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Onita T, Ikawa K, Nakamura K, Nishikawa G, Kobayashi I, Ishihara N, Tamaki H, Yano T, Naora K, Morikawa N. Prostatic Pharmacokinetic/Pharmacodynamic Evaluation of Ampicillin-Sulbactam for Bacterial Prostatitis and Preoperative Prophylaxis. J Clin Pharmacol 2021; 61:820-831. [PMID: 33314138 DOI: 10.1002/jcph.1800] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/08/2020] [Indexed: 12/23/2022]
Abstract
This study aims to define the penetration of ampicillin and sulbactam into prostate tissue, develop a prostatic pharmacokinetic model of each drug, and assess the appropriateness of ampicillin-sulbactam regimens for the treatment of prostatitis and the prophylaxis of postoperative infection, based on a pharmacokinetic and pharmacodynamic simulation. Subjects were prostatic hyperplasia patients prophylactically receiving a 0.5-hour infusion of 1.5 g (1:0.5 g) or 3 g (2:1 g) ampicillin-sulbactam before transurethral resection of the prostate. Ampicillin and sulbactam concentrations in plasma and prostate tissue were measured. The prostate tissue/plasma ratios of both ampicillin and sulbactam were approximately 0.37 (area under the drug concentration-time curve), and penetration was similar. The prostatic population pharmacokinetic model, which included a covariate analysis, adequately predicted prostate tissue concentrations in our patient population. For therapeutic use, aiming for a bactericidal target of 50% of time above minimum inhibitory concentration (T > MIC) in prostate tissue, 3 g ampicillin-sulbactam 4 times daily achieved ≥90% expected probability against only Enterococcus faecalis in typical patients with a creatinine clearance (CLcr ) of 30 mL/min. For prophylactic use, aiming for a bacteriostatic target of 30% T > MIC, 3 g ampicillin-sulbactam 4 times daily achieved ≥90% expected probability of attaining the bacteriostatic target against E. faecalis and Proteus species when CLcr was 30 mL/min. Based on prostatic simulations, the present study provides helpful recommendations for the treatment of bacterial prostatitis and preoperative prophylaxis in prostatectomy.
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Affiliation(s)
- Tetsushu Onita
- Department of Clinical Pharmacotherapy, Hiroshima University, Minami-ku, Hiroshima, Japan.,Department of Pharmacy, Shimane University Hospital, Izumo, Shimane, Japan
| | - Kazuro Ikawa
- Department of Clinical Pharmacotherapy, Hiroshima University, Minami-ku, Hiroshima, Japan
| | - Kogenta Nakamura
- Department of Urology, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Genya Nishikawa
- Department of Urology, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Ikuo Kobayashi
- Department of Urology, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Noriyuki Ishihara
- Department of Pharmacy, Shimane University Hospital, Izumo, Shimane, Japan
| | - Hiroki Tamaki
- Department of Pharmacy, Shimane University Hospital, Izumo, Shimane, Japan
| | - Takahisa Yano
- Department of Pharmacy, Shimane University Hospital, Izumo, Shimane, Japan
| | - Kohji Naora
- Department of Pharmacy, Shimane University Hospital, Izumo, Shimane, Japan
| | - Norifumi Morikawa
- Department of Clinical Pharmacotherapy, Hiroshima University, Minami-ku, Hiroshima, Japan
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Děrgel M, Voborník M, Pojar M, Karalko M, Gofus J, Radochová V, Studená Š, Maláková J, Turek Z, Chládek J, Manďák J. Lung Collapse during Mini-Thoracotomy Reduces Penetration of Cefuroxime to the Tissue: Interstitial Microdialysis Study in Animal Models. Surg Infect (Larchmt) 2020; 22:283-291. [PMID: 32633629 DOI: 10.1089/sur.2019.273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: Single-lung ventilation facilitates surgical exposure during minimally invasive cardiac surgery. However, a deeper knowledge of antibiotic distribution within a collapsed lung is necessary for effective antibiotic prophylaxis of pneumonia. Patients and Methods: The pharmacokinetics/pharmacodynamics (PK/PD) of cefuroxime were compared between the plasma and interstitial fluid (ISF) of collapsed and ventilated lungs in 10 anesthetized pigs, which were ventilated through a double-lumen endotracheal cannula. Cefuroxime (20 mg/kg) was administered in single 30-minute intravenous infusion. Samples of blood and lung microdialysate were collected until six hours post-dose. Ultrafiltration, in vivo retrodialysis, and high-performance liquid chromatography-tandem mass spectrometry were used to determine plasma and ISF concentrations of free drug. The concentrations were examined with non-compartmental analysis and compartmental modeling. Results: The concentration of free cefuroxime in ISF was lower in the non-ventilated lung than the ventilated one, evidenced by a lung penetration factor of 47% versus 63% (p < 0.05), the ratio between maximum concentrations (65%, p < 0.05), and the ratio between the areas under the concentration-time curve (78%, p = 0.12). The time needed to reach a minimum inhibitory concentration (MIC) was 30%-40% longer for a collapsed lung than for a ventilated one. In addition, a delay of 10-40 minutes was observed for lung ISF compared with plasma. The mean residence time values (ISF collapsed lung > ISF ventilated lung > plasma) could explain the absence of practically important differences in the time interval with the concentration of cefuroxime exceeding the MICs of sensitive strains (≤4 mg/L). Conclusion: The concentration of cefuroxime in the ISF of a collapsed porcine lung is lower than in a ventilated one; furthermore, its equilibration with plasma is delayed. Administration of the first cefuroxime dose earlier or at a higher rate may be warranted, as well as dose intensification of the perioperative prophylaxis of pneumonia caused by pathogens with higher MICs.
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Affiliation(s)
- Martin Děrgel
- Department of Cardiac Surgery, Resuscitation and Intensive Medicine, Charles University, Faculty of Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Martin Voborník
- Department of Cardiac Surgery, Resuscitation and Intensive Medicine, Charles University, Faculty of Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Marek Pojar
- Department of Cardiac Surgery, Resuscitation and Intensive Medicine, Charles University, Faculty of Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Mikita Karalko
- Department of Cardiac Surgery, Resuscitation and Intensive Medicine, Charles University, Faculty of Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Jan Gofus
- Department of Cardiac Surgery, Resuscitation and Intensive Medicine, Charles University, Faculty of Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Věra Radochová
- Animal Research Facility, Faculty of Military Health Sciences, University of Defense, Třebešská, Králové, Czech Republic
| | - Šárka Studená
- Department of Pharmacology, Resuscitation and Intensive Medicine, Charles University, Faculty of Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Jana Maláková
- Institute of Clinical Biochemistry and Diagnoses, Resuscitation and Intensive Medicine, Charles University, Faculty of Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Zdeněk Turek
- Department of Anesthesiology, Resuscitation and Intensive Medicine, Charles University, Faculty of Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Jaroslav Chládek
- Department of Pharmacology, Resuscitation and Intensive Medicine, Charles University, Faculty of Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Jiří Manďák
- Department of Cardiac Surgery, Resuscitation and Intensive Medicine, Charles University, Faculty of Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
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Rimmler C, Lanckohr C, Akamp C, Horn D, Fobker M, Wiebe K, Redwan B, Ellger B, Koeck R, Hempel G. Physiologically based pharmacokinetic evaluation of cefuroxime in perioperative antibiotic prophylaxis. Br J Clin Pharmacol 2019; 85:2864-2877. [PMID: 31487057 PMCID: PMC6955413 DOI: 10.1111/bcp.14121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/19/2019] [Accepted: 08/30/2019] [Indexed: 12/18/2022] Open
Abstract
Aims Adequate plasma concentrations of antibiotics during surgery are essential for the prevention of surgical site infections. We examined the pharmacokinetics of 1.5 g cefuroxime administered during induction of anaesthesia with follow‐up doses every 2.5 hours until the end of surgery. We built a physiologically based pharmacokinetic model with the aim to ensure adequate antibiotic plasma concentrations in a heterogeneous population. Methods A physiologically based pharmacokinetic model (PK‐Sim®/MoBi®) was developed to investigate unbound plasma concentrations of cefuroxime. Blood samples from 25 thoracic surgical patients were analysed with high‐performance liquid chromatography. To evaluate optimized dosing regimens, physiologically based pharmacokinetic model simulations were conducted. Results Dosing simulations revealed that a standard dosing regimen of 1.5 g every 2.5 hours reached the pharmacokinetic/pharmacodynamic target for Staphylococcus aureus. However, for Escherichia coli, >50% of the study participants did not reach predefined targets. Effectiveness of cefuroxime against E. coli can be improved by administering a 1.5 g bolus immediately followed by a continuous infusion of 3 g cefuroxime over 3 hours. Conclusion The use of cefuroxime for perioperative antibiotic prophylaxis to prevent staphylococcal surgical site infections appears to be effective with standard dosing of 1.5 g preoperatively and follow‐up doses every 2.5 hours. In contrast, if E. coli is relevant in surgeries, this dosing regimen appears insufficient. With our derived dose recommendations, we provide a solution for this issue.
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Affiliation(s)
- Christer Rimmler
- Department of Pharmaceutical and Medical Chemistry-Clinical Pharmacy, Muenster, Germany
| | - Christian Lanckohr
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Muenster, Muenster, Germany
| | - Ceren Akamp
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Muenster, Muenster, Germany
| | - Dagmar Horn
- Department of Pharmacy, University Hospital of Muenster, Muenster, Germany
| | - Manfred Fobker
- Center for Laboratory Medicine, University Hospital Muenster, Muenster, Germany
| | - Karsten Wiebe
- Department of Cardiothoracic Surgery, Division of Thoracic Surgery and Lung Transplantation, University Hospital Muenster, Muenster, Germany
| | - Bassam Redwan
- Department of Cardiothoracic Surgery, Division of Thoracic Surgery and Lung Transplantation, University Hospital Muenster, Muenster, Germany
| | - Bjoern Ellger
- Department of Anesthesiology, Intensive Care and Pain Medicine, Klinikum Westfalen, Dortmund, Germany
| | - Robin Koeck
- Institute of Hygiene, DRK Kliniken Berlin Westend, Berlin, Germany
| | - Georg Hempel
- Department of Pharmaceutical and Medical Chemistry-Clinical Pharmacy, Muenster, Germany
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Crimi E, Hernandez-Barajas D, Seller A, Ashton J, Martin M, Vasilopoulos T, Gravenstein N. The Effect of Modified Ultrafiltration on Serum Vancomycin Levels During Cardiopulmonary Bypass in Cardiac Surgery. J Cardiothorac Vasc Anesth 2018; 33:102-106. [PMID: 30143360 DOI: 10.1053/j.jvca.2018.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of this study was to investigate whether the use of modified ultrafiltration at the end of cardiopulmonary bypass for cardiac surgical procedures significantly changes vancomycin serum concentrations. DESIGN Prospective study. SETTING Single tertiary cardiac center. PARTICIPANTS Twenty-six elective adult patients undergoing cardiac surgery with cardiopulmonary bypass from April 2014 to April 2015. INTERVENTIONS Serum vancomycin concentrations were measured just before cardiopulmonary bypass; during cardiopulmonary bypass at 5, 30, 60 minutes and then every 60 minutes; after completion of cardiopulmonary bypass before initiation of modified ultrafiltration; and at the end of modified ultrafiltration. MEASUREMENTS AND MAIN RESULTS Seventeen patients received modified ultrafiltration at the end of cardiopulmonary bypass. Serum vancomycin concentrations prior to cardiopulmonary bypass (45.9 ± 17.3 μg/mL) were significantly higher (P < 0.0001) than each time point following cardiopulmonary bypass (5 min 20.4 ± 6.4 μg/mL, 30 min 18.8 ± 5.4 μg/mL, 60 min 16.6 ± 4.9 μg/mL, and 120 min 14.3 ± 4.7 μg/mL). In the modified ultrafiltration group, serum vancomycin concentrations were 14.7 ± 4.6 μg/mL prior to modified ultrafiltration and 13.9 ± 4.3 μg/mL after ultrafiltration; this difference was statistically significant (P = 0.0288). The mean modified ultrafiltration volume was 465 ± 158 mL. CONCLUSIONS Using modified ultrafiltration at the end of cardiopulmonary bypass significantly decreases serum vancomycin levels, but not by a clinically relevant amount. The decrease is to a concentration that is still significantly higher than the minimum inhibitory concentration for Staphylococcus epidermidis and Staphylococcus aureus; thus additional vancomycin administration is not recommended.
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Affiliation(s)
| | | | | | - Jennifer Ashton
- College of Medicine, University of Florida, 1600 SW Archer Road, PO Box 100254, Gainesville, FL 32610
| | - Mark Martin
- College of Medicine, University of Florida, 1600 SW Archer Road, PO Box 100254, Gainesville, FL 32610
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Ansari J, Carvalho B, Shafer SL, Flood P. Pharmacokinetics and Pharmacodynamics of Drugs Commonly Used in Pregnancy and Parturition. Anesth Analg 2016; 122:786-804. [DOI: 10.1213/ane.0000000000001143] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Gravenstein N, Fish JT, Klinker KP, Coursin DB. Prophylactic perioperative antibiotic administration: is it time to infuse our practices with new approaches? Anesth Analg 2015; 120:709-11. [PMID: 25790201 DOI: 10.1213/ane.0000000000000541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Nikolaus Gravenstein
- From the *Department of Anesthesiology, University of Florida, Gainesville, Florida; †Department of Critical Care, University of Wisconsin Hospitals, Madison, Wisconsin; ‡UF Health Shands Hospital, Gainesville, Florida; and §University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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