both brands of meropenem demonstrated similar curves in donor plasma when concentrations in vials were confirmed. Patient-specific serum concentrations were determined from zones of inhibition against a standard laboratory Klebsiella strain ex vivo, confirming at least similar in vivo concentrations as the concentration curves (90% confidence interval) overlapped; however, the upper limit of the area under the curve for the ratio comparator/innovator exceeded the 1.25-point estimate, i.e., 4% higher for comparator meropenem.

Conclusion

This observational, in-practice study demonstrates similar ex vivo activity and in vivo plasma concentration time curves for the products under observation. Assay sensitivity is also confirmed. Current registration status of generic small molecules is in place. The products are therefore clinically interchangeable based on registration status as well as bioassay results, demonstrating sufficient overlap for clinical comfort. The slightly higher observed comparator meropenem concentration (4%) is still clinically acceptable due to the large therapeutic index and should ally fears of inferiority.

Ethosomes for enhanced skin delivery of griseofulvin

Griseofulvin (GRF) is an important antifungal drug with low bioavailability and, for this reason, a topical formulation with a targeted action and minimal systemic effects, appears to be a preferable solution. GRF poor solubility has limited the development of topical formulations and their release to the market. The aim of this work was to prepare a new GRF formulation for topical application using lipid-based nanosystems; to study its permeation and penetration, cell viability and to evaluate its therapeutic action. Ethosomal systems composed of soy bean phosphatidylcholine, ethanol and water were prepared for incorporating GRF. After the characterization of the vesicles in terms of size, charge and penetrability, permeation through newborn pig using Franz diffusion cells was conducted. Cell viability at different concentrations of the chosen formulation was determined. At last, skin adapted agar diffusion test was performed to assess the therapeutic efficacy of the formulation. GRF vesicles had mean size of 130nm. Permeation and penetration assays revealed that GRF-loaded ethosomes have an adequate profile to be used in a topical formulation since drug retention in the stratum corneum was achieved. Cell viability tests proved this formulation presented no cytotoxicity to HaCaT cells for concentrations below 50μg/mL. The skin diffusion test evidenced the potential of developed formulation to target skin dermatophytes. The results obtained in this study contribute to a new perspective in topical treatment of fungal infections.

Selection of appropriate analytical tools to determine the potency and bioactivity of antibiotics and antibiotic resistance

Antibiotics are the chemotherapeutic agents that kill or inhibit the pathogenic microorganisms. Resistance of microorganism to antibiotics is a growing problem around the world due to indiscriminate and irrational use of antibiotics. In order to overcome the resistance problem and to safely use antibiotics, the correct measurement of potency and bioactivity of antibiotics is essential. Microbiological assay and high performance liquid chromatography (HPLC) method are used to quantify the potency of antibiotics. HPLC method is commonly used for the quantification of potency of antibiotics, but unable to determine the bioactivity; whereas microbiological assay estimates both potency and bioactivity of antibiotics. Additionally, bioassay is used to estimate the effective dose against antibiotic resistant microbes.

Simultaneously, microbiological assay addresses the several parameters such as minimal inhibitory concentration (MIC), minimum bactericidal concentration (MBC), mutation prevention concentration (MPC) and critical concentration (Ccr) which are used to describe the potency in a more informative way. Microbiological assay is a simple, sensitive, precise and cost effective method which gives reproducible results similar to HPLC. However, the HPLC cannot be a complete substitute for microbiological assay and both methods have their own significance to obtain more realistic and precise results.

Personalised beta-lactam therapy: basic principles and practical approach

Bacterial infections are potentially life-threatening diseases requiring effective antibiotic treatment right from the outset to achieve a favourable prognosis. Therapeutic success depends on the susceptibility of the bacterial pathogen, determined by the minimum inhibitory concentration (MIC), and the concentration of the antibiotic at the focus of infection, which is influenced by drug metabolism and pharmacokinetic (PK) factors. Beta-lactams are time-dependent antibiotics. Bacterial killing correlates with the duration of the drug concentration above the MIC of the pathogen. Critical illness is associated with major PK changes. This may lead to unexpected drug concentrations and unpredictable dose requirements differing significantly from standard dosages. Emerging dosing strategies are therefore based on PK/pharmacodynamic (PD) principles. Therapeutic drug monitoring (TDM) is increasingly playing a key role in antibiotic treatment optimisation in general and in beta-lactam therapy, in particular, notably in severely ill patients. Furthermore, evidence of the superiority of continuous beta-lactam infusions over shorter administration regimens is growing. Target drug concentrations have to be defined, considering MIC values especially in pathogens with limited susceptibility. For reliable TDM results, correct pre-analytical sample handling is indispensable. Personalised, TDM-guided therapy currently offers the most promising approach to assuring that beta-lactam treatment is effective, especially in critically ill patients.

Pharmacodynamics of nine generic products of amikacin compared with the innovator in the neutropenic mouse thigh infection model

Background

Previously, we validated the mouse thigh infection model to test the therapeutic equivalence of generic antibiotic products. Here, our aim was to compare the in vivo efficacy of amikacin products in clinical use in Colombia using this animal model.

Results

All except one generic product had the same in vitro potency, judging by the lack of differences on MIC and MBC compared with the innovator. However, eight of nine generic products failed in the neutropenic mouse thigh infection model to achieve the innovator’s maximum effect (E_max ≤ 5.65 for the generics vs. 6.58 log₁₀ CFU/g for the innovator) against Escherichia coli SIG-1, after subcutaneous treatment every 6 h with doses ranging from 1.5 to 3072 mg/kg per day.

Conclusion

As we demonstrated previously with other antibiotics such as vancomycin, gentamicin and oxacillin, the generic products of amikacin failed the in vivo efficacy testing. The therapeutic equivalence should be assessed in vivo before clinical approval of generic products.

Study of the Efficacy of Real Time-PCR Method for Amikacin Determination Using Microbial Assay

PURPOSE

Microbial assay is used to determine the potency of antibiotics and vitamins. In spite of its advantages like simplicity and easiness, and to reveal the slight changes in the molecules, the microbial assay suffers from significant limitations; these methods are of lower specificity, accuracy and sensitivity. The objective of the present study is to evaluate the efficacy of real time-PCR technique in comparison with turbidimetric method for microbial assay of amikacin.

METHODS

Microbial determination of amikacin by turbidimetric method was performed according to USP. Also amikacin concentrations were determined by microbial assay using taq-man quantitative PCR method. Standard curves in different concentration for both methods were plotted and method validation parameters of linearity, precision and accuracy were calculated using statistical procedures.

RESULTS

The RT-PCR method was linear in the wider concentration range (5.12 - 38.08 for RT-PCR versus 8.00 - 30.47 for turbidimetric method) with a better correlation coefficient (0.976 for RT-PCR versus 0.958 for turbidimetric method). RT-PCR method with LOQ of 5.12 ng/ml was more sensitive than turbidimetric method with LOQ of 8.00 ng/ml and the former could detect and quantify low concentrations of amikacin. The results of accuracy and precision evaluation showed that the RT-PCR method was accurate and precise in all of the tested concentration.

CONCLUSION

The RT-PCR method described here provided an accurate and precise technique for measurement of amikacin potency and it can be a candidate for microbial determination of the antibiotics with the same test organism.

A new, bioactive, antibacterial-eluting, composite graft for infection-free wound healing

The current work focuses on the in vivo performance of a newly developed injectable composite graft in infected full-thickness wounds. The composite graft was composed of bioactive porous Poly dl-lactide-co-glycolide scaffolds, antibiotic gentamicin, and crosslinked gelatin as carrier gel. Treated infected wounds exhibited a faster wound closure, rapid weight gain, lower neutrophil count, higher breaking strength, and 100 times lesser microbial count (10(2) colony forming units/g in infected treated vs. 10(4)  colony forming units/g in infected control group) in comparison with infected control group 28 days post treatment. During healing, collagen production was more in the treated groups at day 7 than controls and thereafter gradually reduced to normal levels. Histology revealed a mature scar tissue formation, fibroblast proliferation, epidermal resurfacing, and collagen deposition in reticular alignment similar to normal healthy skin in treated wounds. Further, the plasma concentration of gentamicin was 35-45 μg/mL during the initial 12 hours and reduced to 1 μg/mL in 24 hours, which indicated safe levels of the antibiotic drug during healing. These results clearly indicate a faster, infection-free, and safe after treatment with the developed graft.

Relevance of various animal models of human infections to establish therapeutic equivalence of a generic product of piperacillin/tazobactam

After demonstrating with diverse intravenous antibacterials that pharmaceutical equivalence (PE) does not predict therapeutic equivalence, we tested a single generic product of piperacillin/tazobactam (TZP) in terms of PE, pharmacokinetics and in vitro/vivo pharmacodynamics against several pathogens in neutropenic mouse thigh, lung and brain infection models. A generic product was compared head-to-head against the innovator. PE was evaluated by microbiological assay. Single-dose serum pharmacokinetics were determined in infected mice, and the MIC/MBC were determined by broth microdilution. In vivo experiments were done in a blind fashion. Reproducibility was tested on different days using different infecting organisms and animal models. Neutropenic MPF mice were infected in the thighs with Staphylococcus aureus GRP-0057 or Pseudomonas aeruginosa PA01 and in the lungs or brain with Klebsiella pneumoniae ATCC 10031. Treatment started 2h (thigh and brain) or 14 h (lung) after infection and was administered every 3h over 24h (thigh and lung) or 48 h (brain). Both products exhibited the same MIC/MBC against each strain, yielded overlaid curves in the microbiological assay (P>0.21) and were bioequivalent (IC90 83-117% for AUC test/reference ratio). In vivo, the generic product and innovator were again undistinguishable in all models and against the different bacterial pathogens involved. The relevance of these neutropenic murine models of infection was established by demonstrating their accuracy to predict the biological response following simultaneous treatment with a generic product or the innovator of TZP. Therapeutic equivalence of the generic product was proved in every model and against different pathogens.

Impact on resistance of the use of therapeutically equivalent generics: the case of ciprofloxacin

Therapeutic nonequivalence of generic antibiotics may lead to treatment failure and enrichment of resistance. However, there has been no demonstration that an equivalent generic displays the same resistance selection profile as the innovator drug. We aimed to test this hypothesis with five generic versions of ciprofloxacin by assessing their pharmaceutical equivalence with microbiological assays and their efficacy against Pseudomonas aeruginosa PAO1 in the neutropenic murine thigh infection model. One equivalent generic was selected for analysis by high-pressure liquid chromatography-tandem mass spectrometry (LC-MS/MS), to confirm chemical identity, and resistance selection experiments in a hollow-fiber (HF) system simulating two clinical dosing regimens. Total and resistant populations were measured, and the MICs of the resistant cells with and without an efflux pump inhibitor were determined. LC-MS/MS found no differences between products, and the innovator and the generic selected resistance with the same magnitude and mechanism after 7 days of treatment in the HF system, supporting the fact that a generic with demonstrated equivalence in vivo is also equivalent regarding resistance selection.

Investigating the dissolution profiles of amoxicillin, metronidazole, and zidovudine formulations used in Trinidad and Tobago, West Indies

Trinidad and Tobago is a twin-island Republic in the Caribbean and like many developing countries, it has included generic drugs on the national drug formulary to decrease the financial burden of pharmaceutical medications. However, to ensure that medications received by patients are beneficial, generic drugs need to be interchangeable with the innovator which has demonstrated safety, efficacy, and quality. The objective of the study was to compare the dissolution profiles and weight variations for different formulations of amoxicillin, metronidazole, and zidovudine that are on the national drug formulary and marketed in Trinidad and Tobago. All the products investigated are categorized as class 1 drugs according to the Biopharmaceutics Classification System (BCS) and the dissolution profiles were assessed according to the World Health Organization (WHO) criteria for interchangeability between products. The similarity factor, f 2, was used to determine sameness between the products. No generic formulation was found to be similar to Amoxil® 500-mg capsules. The two generic products for metronidazole 200-mg tablets demonstrated more than 85% drug release within 15 min in all three of the buffers; however, their 400-mg counterparts did not fulfill this requirement. The zidovudine 300-mg tablet complied with the requirements in buffer pH 4.5 and simulated gastric fluid (SGF) but not for simulated intestinal fluid (SIF). Some Class 1 pharmaceutical formulations may possess the same active ingredient and amount of drug but may show significant differences to in vitro equivalence requirements. Nevertheless, the dissolution process is suitable to detect these variations.

Development and validation of microbial bioassay for quantification of Levofloxacin in pharmaceutical preparations

The aim of this study was to develop and validate a simple, sensitive, precise and cost-effective one-level agar diffusion (5+1) bioassay for estimation of potency and bioactivity of Levofloxacin in pharmaceutical preparation which has not yet been reported in any pharmacopoeia. Among 16 microbial strains, Bacillus pumilus ATCC-14884 was selected as the most significant strain against Levofloxacin. Bioassay was optimized by investigating several factors such as buffer pH, inoculums concentration and reference standard concentration. Identification of Levofloxacin in commercial sample Levoflox tablet was done by FTIR spectroscopy. Mean potency recovery value for Levofloxacin in Levoflox tablet was estimated as 100.90%. A validated bioassay method showed linearity (r²=0.988), precision (Interday RSD=1.05%, between analyst RSD=1.02%) and accuracy (101.23%, RSD=0.72%). Bioassay was correlated with HPLC using same sample and estimated potencies were 100.90% and 99.37%, respectively. Results show that bioassay is a suitable method for estimation of potency and bioactivity of Levofloxacin pharmaceutical preparations.

Even apparently insignificant chemical deviations among bioequivalent generic antibiotics can lead to therapeutic nonequivalence: the case of meropenem

Several studies with animal models have demonstrated that bioequivalence of generic products of antibiotics like vancomycin, as currently defined, do not guarantee therapeutic equivalence. However, the amounts and characteristics of impurities and degradation products in these formulations do not violate the requirements of the U.S. Pharmacopeia (USP). Here, we provide experimental data with three generic products of meropenem that help in understanding how these apparently insignificant chemical differences affect the in vivo efficacy. Meropenem generics were compared with the innovator in vitro by microbiological assay, susceptibility testing, and liquid chromatography/mass spectrometry (LC/MS) analysis and in vivo with the neutropenic guinea pig soleus infection model (Pseudomonas aeruginosa) and the neutropenic mouse thigh (P. aeruginosa), brain (P. aeruginosa), and lung (Klebisella pneumoniae) infection models, adding the dihydropeptidase I (DHP-I) inhibitor cilastatin in different proportions to the carbapenem. We found that the concentration and potency of the active pharmaceutical ingredient, in vitro susceptibility testing, and mouse pharmacokinetics were identical for all products; however, two generics differed significantly from the innovator in the guinea pig and mouse models, while the third generic was therapeutically equivalent under all conditions. Trisodium adducts in a bioequivalent generic made it more susceptible to DHP-I hydrolysis and less stable at room temperature, explaining its therapeutic nonequivalence. We conclude that the therapeutic nonequivalence of generic products of meropenem is due to greater susceptibility to DHP-I hydrolysis. These failing generics are compliant with USP requirements and would remain undetectable under current regulations.

In Vivo Effects of Cefazolin, Daptomycin, and Nafcillin in Experimental Endocarditis with a Methicillin-Susceptible Staphylococcus aureus Strain Showing an Inoculum Effect against Cefazolin

Several reports have implicated the inoculum effect that some strains of type A beta-lactamase (Bla)-producing, methicillin-susceptible Staphylococcus aureus (MSSA) show against cefazolin as the cause for clinical failures in certain serious deep-seated infections. Here, using a previously reported MSSA strain displaying this phenotype (TX0117), we obtained a Bla-cured derivative (TX0117c) with a combination of novobiocin and high temperature. Both isolates were then used in a rat endocarditis model and treated with cefazolin, nafcillin, and daptomycin, given to simulate human dosing. Animals were treated for 3 days and either sacrificed at 24 h after the last antibiotic dose (standard group) or left untreated for an additional 3 days (relapse group). With TX0117 in the standard treatment group, daptomycin and nafcillin were both significantly better than cefazolin in reducing CFU/g of vegetations, achieving mean log₁₀ reductions compared to levels in untreated rats of 7.1, 5.3, and 1.8, respectively (cefazolin versus daptomycin, P < 0.0001; cefazolin versus nafcillin, P = 0.005; daptomycin versus nafcillin, P = 0.053). In addition, cefazolin was significantly more effective in reducing vegetation titers of TX0117c than of TX0117 (mean log₁₀ reduction of 1.4 versus 5.5, respectively; P = 0.0001). Similar results were observed with animals in the relapse group. Thus, these data show that there can be an in vivo consequence of the in vitro inoculum effect that some MSSA strains display against cefazolin and indicate a specific role for Bla production using a Bla-cured derivative strain against which cefazolin regained both in vitro and in vivo activity.

Charting microbial phenotypes in multiplex nanoliter batch bioreactors

High-throughput growth phenotyping is receiving great attention for establishing the genotype-phenotype map of sequenced organisms owing to the ready availability of complete genome sequences. To date, microbial growth phenotypes have been investigated mostly by the conventional method of batch cultivation using test tubes, Erlenmeyer flasks, or the recently available microwell plates. However, the current batch cultivation methods are time- and labor-intensive and often fail to consider sophisticated environmental changes. The implementation of batch cultures at the nanoliter scale has been difficult because of the quick evaporation of the culture medium inside the reactors. Here, we report a microfluidic system that allows independent cell cultures in evaporation-free multiplex nanoliter reactors under different culture conditions to assess the behavior of cells. The design allows three experimental replicates for each of eight culture environments in a single run. We demonstrate the versatility of the device by performing growth curve experiments with Escherichia coli and microbiological assays of antibiotics against the opportunistic pathogen Pseudomonas aeruginosa. Our study highlights that the microfluidic system can effectively replace the traditional batch culture methods with nanoliter volumes of bacterial cultivations, and it may be therefore promising for high-throughput growth phenotyping as well as for single-cell analyses.

Comparative potencies of contemporary generic vancomycin lot: in vitro assay results from nine products and a reference reagent-grade sample

Numerous studies of generic vancomycin (GV) lots have emerged since the 1980s, casting some doubt on product quality. Publications question the in vivo activity, even when concurrent in vitro and chemical assays meet regulatory guidelines. This study assessed contemporary GV lots by an in vitro assay capable of measuring small variations from target-benchmark (BM) activity. Nine GV lots (Hospira [6 lots; 0.5- or 1.0-g vials], Akorn [1 lot; 1.0-g vial], APP [2 lots; 1.0-g vials]) were obtained from local United States distributors. A reagent-grade lot (Sigma lot 080M1341V) was tested as BM component due to the inability to purchase branded product vials in the USA. All lots of GV did not vary significantly from the analytical control when testing the 3 Staphylococcus aureus (wild-type 4B25, ATCC 25923, and 29213) and Enterococcus faecalis (ATCC 29212) strains. These MIC end points were read at 18 h of incubation, and Hospira lots averaged +3.5% potency (range, -3% to +8%), and Akorn and APP at 0% variance, e.g., acceptable performance. In conclusion, with a validated, precise multi-organism assay, current GV lots marketed in the USA showed minimal activity variations from a selected BM control lot. Generic antimicrobial products, in general, should be regularly monitored for potency, chemical purity, and in vivo activity before routine use in medical centers.

Opto-electrokinetic manipulation for high-performance on-chip bioassays

This communication first demonstrates bio-compatibility of a recently developed opto-electrokinetic manipulation technique, using microorganisms. Aggregation, patterning, translation, trapping and size-based separation of microorganisms performed with the technique firmly establishes its usefulness for development of a high-performance on-chip bioassay system.

Generic antibiotic drugs: is effectiveness guaranteed?

There are recently published arguments suggesting all generic antibiotic drugs do not present the full reliability needed to claim therapeutic equivalence with branded drugs. The problem is especially crucial for generic intravenous drugs, which do not need any bioequivalence study before they can be marketed. The evaluation of generic antibiotic drug effectiveness yields an important dispersion of results according to antibiotic agents and for the same antibiotic agent all generic drugs are not equivalent. There are differences at all levels: drug components, levels of impurity, pharmacokinetics, pharmacokinetic/pharmacodynamic relationship, in vitro effectiveness, therapeutic effectiveness in experimental models, etc. So that finally, the specifications approved in the initial submission file of a brand name drugs are not always respected by a generic drug. There is also a specific problem of taste and treatment acceptability for pediatric oral antibiotic drugs. Available data on clinical effectiveness is excessively rare. The marketing of a great number of generic drugs of the same specialty is followed by a sometimes very important increase of their use, even in countries where consumption is low. The corollary of this increase in consumption is an increase of resistance, and this is especially true for oral fluoroquinolones. Even if most of this information needs to be verified, it seems necessary to review regulations for marketing authorization of generic antibiotic drugs.

Therapeutic equivalence requires pharmaceutical, pharmacokinetic, and pharmacodynamic identities: true bioequivalence of a generic product of intravenous metronidazole

Animal models of infection have been used to demonstrate the therapeutic failure of "bioequivalent" generic products, but their applicability for this purpose requires the accurate identification of those products that are truly bioequivalent. Here, we present data comparing one intravenous generic product of metronidazole with the innovator product in a neutropenic mouse thigh anaerobic infection model. Simultaneous experiments allowed comparisons (generic versus innovator) of potency and the concentration of the active pharmaceutical ingredient (API), analytical chemistry (liquid chromatography/mass spectrometry [LC/MS]), in vitro susceptibility testing, single-dose serum pharmacokinetics (PK) in infected mice, and in vivo pharmacodynamics (PD) against Bacteroides fragilis ATCC 25825 in synergy with Escherichia coli SIG-1 in the neutropenic mouse thigh anaerobic infection model. The Hill dose-response model followed by curve-fitting analysis was used to calculate and compare primary and secondary PD parameters. The generic and the innovator products were identical in terms of the concentration and potency of the API, chromatographic and spectrographic profiles, MIC and minimal bactericidal concentrations (MBC) (2.0 mg/liter), and mouse PK. We found no differences between products in bacteriostatic doses (BD) (15 to 22 mg/kg of body weight per day) or the doses needed to kill 1 log (1LKD) (21 to 29 mg/kg per day) or 2 logs (2LKD) (28 to 54 mg/kg per day) of B. fragilis under dosing schedules of every 12 h (q12h), q8h, or q6h. The area under the concentration-time curve over 24 h in the steady state divided by the MIC (AUC/MIC ratio) was the best PD index to predict the antibacterial efficacy of metronidazole (adjusted coefficient of determination [AdjR(2)] = 84.6%), and its magnitude to reach bacteriostasis in vivo (56.6 ± 5.17 h) or to kill the first (90.8 ± 9.78 h) and second (155.5 ± 22.2 h) logs was the same for both products. Animal models of infection allow a thorough demonstration of the therapeutic equivalence of generic antimicrobials.

Comparative in vitro study of the antimicrobial activities of different commercial antibiotic products of vancomycin

Background

One of the most critical problems about antimicrobial therapy is the increasing resistance to antibiotics. Previous studies have shown that there is a direct relation between erroneous prescription, dosage, route, duration of the therapy and the antibiotics resistance. Other important point is the uncertainty about the quality of the prescribed medicines. Some physicians believe that generic drugs are not as effective as innovator ones, so it is very important to have evidence that shows that all commercialized drugs are suitable for therapeutic use.

Methods

Microbial assays were used to establish the potency, the Minimal Inhibitory Concentrations (MICs), the Minimal Bactericidal Concentration (MBCs), the critical concentrations, and the production of spontaneous mutants that are resistant to vancomycin.

Results

The microbial assay was validated in order to determine the Vancomycin potency of the tasted samples. All the products showed that have potency values between 90 - 115% (USP requirement). The products behave similarly because the MICs, The MBCs, the critical concentrations, the critical concentrations ratios between standard and samples, and the production of spontaneous mutants don't have significant differences.

Conclusions

All products analyzed by microbiological tests, show that both trademarks and generics do not have statistical variability and the answer of antimicrobial activity Show also that they are pharmaceutical equivalents.

Should we have concerns with generic versus brand antimicrobial drugs? A review of issues

Objectives

To explore the issues involving generic versus brand antimicrobial drug products and provide an overview of assessments of equivalence and their potential relevance to health outcomes.

Methods

In April and May 2010, literature searches were performed in MEDLINE and EMBASE for studies involving antimicrobial drug products that convey equivalence or non-equivalence of generic and brand-name drugs.

Key findings

Sixty-six studies involving antibiotics, antifungals, antivirals and antimalarials were identified for analysis. The types of studies were categorized into microbial assays, pharmaceutical assays, bioequivalence and those that assess clinical endpoints. Studies varied markedly on equivalence measures between generic and brand drug products. Thirty-four of 66 (52%) were primarily bioequivalency studies with 30 of 34 (88%) demonstrating positive outcomes for equivalency. Two of 22 studies (9%) involved microbial and/or pharmaceutical assays for quality assurance testing and presented the largest disparity in equivalence. Ten studies compared outcomes of a clinical nature and concluded no significant difference in outcome between generic and brand products. Ten of 66 (15%) studies were published before 2000 and 11 (17%) were conducted in the USA.

Conclusions

In the USA, it is unlikely that use of generic antibiotics and antimicrobials pose a problem for patients with infectious diseases, where quality safeguards exist and patients are informed when generic substitution occurs. However, with expansion of international markets and questionable drug supply chains – particularly with the advent of the internet – consumers and providers should be aware of drug product quality differences that may impact patient outcomes.

Generic vancomycin products fail in vivo despite being pharmaceutical equivalents of the innovator

Generic versions of intravenous antibiotics are not required to demonstrate therapeutic equivalence with the innovator because therapeutic equivalence is assumed from pharmaceutical equivalence. To test such assumptions, we studied three generic versions of vancomycin in simultaneous experiments with the innovator and determined the concentration and potency of the active pharmaceutical ingredient by microbiological assay, single-dose pharmacokinetics in infected mice, antibacterial effect by broth microdilution and time-kill curves (TKC), and pharmacodynamics against two wild-type strains of Staphylococcus aureus by using the neutropenic mouse thigh infection model. The main outcome measure was the comparison of magnitudes and patterns of in vivo efficacy between generic products and the innovator. Except for one product exhibiting slightly greater concentration, vancomycin generics were undistinguishable from the innovator based on concentration and potency, protein binding, in vitro antibacterial effect determined by minimal inhibitory or bactericidal concentrations and TKC, and serum pharmacokinetics. Despite such similarities, all generic products failed in vivo to kill S. aureus, while the innovator displayed the expected bactericidal efficacy: maximum antibacterial effect (Emax) (95% confidence interval [CI]) was 2.04 (1.89 to 2.19), 2.59 (2.21 to 2.98), and 3.48 (2.92 to 4.04) versus 5.65 (5.52 to 5.78) log10 CFU/g for three generics and the innovator product, respectively (P<0.0001, any comparison). Nonlinear regression analysis suggests that generic versions of vancomycin contain inhibitory and stimulatory principles within their formulations that cause agonistic-antagonistic actions responsible for in vivo failure. In conclusion, pharmaceutical equivalence does not imply therapeutic equivalence for vancomycin.

In vitro and in vivo comparison of the anti-staphylococcal efficacy of generic products and the innovator of oxacillin

BACKGROUND

Oxacillin continues to be an important agent in the treatment of staphylococcal infections; many generic products are available and the only requirement for their approval is demonstration of pharmaceutical equivalence. We tested the assumption that pharmaceutical equivalence predicts therapeutic equivalence by comparing 11 generics with the innovator product in terms of concentration of the active pharmaceutical ingredient (API), minimal inhibitory (MIC) and bactericidal concentrations (MBC), and antibacterial efficacy in the neutropenic mouse thigh infection model.

METHODS

The API in each product was measured by a validated microbiological assay and compared by slope (potency) and intercept (concentration) analysis of linear regressions. MIC and MBC were determined by broth microdilution according to Clinical and Laboratory Standard Institute (CLSI) guidelines. For in vivo efficacy, neutropenic ICR mice were inoculated with a clinical strain of Staphylococcus aureus. The animals had 4.14 +/- 0.18 log10 CFU/thigh when treatment started. Groups of 10 mice per product received a total dose ranging from 2.93 to 750 mg/kg per day administered q1h. Sigmoidal dose-response curves were generated by nonlinear regression fitted to Hill equation to compute maximum effect (Emax), slope (N), and the effective dose reaching 50% of the Emax (ED50). Based on these results, bacteriostatic dose (BD) and dose needed to kill the first log of bacteria (1LKD) were also determined.

RESULTS

4 generic products failed pharmaceutical equivalence due to significant differences in potency; however, all products were undistinguishable from the innovator in terms of MIC and MBC. Independently of their status with respect to pharmaceutical equivalence or in vitro activity, all generics failed therapeutic equivalence in vivo, displaying significantly lower Emax and requiring greater BD and 1LKD, or fitting to a non-sigmoidal model.

CONCLUSIONS

Pharmaceutical or in vitro equivalence did not entail therapeutic equivalence for oxacillin generic products, indicating that criteria for approval deserve review to include evaluation of in vivo efficacy.

Determination of therapeutic equivalence of generic products of gentamicin in the neutropenic mouse thigh infection model

Background

Drug regulatory agencies (DRA) support prescription of generic products of intravenous antibiotics assuming therapeutic equivalence from pharmaceutical equivalence. Recent reports of deaths associated with generic heparin and metoprolol have raised concerns about the efficacy and safety of DRA-approved drugs.

Methodology/Principal Findings

To challenge the assumption that pharmaceutical equivalence predicts therapeutic equivalence, we determined in vitro and in vivo the efficacy of the innovator product and 20 pharmaceutically equivalent generics of gentamicin. The data showed that, while only 1 generic product failed in vitro (MIC = 45.3 vs. 0.7 mg/L, P<0.05), 10 products (including gentamicin reference powder) failed in vivo against E. coli due to significantly inferior efficacy (E_max = 4.81 to 5.32 vs. 5.99 log₁₀ CFU/g, P≤0.043). Although the design lacked power to detect differences in survival after thigh infection with P. aeruginosa, dissemination to vital organs was significantly higher in animals treated with generic gentamicin despite 4 days of maximally effective treatment.

Conclusion

Pharmaceutical equivalence does not predict therapeutic equivalence of generic gentamicin. Stricter criteria based on solid experimental evidence should be required before approval for human use.

Comparative in vitro study of the antimicrobial activities of different commercial antibiotic products for intravenous administration

Background

The antimicrobial resistance is a global problem, probably due to the indiscriminate and irrational use of antibiotics, prescriptions for incorrect medicines or incorrect determinations of dose, route and/or duration. Another consideration is the uncertainty of patients receiving antibiotics about whether the quality of a generic medicine is equal to, greater than or less than its equivalent brand-name drug. The antibiotics behaviors must be evaluated in vitro and in vivo in order to confirm their suitability for therapeutic use.

Methods

The antimicrobial activities of Meropenem and Piperacillin/Tazobactam were studied by microbiological assays to determine their potencies (content), minimal inhibitory concentrations (MICs), critical concentrations and capacity to produce spontaneous drug-resistant mutants.

Results

With respect to potency (content) all the products fulfill USP requirements, so they should all be considered pharmaceutical equivalents. The MIC values of the samples evaluated (trade marks and generics) were the same for each strain tested, indicating that all products behaved similarly. The critical concentration values were very similar for all samples, and the ratios between the critical concentration of the standard and those of each sample were similar to the ratios of their specific antibiotic contents. Overall, therefore, the results showed no significant differences among samples. Finally, the production of spontaneous mutants did not differ significantly among the samples evaluated.

Conclusions

All the samples are pharmaceutical equivalents and the products can be used in antimicrobial therapy.