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Taha AM, Elmasry MS, Hassan WS, Sayed RA. Spider chart, greenness and whiteness assessment of experimentally designed multivariate models for simultaneous determination of three drugs used as a combinatory antibiotic regimen in critical care units: Comparative study. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2024; 313:124115. [PMID: 38484641 DOI: 10.1016/j.saa.2024.124115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/24/2024] [Accepted: 03/02/2024] [Indexed: 04/02/2024]
Abstract
In this study, five earth-friendly spectrophotometric methods using multivariate techniques were developed to analyze levofloxacin, linezolid, and meropenem, which are utilized in critical care units as combination therapies. These techniques were used to determine the mentioned medications in laboratory-prepared mixtures, pharmaceutical products and spiked human plasma that had not been separated before handling. These methods were named classical least squares (CLS), principal component regression (PCR), partial least squares (PLS), genetic algorithm partial least squares (GA-PLS), and artificial neural network (ANN). The methods used a five-level, three-factor experimental design to make different concentrations of the antibiotics mentioned (based on how much of them are found in the plasma of critical care patients and their linearity ranges). The approaches used for levofloxacin, linezolid, and meropenem were in the ranges of 3-15, 8-20, and 5-25 µg/mL, respectively. Several analytical tools were used to test the proposed methods' performance. These included the root mean square error of prediction, the root mean square error of cross-validation, percentage recoveries, standard deviations, and correlation coefficients. The outcome was highly satisfactory. The study found that the root mean square errors of prediction for levofloxacin were 0.090, 0.079, 0.065, 0.027, and 0.001 for the CLS, PCR, PLS, GA-PLS, and ANN models, respectively. The corresponding values for linezolid were 0.127, 0.122, 0.108, 0.05, and 0.114, respectively. For meropenem, the values were 0.230, 0.222, 0.179, 0.097, and 0.099 for the same models, respectively. These results indicate that the developed models were highly accurate and precise. This study compared the efficiency of artificial neural networks and classical chemometric models in enhancing spectral data selectivity for quickly identifying three antimicrobials. The results from these five models were subjected to statistical analysis and compared with each other and with the previously published ones. Finally, the whiteness of the methods was assessed by the recently published white analytical chemistry (WAC) RGB 12, and the greenness of the proposed methods was assessed using AGREE, GAPI, NEMI, Raynie and Driver, and eco-scale, which showed that the suggested approaches had the least negative environmental impact. Furthermore, to demonstrate solvent sustainability, a greenness index using a spider chart methodology was employed.
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Affiliation(s)
- Asmaa M Taha
- Analytical Chemistry Department, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt.
| | - Manal S Elmasry
- Analytical Chemistry Department, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt
| | - Wafaa S Hassan
- Analytical Chemistry Department, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt
| | - Rania A Sayed
- Analytical Chemistry Department, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt
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Kamatham S, Seeralan M, Sekar U, Kuppusamy S. Development and Validation of UFLC-MS/MS Analytical Method for the Simultaneous Quantification of Antibiotic Residues in Surface Water, Groundwater, and Pharmaceutical Waste Water Samples from South India. ACS OMEGA 2024; 9:12801-12809. [PMID: 38524455 PMCID: PMC10956121 DOI: 10.1021/acsomega.3c08566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/14/2024] [Accepted: 02/21/2024] [Indexed: 03/26/2024]
Abstract
Antibiotic residues in pharmaceutical wastewater pose a significant environmental concern due to their potential role in fostering antimicrobial resistance. South Indian pharmaceutical companies produce a wide range of antibiotics. As a result, the industries that discharge water may include antibiotic residues, which could be harmful to the environment. In this study, a novel, quick, accurate, and sensitive approach for the simultaneous detection of 11 antibiotics was established, and triple quadrupole mass spectrometry, ultra-fast liquid chromatography-tandem mass spectrometry (UFLC-MS/MS), and selective solid-phase extraction (SPE) were used for validation. Utilizing a mixed mode reversed-phase/cation-exchange cartridge (SPE using Strata X, 33 μm), the single-cartridge extraction procedure was performed and validated. Relative standard deviations for most of the antibiotics ranged from 3.5 to 0.56 with recoveries ranging from 57 to 85%. The samples were injected into the UFLC-MS/MS apparatus at a volume of 10 μL for analysis. The auto sampler cooler temperature was kept at 150 °C, while the column temperature was kept at 40 °C. After validation, the technique was determined to be linear in the range of 2.0-1000.0 ng/mL. The retention period for antibiotics was between 1.2 and 1.5 min. Antibiotics transitions for multiple reaction monitoring| were between 235.1/105.9 and 711.5/467.9 m/z. The method of analysis took 2.5 min to run completely. Antibiotic residues were efficiently analyzed using the established analytical approach in pharmaceutical wastewater (influent and effluent), surface, and groundwater. Eleven antibiotics were found in the water samples during examination with concentrations ranging between 2.313 and 95.744 ng/L. The procedure was shown to be much more environmentally friendly than other contemporary methods based on the green analytical procedure index's evaluation of greenness. Blue applicability grade index tool indicated the developed method's practicality in comparison with that of other reported method.
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Affiliation(s)
- Sravani Kamatham
- Department
of Pharmacology, Sri Ramachandra Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research, (DU), Porur, Chennai 600116, India
| | - Manoharan Seeralan
- Vaccine
Research Centre—Bacterial Vaccine, Centre for Animal Health
Studies, TANUVAS, Madhavaram, Chennai 600051, India
| | - Uma Sekar
- Department
of Microbiology, SRMC & RI, Sri Ramachandra
Institute of Higher Education and Research, (DU), Porur, Chennai 600116, India
| | - Sujatha Kuppusamy
- Department
of Pharmacology, Sri Ramachandra Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research, (DU), Porur, Chennai 600116, India
- Department
of Pharmaceutical Chemistry, Sri Ramachandra Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and
Research, (DU), Porur, Chennai 600116, India
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Berska J, Bugajska J, Sztefko K. A Liquid Chromatography-Tandem Mass Spectrometry Method for Simultaneously Determining Meropenem and Linezolid in Blood and Cerebrospinal Fluid. Ann Lab Med 2024; 44:174-178. [PMID: 37869779 PMCID: PMC10628749 DOI: 10.3343/alm.2023.0250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/03/2023] [Accepted: 09/14/2023] [Indexed: 10/24/2023] Open
Abstract
Antibiotic therapy requires appropriate dosage of drugs for effective treatment. Too low antibiotic concentrations may lead to treatment failure and the development of resistant pathogens, whereas overdosing may cause neurological side effects or hemolytic diseases. Meropenem and linezolid are used only in the treatment of serious infections or when other antibiotics are no longer effective as well as for treating central nervous system infections. It is difficult or sometimes even impossible to predict the relation between dosing of antibiotics and its cerebrospinal fluid (CSF) concentration; thus, a method of determining antibiotics not only in the blood but also in the CSF is needed. Analytical method validation is an integral part of good laboratory practice and ensures high accuracy of the results. We performed complete validation process according to the Food and Drug Administration and European Medicine Agency, covering the aspects precision, specificity, accuracy, recovery, limit of detection, limit of quantification, stability, carry-over, and matrix effects. Our liquid chromatography-tandem mass spectrometry method for the simultaneous measurement of meropenem and linezolid in different matrix meets all the acceptance criteria. The method was successfully applied to determine meropenem and linezolid concentrations in serum and CSF samples obtained from children treated with these antibiotics.
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Affiliation(s)
- Joanna Berska
- Department of Clinical Biochemistry, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Jolanta Bugajska
- Department of Clinical Biochemistry, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Krystyna Sztefko
- Department of Clinical Biochemistry, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
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Jin Y, Ma H, Fu L, Qi X, Zhang M, Di X, Zheng L, He C, Wang Z. Quantification of meropenem in serum and cerebrospinal fluid in children with bacterial meningitis with augmented renal clearance by UPLC-MS/MS. Heliyon 2024; 10:e26132. [PMID: 38390088 PMCID: PMC10881352 DOI: 10.1016/j.heliyon.2024.e26132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 01/25/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024] Open
Abstract
Meropenem is an ultrabroad-spectrum antimicrobial agent that is often recommended for the treatment of bacterial meningitis (BM) in children. However, a subtherapeutic phenomenon occurred in BM children complicated with augmented renal clearance (ARC) at the recommended dose of meropenem. To support its pharmacokinetics, a sensitive, fast and robust ultra-liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method was developed to measure meropenem concentrations in serum and cerebrospinal fluid (CSF). The method involved protein precipitation, and samples were diluted with a large proportion of water to eliminate solvent effects. The separation of samples was performed on a Waters Acquity™ BEH C18 column (2.1 × 50 mm i.d., 1.7 μm) with a gradient profile. The mobile phases were formic acid-water (1:1000, v/v) and acetonitrile. The linear range was good, with a concentration range of 0.100-100 μg/mL for serum and 0.0400-20.0 μg/mL for CSF. The intra-day and inter-day precisions were less than 8.0%, and the intra-day and inter-day accuracies varied -6.6% from 6.5% for the both serum and CSF. The selectivity, carry-over, dilution integrity, matrix effect, recovery and stability were validated according to international guidelines. The developed UPLC-MS/MS method successfully determined the meropenem concentrations in the serum and CSF of children with BM complicated with ARC. The results indicated that under the recommended dosing regimen (40 mg/kg every 8 h), the time to reach the effective treatment target of 50%T > MIC was only approximately 3 h and lower CSF concentrations of meropenem were observed in children with BM with ARC.
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Affiliation(s)
- Ying Jin
- Department of Pharmacy, NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, West China Hospital, Sichuan University, Chengdu, 610041, China
- Clinical Trial Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Hongtu Ma
- Department of Neurosurgery Children's Hospital of Chongqing Medical University. Chongqi, China
| | - Lisha Fu
- Department of Pharmacy, NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, West China Hospital, Sichuan University, Chengdu, 610041, China
- Clinical Trial Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xiaohui Qi
- Department of Pharmacy, NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, West China Hospital, Sichuan University, Chengdu, 610041, China
- Clinical Trial Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- Chengdu Medical College, Chengdu, Sichuan, China
| | - Mengyu Zhang
- Department of Pharmacy, NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, West China Hospital, Sichuan University, Chengdu, 610041, China
- Clinical Trial Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xiangjie Di
- Department of Pharmacy, NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, West China Hospital, Sichuan University, Chengdu, 610041, China
- Clinical Trial Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Li Zheng
- Department of Pharmacy, NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, West China Hospital, Sichuan University, Chengdu, 610041, China
- Clinical Trial Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Cuiyao He
- Department of Pharmacy, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, 136 Zhongshan Second Road, Yuzhong District, Chongqing 400014, China
| | - Zhenlei Wang
- Department of Pharmacy, NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, West China Hospital, Sichuan University, Chengdu, 610041, China
- Clinical Trial Center, West China Hospital, Sichuan University, Chengdu, 610041, China
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Brozmanová H, Šištík P, Ďuricová J, Kacířová I, Kaňková K, Kolek M. Liquid chromatography-tandem mass spectrometry methods for quantification of total and free antibiotic concentrations in serum and exudate from patients with post-sternotomy deep sternal wound infection receiving negative pressure wound therapy. Clin Chim Acta 2024; 554:117704. [PMID: 38185284 DOI: 10.1016/j.cca.2023.117704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Systemically administered antibiotics are thought to penetrate the wounds more effectively during negative pressure wound therapy (NPWT).To test this hypothesis total and free antibiotic concentrations were quantified in serum and wound exudate. METHODS UHPLC-MS/MS methods were developed and validated for the determination of ceftazidime, cefepime, cefotaxime, cefuroxime, cefazolin, meropenem, oxacillin, piperacillin with tazobactam, clindamycin, ciprofloxacin, sulfamethoxazole/trimethoprim (cotrimoxazole), gentamicin, vancomycin, and linezolid. The unbound antibiotic fraction was obtained by ultrafiltration using a Millipore Microcon-30kda Centrifugal Filter Unit. Analysis was performed on a 1.7-µm Acquity UPLC BEH C18 2.1 × 100-mm column with a gradient elution. RESULTS The validation was performed for serum, exudates and free fractions. For all matrices, requirements were met regarding linearity, precision, accuracy, limit of quantitation, and matrix effect. The coefficient of variation was in the range of 1.2-13.6%.and the recovery 87.6-115.6%, respectively. Among the 29 applications of antibiotics thus far, including vancomycin, clindamycin, ciprofloxacin, oxacillin, cefepime, cefotaxime, cotrimoxazole, and gentamicin, total and free antibiotic concentrations in serum and exudate were correlated. CONCLUSION This method can accurately quantify the total and free concentrations of 16 antibiotics. Comparison of concentration ratios between serum and exudates allows for monitoring individual antibiotics' penetration capacity in patients receiving NPWT.
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Affiliation(s)
- Hana Brozmanová
- Department of Clinical Pharmacology, Institute of Laboratory Medicine, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic; Department of Clinical Pharmacology, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
| | - Pavel Šištík
- Department of Clinical Pharmacology, Institute of Laboratory Medicine, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic; Department of Clinical Pharmacology, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic.
| | - Jana Ďuricová
- Department of Clinical Pharmacology, Institute of Laboratory Medicine, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic; Department of Clinical Pharmacology, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
| | - Ivana Kacířová
- Department of Clinical Pharmacology, Institute of Laboratory Medicine, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic; Department of Clinical Pharmacology, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
| | - Klára Kaňková
- Department of Cardiac Surgery, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic
| | - Martin Kolek
- Department of Cardiac Surgery, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic; Department of Clinic Subjects, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
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Khromov T, Dihazi GH, Brockmeyer P, Fischer A, Streit F. 24/7 Therapeutic Drug Monitoring of Beta-Lactam Antibiotics with CLAM-2000. Antibiotics (Basel) 2023; 12:1526. [PMID: 37887227 PMCID: PMC10604791 DOI: 10.3390/antibiotics12101526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND The aim of this study was to evaluate the CLAM-2000 automated preanalytical sample preparation module with integrated liquid chromatography-mass spectrometry/mass spectrometry (LC-MS/MS) as a method for 24/7 therapeutic drug monitoring (TDM) of beta-lactam antibiotics in routine clinical diagnostics. METHODS Method validation was performed using quality control samples. Method comparison was performed with routine samples from patients treated with beta-lactam antibiotics. RESULTS The determination of piperacillin, meropenem, ceftazidime, flucloxacillin, and cefotaxime was performed using D5-piperacillin and D6-meropenem as internal standards. The linearity of the method was within the therapeutic range of beta-lactam antibiotics. The imprecision and accuracy data obtained from quality control samples were within 15%, and the imprecision of patient samples on the instrument was less than the 5% coefficient of variation (CV). Internal standards stored in the instrument at 9 °C for at least one week were stable, which facilitated reagent use and storage. CONCLUSION The CLAM-2000 (Shimadzu, Kyoto, Japan) provides reproducible results as an established routine instrument and is a useful tool for 24/7 TDM of beta-lactam antibiotics in routine clinical diagnostics.
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Affiliation(s)
- Tatjana Khromov
- Department of Clinical Chemistry, University Medical Center Goettingen, Robert-Koch Str. 40, D-37075 Goettingen, Germany; (G.H.D.); (A.F.); (F.S.)
| | - Gry Helene Dihazi
- Department of Clinical Chemistry, University Medical Center Goettingen, Robert-Koch Str. 40, D-37075 Goettingen, Germany; (G.H.D.); (A.F.); (F.S.)
| | - Phillipp Brockmeyer
- Department of Oral and Maxillofacial Surgery, University Medical Center Goettingen, Robert-Koch Str. 40, D-37075 Goettingen, Germany;
| | - Andreas Fischer
- Department of Clinical Chemistry, University Medical Center Goettingen, Robert-Koch Str. 40, D-37075 Goettingen, Germany; (G.H.D.); (A.F.); (F.S.)
| | - Frank Streit
- Department of Clinical Chemistry, University Medical Center Goettingen, Robert-Koch Str. 40, D-37075 Goettingen, Germany; (G.H.D.); (A.F.); (F.S.)
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Ramadan O, Schatz LM, van den Heuvel I, Masjosthusmann K, Groll AH, Hempel G. Developing a Method for Quantifying Meropenem in Children-Volumetric Adsorptive Microsampling Versus Plasma Sampling. Ther Drug Monit 2023; 45:623-630. [PMID: 37199434 DOI: 10.1097/ftd.0000000000001105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/12/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Meropenem is a carbapenem antibiotic often used in pediatric intensive care units due to its broad spectrum of activity. Therapeutic drug monitoring (TDM) is a useful tool to increase the effectiveness of meropenem by adjusting the dose based on plasma levels; however, the relatively large sample volume required for TDM can limit its use in children. Therefore, this study aimed to determine meropenem concentrations and consequently perform TDM effectively using the smallest possible sample volume. Volumetric absorptive microsampling (VAMS) is a sampling technology developed to collect a small, precise volume of blood. For the applicability of VAMS in TDM, plasma concentrations must be reliably calculated from whole blood (WB) collected by VAMS. METHODS VAMS technology using 10 µL of WB was evaluated and compared with EDTA-plasma sampling. High-performance liquid chromatography with UV detection was applied to quantify meropenem in VAMS and plasma samples after the removal of proteins by precipitation. Ertapenem was used as the internal standard. Samples were collected simultaneously from critically ill children receiving meropenem using VAMS and traditional sampling. RESULTS It was found that no consistent factor could be determined to calculate meropenem plasma concentrations from the WB, indicating that VAMS was not reliable in the TDM of meropenem. Therefore, to reduce the required sample amount in pediatric patients, a method for quantifying meropenem from 50 µL of plasma with a lower limit of quantification of 1 mg/L was developed and successfully validated. CONCLUSIONS A simple, reliable, and low-cost method was established using high-performance liquid chromatography-UV to determine the concentration of meropenem in 50 µL of plasma. VAMS using WB does not seem to be suitable for TDM of meropenem.
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Affiliation(s)
- Ola Ramadan
- Department of Pharmaceutical and Medical Chemistry, Clinical Pharmacy, University of Münster, Münster, Germany
| | - Lea Marie Schatz
- Department of Pharmaceutical and Medical Chemistry, Clinical Pharmacy, University of Münster, Münster, Germany
| | - Ingeborg van den Heuvel
- Department of General Paediatrics, University Children's Hospital Münster, Münster, Germany; and
| | - Katja Masjosthusmann
- Department of General Paediatrics, University Children's Hospital Münster, Münster, Germany; and
| | - Andreas H Groll
- Department of Pediatric Hematology/Oncology, University Children's Hospital Münster, Münster, Germany
| | - Georg Hempel
- Department of Pharmaceutical and Medical Chemistry, Clinical Pharmacy, University of Münster, Münster, Germany
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Bilal M, Zoller M, Fuhr U, Jaehde U, Ullah S, Liebchen U, Büsker S, Zander J, Babouee Flury B, Taubert M. Cefepime Population Pharmacokinetics, Antibacterial Target Attainment, and Estimated Probability of Neurotoxicity in Critically Ill Patients. Antimicrob Agents Chemother 2023; 67:e0030923. [PMID: 37366614 PMCID: PMC10353438 DOI: 10.1128/aac.00309-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023] Open
Abstract
Cefepime has been reported to cause concentration-related neurotoxicity, especially in critically ill patients with renal failure. This evaluation aimed to identify a dosing regimen providing a sufficient probability of target attainment (PTA) and the lowest justifiable risk of neurotoxicity in critically ill patients. A population pharmacokinetic model was developed based on plasma concentrations over four consecutive days obtained from 14 intensive care unit (ICU) patients. The patients received a median dose of 2,000 mg cefepime by 30-min intravenous infusions with dosing intervals of every 8 h (q8h) to q24h. A time that the free drug concentration exceeds the MIC over the dosing interval (fT>MIC) of 65% and an fT>2×MIC of 100% were defined as treatment targets. Monte Carlo simulations were carried out to identify a dosing regimen for a PTA of 90% and a probability of neurotoxicity not exceeding 20%. A two-compartment model with linear elimination best described the data. Estimated creatinine clearance was significantly related to the clearance of cefepime in nondialysis patients. Interoccasion variability on clearance improved the model, reflecting dynamic clearance changes. The evaluations suggested combining thrice-daily administration as an appropriate choice. In patients with normal renal function (creatinine clearance, 120 mL/min), for the pharmacodynamics target of 100% fT>2×MIC and a PTA of 90%, a dose of 1,333 mg q8h was found to be related to a probability of neurotoxicity of ≤20% and to cover MICs up to 2 mg/L. Continuous infusion appears to be superior to other dosing regimens by providing higher efficacy and a low risk of neurotoxicity. The model makes it possible to improve the predicted balance between cefepime efficacy and neurotoxicity in critically ill patients. (This study has been registered at ClinicalTrials.gov under registration no. NCT01793012).
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Affiliation(s)
- Muhammad Bilal
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Pharmacology, Department I of Pharmacology, Cologne, Germany
- Department of Clinical Pharmacy, Institute of Pharmacy, University of Bonn, Bonn, Germany
| | - Michael Zoller
- Department of Anaesthesiology, Hospital of the Ludwig Maximilians University of Munich, Munich, Germany
| | - Uwe Fuhr
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Pharmacology, Department I of Pharmacology, Cologne, Germany
| | - Ulrich Jaehde
- Department of Clinical Pharmacy, Institute of Pharmacy, University of Bonn, Bonn, Germany
| | - Sami Ullah
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Pharmacology, Department I of Pharmacology, Cologne, Germany
| | - Uwe Liebchen
- Department of Anaesthesiology, Hospital of the Ludwig Maximilians University of Munich, Munich, Germany
| | - Sören Büsker
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Pharmacology, Department I of Pharmacology, Cologne, Germany
| | | | - Baharak Babouee Flury
- Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Max Taubert
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Pharmacology, Department I of Pharmacology, Cologne, Germany
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9
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Schatz LM, Brinkmann A, Röhr A, Frey O, Greppmair S, Weinelt F, Zoller M, Scharf C, Hempel G, Liebchen U. Systematic Evaluation of Pharmacokinetic Models for Model-Informed Precision Dosing of Meropenem in Critically Ill Patients Undergoing Continuous Renal Replacement Therapy. Antimicrob Agents Chemother 2023; 67:e0010423. [PMID: 37125925 DOI: 10.1128/aac.00104-23] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
The altered pharmacokinetics of renally cleared drugs such as meropenem in critically ill patients receiving continuous renal replacement therapy (CRRT) might impact target attainment. Model-informed precision dosing (MIPD) is applied to individualize meropenem dosing. However, most population pharmacokinetic (PopPK) models developed to date have not yet been evaluated for MIPD. Eight PopPK models based on adult CRRT patients were identified in a systematic literature research and encoded in NONMEM 7.4. A data set of 73 CRRT patients from two different study centers was used to evaluate the predictive performance of the models using simulation and prediction-based diagnostics for i) a priori dosing based on patient characteristics only and ii) Bayesian dosing by including the first measured trough concentration. Median prediction error (MPE) for accuracy within |20%| (95% confidence intervals including zero) and median absolute prediction error (MAPE) for precision ≤ 30% were considered clinically acceptable. For a priori dosing, most models (n = 5) showed accuracy and precision MPE within |20%| and MAPE <35%. The integration of the first measured meropenem concentration improved the predictive performance of all models (median MAPE decreased from 35.4 to 25.0%; median MPE decreased from 21.8 to 4.6%). The best predictive performance for intermittent infusion was observed for the O'Jeanson model, including residual diuresis as covariate (a priori and Bayesian dosing MPE within |2%|, MAPE <30%). Our study revealed the O'Jeanson model as the best-predicting model for intermittent infusion. However, most of the selected PopPK models are suitable for MIPD in CRRT patients when one therapeutic drug monitoring sample is available.
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Affiliation(s)
- Lea Marie Schatz
- Department of Pharmaceutical and Medical Chemistry, Clinical Pharmacy, University of Muenster, Muenster, Germany
| | - Alexander Brinkmann
- Department of Anaesthesiology and Intensive Care Medicine, General Hospital of Heidenheim, Heidenheim, Germany
| | - Anka Röhr
- Department of Pharmacy, General Hospital of Heidenheim, Heidenheim, Germany
| | - Otto Frey
- Department of Pharmacy, General Hospital of Heidenheim, Heidenheim, Germany
| | - Sebastian Greppmair
- Department of Anesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Ferdinand Weinelt
- Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Freie Universitaet Berlin, Berlin, Germany
| | - Michael Zoller
- Department of Anesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Christina Scharf
- Department of Anesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Georg Hempel
- Department of Pharmaceutical and Medical Chemistry, Clinical Pharmacy, University of Muenster, Muenster, Germany
| | - Uwe Liebchen
- Department of Anesthesiology, University Hospital, LMU Munich, Munich, Germany
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10
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Barone R, Conti M, Giorgi B, Gatti M, Cojutti PG, Viale P, Pea F. Fast and Sensitive Method for Simultaneous Quantification of Meropenem and Vaborbactam in Human Plasma Microsamples by Liquid Chromatography-Tandem Mass Spectrometry for Therapeutic Drug Monitoring. Antibiotics (Basel) 2023; 12:antibiotics12040719. [PMID: 37107082 PMCID: PMC10135283 DOI: 10.3390/antibiotics12040719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 03/31/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023] Open
Abstract
Meropenem (MRP)-Vaborbactam (VBR) is a novel beta-lactam/beta-lactamase inhibitor used for the management of difficult-to-treat Gram-negative infections. Among critically ill patients, MRP-VBR shows remarkable inter-individual variability in pharmacokinetic behavior, thus justifying the implementation of therapeutic drug monitoring (TDM) for improving real-time management in different challenging scenarios. In this study, we developed and validated a fast and sensitive Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS) method for the simultaneous quantification of MRP and VBR in human plasma microsamples of 3 microliters. The analysis required only a single-step sample preparation and was performed by means of a fast chromatographic run of 4 min, followed by positive electrospray ionization and detection on a high-sensitivity triple quadrupole tandem mass spectrometer operated in multiple reaction monitoring modes. The straightforward analytical procedure was successfully validated, based on the EMA guidelines, in terms of specificity, sensitivity, linearity, precision, accuracy, matrix effect, extraction recovery, the limit of quantification, and stability. The novel method was successfully applied for simultaneously measuring MRP and VBR concentrations in more than 42 plasma samples collected from critically ill patients affected by carbapenem-resistant Gram-negative bacteria infections.
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Affiliation(s)
- Rossella Barone
- Clinical Pharmacology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Matteo Conti
- Clinical Pharmacology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Beatrice Giorgi
- Clinical Pharmacology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Milo Gatti
- Clinical Pharmacology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Pier Giorgio Cojutti
- Clinical Pharmacology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Federico Pea
- Clinical Pharmacology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
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11
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LC-MS/MS method for simultaneous quantification of ten antibiotics in human plasma for routine therapeutic drug monitoring. J Mass Spectrom Adv Clin Lab 2022; 26:48-59. [DOI: 10.1016/j.jmsacl.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 10/13/2022] [Accepted: 11/15/2022] [Indexed: 11/19/2022] Open
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12
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Rankin-Turner S, Heaney LM. Mass spectrometry in the clinical laboratory. A short journey through the contribution to the scientific literature by CCLM. Clin Chem Lab Med 2022; 61:873-879. [PMID: 36282951 DOI: 10.1515/cclm-2022-0984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 10/04/2022] [Indexed: 11/15/2022]
Abstract
Abstract
Mass spectrometry (MS) has been a gold standard in the clinical laboratory for decades. Although historically refined to limited areas of study such as neonatal screening and steroid analysis, technological advancements in the field have resulted in MS becoming more powerful, versatile, and user-friendly than ever before. As such, the potential for the technique in clinical chemistry has exploded. The past two decades have seen advancements in biomarker detection for disease diagnostics, new methods for protein measurement, improved methodologies for reliable therapeutic drug monitoring, and novel technologies for automation and high throughput. Throughout this time, Clinical Chemistry and Laboratory Medicine has embraced the rapidly developing field of mass spectrometry, endeavoring to highlight the latest techniques and applications that have the potential to revolutionize clinical testing. This mini review will highlight a selection of these critical contributions to the field.
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Affiliation(s)
- Stephanie Rankin-Turner
- W. Harry Feinstone Department of Molecular Microbiology and Immunology , Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University , Baltimore , MD , USA
| | - Liam M. Heaney
- School of Sport, Exercise and Health Sciences , Loughborough University , Loughborough , UK
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13
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Design of an Experimental Study for the Simultaneous Determination of Cefepime, Piperacillin and Tazobactam Using Micellar Organic Solvent-Free HPLC. SEPARATIONS 2022. [DOI: 10.3390/separations9080215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Application of Sustainable analytical chemistry concepts has become crucial in order to remove the environmentally harmful impacts originating from the routine use of analytical techniques. Here, a new LC method is developed and its parameters are analyzed, depending on a mixed micellar mobile phase. This was primarily aimed at getting rid of the use of organic solvents in conventional routine analyses. Combinations of tazobactam (TZB) with piperacillin (PPC) or cefepime (CFM) are commonly used as effective antimicrobial therapies, especially for resistant strains. Therefore, the three drugs were separated and quantified using an organic solvent-free mobile phase. The mixed micellar mobile phase was comprised of 15 mM Brij-35 with 38 mM SDS, adjusted to pH 3.5. Separation was performed by HPLC on monolithic RP-C18 column Chromolith® Performance RP-18e (100 mm × 4.6 mm) at a rate of 1 mL per minute of flow in conjunction with a measurement wavelength 210 nm. The method was found valid and applicable in accordance of precision, and accuracy within ranges of 5–100 µg mL−1 for PPC and CFM and of 0.625–12.5 µg mL−1 for TZB. The quality-by-design technique was used to analyze the effect of modifying the mixed micellar ratios on separation efficiency and conclude their behavior. Finally, the suggested approach was assessed applying the green analytical procedure index against the greenest published methodology to show superiority.
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14
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Anjos MVD, Possa E, Fonseca GDS, Bergoza L, Santos PRD, Silva SME, Tasso L. Development and validation of an LC-ESI-QTOF-MS method to measure cefepime in the plasma and peritoneal fluid of rats using microdialysis: application in a pilot pharmacokinetic study. Biomed Chromatogr 2022; 36:e5470. [PMID: 35904365 DOI: 10.1002/bmc.5470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 11/06/2022]
Abstract
Cefepime (CEF) is a cephalosporin and can be administered in secondary peritonitis together with metronidazole to treat sepsis. This study aimed to develop and validate a method of LC-ESI-QTOF-MS for the quantification of cefepime in the plasma and peritoneal microdialysate of healthy Wistar rats. Chromatographic separation was performed using a CLC-ODS C18 column (250 mm x 4.6 mm), a C18 pre-column (4 mm, 5 μm) and isocratic elution. Gallic acid was used as the internal standard (IS). The mobile phase consisted of (A) ultrapure water (pH adjusted to 3.5) and (B) acetonitrile (80:20, v/v) at 0.8 mL/min. Quantification was performed using a mass spectrometer with electrospray ionization in positive mode to monitor ions with m/z 481.1322 (CEF) and m/z 171.0288 (IS). The method was validated for selectivity, precision, accuracy, linearity, stability, lower limit of quantification, carryover, recovery, and matrix effect. Calibration was done in the range of 1-40 μg/mL and 1-100 μg/mL for the peritoneal microdialysate and plasma, respectively. Plasma extraction recovery ranged from 93.9% to 99.9%. The technique was validated and successfully applied in a pilot pharmacokinetic study for estimating the free concentration of CEF in the peritoneal microdialysate of rats for the first time.
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Affiliation(s)
- Michele Vaz Dos Anjos
- Laboratório de Farmacocinética, Programa de Pós-graduação em Ciências da Saúde, Universidade de Caxias do Sul, Rio Grande do Sul, Brasil
| | - Eduarda Possa
- Curso de Farmácia, Universidade de Caxias do Sul, Rio Grande do Sul, Brasil
| | - Gisele da Silva Fonseca
- Programa de Pós-graduação em Biotecnologia, Universidade de Caxias do Sul, Rio Grande do Sul, Brasil
| | - Larissa Bergoza
- Laboratório de Farmacocinética, Programa de Pós-graduação em Ciências da Saúde, Universidade de Caxias do Sul, Rio Grande do Sul, Brasil
| | - Paulo Roberto Dos Santos
- Programa de Pós-graduação em Biotecnologia, Universidade de Caxias do Sul, Rio Grande do Sul, Brasil
| | - Sidnei Moura E Silva
- Programa de Pós-graduação em Biotecnologia, Universidade de Caxias do Sul, Rio Grande do Sul, Brasil
| | - Leandro Tasso
- Laboratório de Farmacocinética, Programa de Pós-graduação em Ciências da Saúde, Universidade de Caxias do Sul, Rio Grande do Sul, Brasil.,Curso de Farmácia, Universidade de Caxias do Sul, Rio Grande do Sul, Brasil.,Programa de Pós-graduação em Biotecnologia, Universidade de Caxias do Sul, Rio Grande do Sul, Brasil
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15
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Pais GM, Chang J, Barreto EF, Stitt G, Downes KJ, Alshaer MH, Lesnicki E, Panchal V, Bruzzone M, Bumanglag AV, Burke SN, Scheetz MH. Clinical Pharmacokinetics and Pharmacodynamics of Cefepime. Clin Pharmacokinet 2022; 61:929-953. [PMID: 35764774 PMCID: PMC9345683 DOI: 10.1007/s40262-022-01137-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 11/28/2022]
Abstract
Cefepime is a broad-spectrum fourth-generation cephalosporin with activity against Gram-positive and Gram-negative pathogens. It is generally administered as an infusion over 30-60 min or as a prolonged infusion with infusion times from 3 h to continuous administration. Cefepime is widely distributed in biological fluids and tissues with an average volume of distribution of ~ 0.2 L/kg in healthy adults with normal renal function. Protein binding is relatively low (20%), and elimination is mainly renal. About 85% of the dose is excreted unchanged in the urine, with an elimination half-life of 2-2.3 h. The pharmacokinetics of cefepime is altered under certain pathophysiological conditions, resulting in high inter-individual variability in cefepime volume of distribution and clearance, which poses challenges for population dosing approaches. Consequently, therapeutic drug monitoring of cefepime may be beneficial in certain patients including those who are critically ill, have life-threatening infections, or are infected with more resistant pathogens. Cefepime is generally safe and efficacious, with a goal exposure target of 70% time of the free drug concentration over the minimum inhibitory concentration for clinical efficacy. In recent years, reports of neurotoxicity have increased, specifically in patients with impaired renal function. This review summarizes the pharmacokinetics, pharmacodynamics, and toxicodynamics of cefepime contemporarily in the setting of increasing cefepime exposures. We explore the potential benefits of extended or continuous infusions and therapeutic drug monitoring in special populations.
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Affiliation(s)
- Gwendolyn M Pais
- Department of Pharmacy Practice, Chicago College of Pharmacy, Midwestern University, 555 31st St., Downers Grove, IL, 60515, USA
- Chicago College of Pharmacy Pharmacometrics Center of Excellence, Midwestern University, Downers Grove, IL, USA
| | - Jack Chang
- Department of Pharmacy Practice, Chicago College of Pharmacy, Midwestern University, 555 31st St., Downers Grove, IL, 60515, USA
- Chicago College of Pharmacy Pharmacometrics Center of Excellence, Midwestern University, Downers Grove, IL, USA
| | | | - Gideon Stitt
- Center for Clinical Pharmacology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kevin J Downes
- Center for Clinical Pharmacology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Mohammad H Alshaer
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA
- Infectious Disease Pharmacokinetics Lab, Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Emily Lesnicki
- College of Graduate Studies, Midwestern University, Downers Grove, IL, USA
| | - Vaidehi Panchal
- Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, IL, USA
| | - Maria Bruzzone
- Division of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Argyle V Bumanglag
- Department of Neuroscience, College of Medicine, University of Florida, Gainesville, FL, USA
- Cognitive Aging and Memory Center, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Sara N Burke
- Department of Neuroscience, College of Medicine, University of Florida, Gainesville, FL, USA
- Cognitive Aging and Memory Center, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Marc H Scheetz
- Department of Pharmacy Practice, Chicago College of Pharmacy, Midwestern University, 555 31st St., Downers Grove, IL, 60515, USA.
- Chicago College of Pharmacy Pharmacometrics Center of Excellence, Midwestern University, Downers Grove, IL, USA.
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16
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Methods for Determination of Meropenem Concentration in Biological Samples. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2022. [DOI: 10.2478/sjecr-2022-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Measuring the concentration of antibiotics in biological samples allow implementation of therapeutic monitoring of these drugs and contribute to the adjustment of the dosing regimen in patients. This increases the effectiveness of antimicrobial therapy, reduces the toxicity of these drugs and prevents the development of bacterial resistance. This review article summarizes current knowledge on methods for determining concentration of meropenem, an antibiotic drug from the group of carbapenems, in different biological samples. It provides a brief discussion of the chemical structure, physicochemical and pharmacokinetic properties of meropenem, different sample preparation techniques, use of apparatus and equipment, knowledge of the advantages and limitations of available methods, as well as directions in which new methods should be developed. This review should facilitate clinical laboratories to select and apply one of the established methods for measuring of meropenem, as well as to provide them with the necessary knowledge to develop new methods for quantification of meropenem in biological samples according to their needs.
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17
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Patil K, Pathan A, Naik S, Zope V, Chavan R, Yeole R. Simultaneous determination of novel β‐lactamase inhibitor WCK 4234 and Meropenem in dog plasma by LC–MS/MS and its application to preclinical pharmacokinetic study. Biomed Chromatogr 2022; 36:e5377. [DOI: 10.1002/bmc.5377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/01/2022] [Accepted: 03/25/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Kiran Patil
- Wockhardt Research Centre, D‐4, MIDC, Chikalthana Aurangabad India
| | - Amin Pathan
- Wockhardt Research Centre, D‐4, MIDC, Chikalthana Aurangabad India
| | - Sukanta Naik
- Wockhardt Research Centre, D‐4, MIDC, Chikalthana Aurangabad India
| | - Vineet Zope
- Wockhardt Research Centre, D‐4, MIDC, Chikalthana Aurangabad India
| | - Rajesh Chavan
- Wockhardt Research Centre, D‐4, MIDC, Chikalthana Aurangabad India
| | - Ravindra Yeole
- Wockhardt Research Centre, D‐4, MIDC, Chikalthana Aurangabad India
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18
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Decheng S, Xia F, Zhiming X, Liyang, Peilong W. Simultaneous determination of eight carbapenems in milk by modified QuEChERS and ultra high performance liquid chromatography coupled with high-field quadrupole-orbitrap high-resolution mass spectrometry. J Chromatogr A 2022; 1670:462979. [DOI: 10.1016/j.chroma.2022.462979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/06/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
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19
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Advances in clinical antibiotic testing. Adv Clin Chem 2022; 110:73-116. [DOI: 10.1016/bs.acc.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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20
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Target Site Pharmacokinetics of Meropenem: Measurement in Human Explanted Lung Tissue by Bronchoalveolar Lavage, Microdialysis, and Homogenized Lung Tissue. Antimicrob Agents Chemother 2021; 65:e0156421. [PMID: 34570645 DOI: 10.1128/aac.01564-21] [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: 11/20/2022] Open
Abstract
Pneumonia is one of the most common infections in intensive care patients, and it is often treated with beta-lactam antibiotics. Even if therapeutic drug monitoring in blood is available, it is unclear whether sufficient concentrations are reached at the target site: the lung. The present study was initiated to fill this knowledge gap. Various compartments from 10 patients' explanted lungs were subjected to laboratory analysis. Meropenem was quantified in serum, bronchoalveolar lavage (BAL) fluid, microdialysate, and homogenized lung tissue with isotope dilution liquid chromatography tandem mass spectrometry (ID-LC-MS/MS). BAL fluid represents diluted epithelial lining fluid (ELF), and microdialysate represents interstitial fluid (IF). Differences between target site and blood concentrations were investigated. The median meropenem concentration in blood, ELF, IF, and tissue were 26.8, 18.0, 12.1, and 9.1 mg/liter, respectively. A total of 37.5% of the target site ELF and IF meropenem concentrations were below the clinical EUCAST breakpoint of 8 mg/liter. The median ELF/serum quotient was 61.8% (interquartile range [IQR], 24.8% to 87.6%), the median IF/serum quotient was 35.4% (IQR, 23.8% to 54.3%), and the median tissue/serum quotient was 34.2% (IQR, 28.3% to 38.2%). We observed a substantial interindividual variability between the blood and the compartments (ELF and IF), whereas the intraindividual variability was relatively low. Target site measurement in different lung compartments was feasible and successfully applied in a clinical setting. A relevant amount of 37.5% of the target site concentrations were below the clinical EUCAST breakpoint, indicating subtherapeutic dosing in high-risk patients receiving perioperative antibiotic prophylaxis in lung transplantation. (This study has been registered at ClinicalTrials.gov under identifier NCT03970265.).
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21
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Analysis of IV Drugs in the Hospital Workflow by Raman Spectroscopy: The Case of Piperacillin and Tazobactam. Molecules 2021; 26:molecules26195879. [PMID: 34641421 PMCID: PMC8513103 DOI: 10.3390/molecules26195879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 11/29/2022] Open
Abstract
Medical errors associated with IV preparation and administration procedures in a hospital workflow can even cost human lives due to the direct effect they have on patients. A large number of such incidents, which have been reported in bibliography up to date, indicate the urgent need for their prevention. This study aims at proposing an analytical methodology for identifying and quantifying IV drugs before their administration, which has the potential to be fully harmonized with clinical practices. More specifically, it reports on the analysis of a piperacillin (PIP) and tazobactam (TAZ) IV formulation, using Raman spectroscopy. The simultaneous analysis of the two APIs in the same formulation was performed in three stages: before reconstitution in the form of powder without removing the substance out of the commercial glass bottle (non-invasively), directly after reconstitution in the same way, and just before administration, either the liquid drug is placed in the infusion set (on-line analysis) or a minimal amount of it is transferred from the IV bag to a Raman optic cell (at-line analysis). Except for the successful identification of the APIs in all cases, their quantification was also achieved through calibration curves with correlation coefficients ranging from 0.953 to 0.999 for PIP and from 0.965 to 0.997 for TAZ. In any case, the whole procedure does not need more than 10 min to be completed. The current methodology, based on Raman spectroscopy, outweighs other spectroscopic (UV/Vis, FT-IR/ATR) or chromatographic (HPLC, UHPLC) protocols, already applied, which are invasive, costly, time-consuming, not environmentally friendly, and require specialized staff and more complex sample preparation procedures, thus exposing the staff to hazardous materials, especially in cases of cytotoxic drugs. Such an approach has the potential to bridge the gap between experimental setup and clinical implementation through exploitation of already developed handheld devices, along with the presence of digital spectral libraries.
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22
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Cojutti PG, Morandin E, Baraldo M, Pea F. Population pharmacokinetics of continuous infusion of piperacillin/tazobactam in very elderly hospitalized patients and considerations for target attainment against Enterobacterales and Pseudomonas aeruginosa. Int J Antimicrob Agents 2021; 58:106408. [PMID: 34314808 DOI: 10.1016/j.ijantimicag.2021.106408] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/01/2021] [Accepted: 07/17/2021] [Indexed: 10/20/2022]
Abstract
Continuous infusion (CI) piperacillin/tazobactam is frequently used to treat infections in very elderly patients. This study aimed to conduct a population pharmacokinetic analysis of CI piperacillin/tazobactam, and to identify optimal dosages for safe and effective probability of target attainment (PTA) against Enterobacterales and Pseudomonas aeruginosa. Non-linear mixed-effects modelling was performed with Pmetrics. Monte Carlo simulations assessed the steady-state concentration (Css) of increasing piperacillin/tazobactam regimens (from 2.25 to 18 g daily by continuous infusion). Permissible doses were defined as those associated with <10% probability of Css >157.2 mg/L. PTA at the pharmacodynamic targets of free plasma steady-state concentration (fCss)/minimum inhibitory concentration (MIC) ≥1 and ≥4 and cumulative fraction of response (CFR) against EUCAST MIC distribution were also calculated. A total of 141 patients (median age 85 years) provided 217 plasma piperacillin Css. Most patients (55.2%) had hospital-acquired pneumonia and intra-abdominal infections. A one-compartment pharmacokinetic model with parallel linear and Michaelis-Menten elimination best described piperacillin data. Creatinine clearance (CLCR) was the covariate retained by the model. Pharmacokinetic estimates were 6.05 L/h for clearance and 3.39 mg/L for the Michaelis-Menten constant. Permissible doses were up to 4.5, 9, 11.25 and 13.5 g daily by continuous infusion for patients with CLCR of 0-19, 20-39, 40-59 and 60-79 mL/min/1.73 m2, respectively. At the clinical breakpoint of 8 mg/L, the permissible doses only achieved optimal PTA for fCss/MIC ≥1 in patients with CLCR 20-79 mL/min/1.73 m2. Optimal CFRs with the permissible doses were only attained against Escherichia coli and Proteus mirabilis. Permissible dosages and CLCR should be considered for prescribing CI piperacillin/tazobactam in very elderly patients.
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Affiliation(s)
- Pier Giorgio Cojutti
- Institute of Clinical Pharmacology, Santa Maria della Misericordia University-Hospital of Udine, ASUFC, Udine, Italy; Department of Medicine, University of Udine, Udine, Italy; SSD Clinical Pharmacology, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy.
| | - Elisa Morandin
- Department of Medicine, University of Udine, Udine, Italy
| | - Massimo Baraldo
- Institute of Clinical Pharmacology, Santa Maria della Misericordia University-Hospital of Udine, ASUFC, Udine, Italy; Department of Medicine, University of Udine, Udine, Italy
| | - Federico Pea
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy; SSD Clinical Pharmacology, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
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23
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Ullah S, Zoller M, Jaehde U, Huseyn-Zada M, Weig T, Fuhr U, Arshad U, Zander J, Taubert M. A Model-Based Approach to Assess Unstable Creatinine Clearance in Critically Ill Patients. Clin Pharmacol Ther 2021; 110:1240-1249. [PMID: 34137456 DOI: 10.1002/cpt.2341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/01/2021] [Indexed: 11/07/2022]
Abstract
Creatinine clearance is an important tool to describe the renal elimination of drugs in pharmacokinetic (PK) evaluations and clinical practice. In critically ill patients, unstable kidney function invalidates the steady-state assumption underlying equations, such as Cockcroft-Gault. Although measured creatinine clearance (mCrCL) is often used in nonsteady-state situations, it assumes that observed data are error-free, neglecting frequently occurring errors in urine collection. In contrast, compartmental nonlinear mixed effects models of creatinine allow to describe dynamic changes in kidney function while explicitly accounting for a residual error associated with observations. Based on 530 serum and 373 urine creatinine observations from 138 critically ill patients, a one-compartment creatinine model with zero-order creatinine generation rate (CGR) and first-order CrCL was evaluated. An autoregressive approach for interoccasion variability provided a distinct model improvement compared to a classical approach (Δ Akaike information criterion (AIC) -49.0). Fat-free mass, plasma urea concentration, age, and liver transplantation were significantly related to CrCL, whereas weight and sex were linked to CGR. The model-based CrCL estimates were superior to standard approaches to estimate CrCL (or glomerular filtration rate) including Cockcroft-Gault, mCrCL, four-variable modification of diet in renal disease (MDRD), six-variable MDRD, and chronic kidney disease epidemiology collaboration as a covariate to describe cefepime and meropenem PKs in terms of objective function value. In conclusion, a dynamic model of creatinine kinetics provides the means to estimate actual CrCL despite dynamic changes in kidney function, and it can easily be incorporated into population PK evaluations.
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Affiliation(s)
- Sami Ullah
- Department I of Pharmacology, Center for Pharmacology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany.,Institute of Pharmacy, Clinical Pharmacy, University of Bonn, Bonn, Germany
| | - Michael Zoller
- Department of Anaesthesiology, Hospital of the Ludwig Maximilians University of Munich, Munich, Germany
| | - Ulrich Jaehde
- Institute of Pharmacy, Clinical Pharmacy, University of Bonn, Bonn, Germany
| | - Mikayil Huseyn-Zada
- Department of Anaesthesiology, Hospital of the Ludwig Maximilians University of Munich, Munich, Germany
| | - Thomas Weig
- Department of Anaesthesiology, Hospital of the Ludwig Maximilians University of Munich, Munich, Germany
| | - Uwe Fuhr
- Department I of Pharmacology, Center for Pharmacology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Usman Arshad
- Department I of Pharmacology, Center for Pharmacology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany.,Institute of Pharmacy, Clinical Pharmacy, University of Bonn, Bonn, Germany
| | - Johannes Zander
- Institute of Laboratory Medicine, Hospital of the Ludwig Maximilians University of Munich, Munich, Germany
| | - Max Taubert
- Department I of Pharmacology, Center for Pharmacology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
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Chrisikou I, Orkoula M, Kontoyannis C. FT-IR/ATR Solid Film Formation: Qualitative and Quantitative Analysis of a Piperacillin-Tazobactam Formulation. Molecules 2020; 25:molecules25246051. [PMID: 33371411 PMCID: PMC7767412 DOI: 10.3390/molecules25246051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 11/16/2022] Open
Abstract
FT-IR/ATR analytical technique is one of the most applicable techniques worldwide. It is closely associated with easy-to-use equipment, rapid analysis, and reliable results. This study reports the simultaneous qualitative and quantitative analysis of two active pharmaceutical ingredients (APIs), of a piperacillin and tazobactam formulation using a film formation method. This method requires film formation on the ATR crystal, resulting from solvent evaporation of a small amount of liquid sample. Good contact between the film and the crystal led to the identification of both APIs, although tazobactam was of low content in the formulation mixture. The quantification of the APIs in the commercial mixture was also achieved, using a single calibration line with a correlation coefficient equal to 0.999, not only after film formation but also in the initial dry formulation before reconstitution. The present spectroscopic technique combined with the proposed relatively simple sample treatment outweighs chromatographic protocols already applied, which require specialized staff and are costly, time-consuming, and not environmentally friendly. Taking all the above into consideration, it turns out that such an approach has the potential to be used for off-line quality control procedures in manufacture or, in terms of portable equipment and automated software, anywhere for on-site analysis, even in a hospital workflow.
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Affiliation(s)
- Ioanna Chrisikou
- Department of Pharmacy, University of Patras, University Campus, GR-26504 Rio Achaias, Greece; (I.C.); (M.O.)
- Institute of Chemical Engineering Sciences, Foundation of Research and Technology-Hellas (ICE-HT/FORTH), GR-26504 Platani Achaias, Greece
| | - Malvina Orkoula
- Department of Pharmacy, University of Patras, University Campus, GR-26504 Rio Achaias, Greece; (I.C.); (M.O.)
| | - Christos Kontoyannis
- Department of Pharmacy, University of Patras, University Campus, GR-26504 Rio Achaias, Greece; (I.C.); (M.O.)
- Institute of Chemical Engineering Sciences, Foundation of Research and Technology-Hellas (ICE-HT/FORTH), GR-26504 Platani Achaias, Greece
- Correspondence: ; Tel.: +30-2610-962328
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Böhle T, Georgi U, Hughes DF, Hauser O, Stamminger G, Pohlers D. Personalized antibiotic therapy – a rapid high performance liquid chromatography–tandem mass spectrometry method for the quantitation of eight antibiotics and voriconazole for patients in the intensive care unit. J LAB MED 2020. [DOI: 10.1515/labmed-2020-0052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Abstract
Objectives
For a long time, the therapeutic drug monitoring of anti-infectives (ATDM) was recommended only to avoid the toxic side effects of overdosing. During the last decade, however, this attitude has undergone a significant change. Insufficient antibiotic therapy may promote the occurrence of drug resistance; therefore, the “one-dose-fits-all” principle can no longer be classified as up to date. Patients in intensive care units (ICU), in particular, can benefit from individualized antibiotic therapies.
Methods
Presented here is a rapid and sufficient LC-MS/MS based assay for the analysis of eight antibiotics (ampicillin, cefepime, cefotaxime, ceftazidime, cefuroxime, linezolid, meropenem, and piperacillin) applicated by continuous infusion and voriconazole. In addition a dose adjustment procedure for individualized antibiotic therapy has been established.
Results
The suggested dose adjustments following the initial dosing of 121 patient samples from ICUs, were evaluated over a period of three months. Only a minor percentage of the serum levels were found to be within the target range while overdosing was often observed for β-lactam antibiotics, and linezolid tended to be often underused. The results demonstrate an appreciable potential for β-lactam savings while enabling optimal therapy.
Conclusions
The presented monitoring method provides high specificity and is very robust against various interferences. A fast and straightforward method, the developed routine ensures rapid turnaround time. Its application has been well received by participating ICUs and has led to an expanding number of hospital wards participating in ATDM.
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Affiliation(s)
- Tony Böhle
- Zentrum für Diagnostik GmbH am Klinikum Chemnitz , Chemnitz , Germany
| | - Ulrike Georgi
- Klinikum Chemnitz gGmbH Zentralapotheke , Chemnitz , Germany
| | - Dewi Fôn Hughes
- Zentrum für Diagnostik GmbH am Klinikum Chemnitz , Chemnitz , Germany
| | - Oliver Hauser
- Zentrum für Diagnostik GmbH am Klinikum Chemnitz , Chemnitz , Germany
| | - Gudrun Stamminger
- Zentrum für Diagnostik GmbH am Klinikum Chemnitz , Chemnitz , Germany
| | - Dirk Pohlers
- Zentrum für Diagnostik GmbH am Klinikum Chemnitz , Chemnitz , Germany
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Tanaka R, Kai M, Goto K, Ohchi Y, Yasuda N, Tatsuta R, Kitano T, Itoh H. High-throughput and wide-range simultaneous determination of linezolid, daptomycin and tedizolid in human plasma using ultra-performance liquid chromatography coupled to tandem mass spectrometry. J Pharm Biomed Anal 2020; 194:113764. [PMID: 33298382 DOI: 10.1016/j.jpba.2020.113764] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/06/2020] [Accepted: 11/11/2020] [Indexed: 10/22/2022]
Abstract
Several recent studies on pharmacokinetics of linezolid (LZD) and daptomycin (DAP) reported that plasma concentration was linked to efficacy and adverse effects, suggesting the usefulness of therapeutic drug monitoring (TDM). The usefulness of TDM for tedizolid (TZD) has not been reported, but a previous report showed individual differences in area under the curve depending on body weight. In intensive care unit (ICU) patients, pharmacokinetics was reported to fluctuate due to various factors. Here, we developed a high-throughput and wide-range simultaneous quantification method for LZD, DAP and TZD in human plasma using ultra-performance liquid chromatography coupled to tandem mass spectrometry (UPLC-MS/MS). Plasma samples were pretreated by solid-phase extraction using Oasis® HLB μElution Plate. The assay fulfilled the requirements of US Food and Drug Administration and the European Medicines Agency for bioanalytical method validation. The assay for LZD, DAP and TZD showed good linearity over wide ranges of 100-100000, 150-150000 and 5-5000 ng/mL, respectively. Within-batch accuracy and precision as well as batch-to-batch accuracy and precision for all three drugs fulfilled the criteria of the above guidance. Extraction recovery rates were more than 92.2 % for LZD, 44.7 % for DAP, and 84.8 % for TZD. Matrix effect showed no remarkable differences among low, medium and high quality control samples for the three drugs. The maximum and trough concentrations of three patients each who received LZD, DAP or TZD in ICU were measured by the novel UPLC-MS/MS method. In all patients, the measured concentrations were within the ranges of the calibration curves, demonstrating the feasibility of clinical application of the novel method. In conclusion, we have succeeded to develop the first method for simultaneous quantification of plasma concentrations of LZD, DAP and TZD.
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Affiliation(s)
- Ryota Tanaka
- Department of Clinical Pharmacy, Oita University Hospital, Yufu-shi, Oita, Japan.
| | - Makoto Kai
- Department of Clinical Pharmacy, Oita University Hospital, Yufu-shi, Oita, Japan
| | - Koji Goto
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Oita University, Yufu-shi, Oita, Japan
| | - Yoshifumi Ohchi
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Oita University, Yufu-shi, Oita, Japan
| | - Norihisa Yasuda
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Oita University, Yufu-shi, Oita, Japan
| | - Ryosuke Tatsuta
- Department of Clinical Pharmacy, Oita University Hospital, Yufu-shi, Oita, Japan
| | - Takaaki Kitano
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Oita University, Yufu-shi, Oita, Japan
| | - Hiroki Itoh
- Department of Clinical Pharmacy, Oita University Hospital, Yufu-shi, Oita, Japan
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Rehm S, Rentsch KM. LC-MS/MS method for nine different antibiotics. Clin Chim Acta 2020; 511:360-367. [PMID: 33159947 DOI: 10.1016/j.cca.2020.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/01/2020] [Accepted: 11/01/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIMS TDM of antibiotics can bring benefits to patients and healthcare systems by providing better treatment and saving healthcare resources. We aimed to develop a multi-analyte method for several diverse antibiotics using LC-MS/MS. MATERIALS AND METHODS Sample preparation consisted of protein precipitation with methanol, dilution and online extraction using a Turboflow Cyclone column. Separation was performed on a Synergi 4 µm Max RP column and deuterated forms of three antibiotics were used as internal standards. RESULTS We present a LC-MS/MS method for the quantitative determination of nine antibiotics, including five cephalosporins, the carbapenem ertapenem, the fluoroquinolone ciprofloxacin as well as the combination drug trimethoprim-sulfamethoxazole from plasma. Additionally, unbound ertapenem and cefazolin were analyzed in plasma water after ultrafiltration using plasma calibrators. Results from routine TDM show the applicability of the method. CONCLUSION The presented method is precise and accurate and was introduced in a university hospital, permitting fast TDM of all nine analytes. It was also used in a clinical study for measuring cefazolin free and total concentrations.
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Affiliation(s)
- Sophia Rehm
- Laboratory Medicine, University Hospital Basel, University Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Katharina M Rentsch
- Laboratory Medicine, University Hospital Basel, University Basel, Petersgraben 4, 4031 Basel, Switzerland.
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Roth T, Weber L, Niestroj M, Cipa F, Löscher A, Mihai S, Parsch H. Simultaneous determination of six antibiotics in human serum by high-performance liquid chromatography with UV detection. Biomed Chromatogr 2020; 35:e5010. [PMID: 33119907 DOI: 10.1002/bmc.5010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/02/2020] [Accepted: 10/16/2020] [Indexed: 11/07/2022]
Abstract
Antibiotics are widely used in intensive care patients to treat severe infections. To avoid bacterial resistance or toxic side effects, the determination of serum concentration of ABs is advisable. Therefore, in this study, we developed and validated a simple and fast high-performance liquid chromatography method with UV detection for the simultaneous determination of four β-lactam ABs (meropenem, imipenem, ceftazidime, and piperacillin) and two coadministered substances (cilastatin and tazobactam) in human serum. Sample preparation required a simple protein precipitation by methanol. The separation of the ABs occurred within a timeframe of 17 min. For this purpose, we used a Kinetex F5 column with a linear gradient of acetonitrile and phosphate buffer (pH 6.9). The UV detector recorded two separate chromatograms at 220 and 295 nm simultaneously. Validation has demonstrated that the method is linear, accurate, and precise within the clinically relevant range for each substance.
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Affiliation(s)
- Thomas Roth
- Central Laboratory, University Hospital Erlangen, Erlangen, Germany
| | - Lea Weber
- Central Laboratory, University Hospital Erlangen, Erlangen, Germany
| | - Marion Niestroj
- Central Laboratory, University Hospital Erlangen, Erlangen, Germany
| | - Franziska Cipa
- Central Laboratory, University Hospital Erlangen, Erlangen, Germany
| | - Astrid Löscher
- Central Laboratory, University Hospital Erlangen, Erlangen, Germany
| | - Sidonia Mihai
- Central Laboratory, University Hospital Erlangen, Erlangen, Germany
| | - Hans Parsch
- Central Laboratory, University Hospital Erlangen, Erlangen, Germany
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Rehm S, Rentsch KM. HILIC LC-MS/MS method for the quantification of cefepime, imipenem and meropenem. J Pharm Biomed Anal 2020; 186:113289. [DOI: 10.1016/j.jpba.2020.113289] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 03/13/2020] [Accepted: 03/25/2020] [Indexed: 01/19/2023]
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Patil KD, Bagade SB, Bonde SC. QbD-Enabled Stability-Indicating Assay Method for the Estimation of Linezolid in Newly Developed Gelatin Nanoparticles for Anti-tubercular Therapy. Chromatographia 2020. [DOI: 10.1007/s10337-020-03925-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Validation and clinical application of a multiplex high performance liquid chromatography - tandem mass spectrometry assay for the monitoring of plasma concentrations of 12 antibiotics in patients with severe bacterial infections. J Chromatogr B Analyt Technol Biomed Life Sci 2020; 1157:122160. [PMID: 32891946 DOI: 10.1016/j.jchromb.2020.122160] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Unpredictable pharmacokinetics of antibiotics in patients with life-threatening bacterial infections is associated with drug under- or overdosing. Therapeutic drug monitoring (TDM) may guide dosing adjustment aimed at maximizing antibacterial efficacy and minimizing toxicity. Rapid and accurate analytical methods are key for real-time TDM. Our objective was to develop a robust high-performance liquid chromatography-tandem mass spectrometry method (HPLC-MS/MS) for multiplex quantification of plasma concentrations of 12 antibiotics: imipenem/cilastatin, meropenem, ertapenem, cefepime, ceftazidime, ceftriaxone, piperacillin/tazobactam, amoxicillin, flucloxacillin, rifampicin, daptomycin. METHODS A single extraction procedure consisting in methanol plasma protein precipitation and H2O dilution was used for all analytes. After chromatographic separation on an Acquity UPLC HSS-T3 2.1 × 50 mm, 1.8 µm (Waters®) column, quantification was performed by electro-spray ionisation-triple quadrupole mass spectrometry with selected reaction monitoring detection. Antibiotics were divided in two pools of calibration according to the frequency of analyses requests in the hospital routine antibiotic TDM program. Stable isotopically-labelled analogues were used as internal standards. A single analytical run lasted less than 9 min. RESULTS The method was validated based on FDA recommendations, including assessment of extraction yield (96-113.8%), matrix effects, and analytical recovery (86.3-99.6%). The method was sensitive (lower limits of quantification 0.02-0.5 µg/mL), accurate (intra/inter-assay bias -11.3 to +12.7%) and precise (intra/inter-assay CVs 2.1-11.5%) over the clinically relevant plasma concentration ranges (upper limits of quantification 20-160 µg/mL). The application of the TDM assay was illustrated with clinical cases that highlight the impact on patients' management of an analytical assay providing information with short turn-around time on antibiotic plasma concentration. CONCLUSION This simple, robust high-throughput multiplex HPLC-MS/MS assay for simultaneous quantification of plasma concentrations of 12 daily used antibiotics is optimally suited for clinically efficient real-time TDM.
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Preanalytical Stability of Piperacillin, Tazobactam, Meropenem, and Ceftazidime in Plasma and Whole Blood Using Liquid Chromatography-Tandem Mass Spectrometry. Ther Drug Monit 2020; 41:538-543. [PMID: 31306394 DOI: 10.1097/ftd.0000000000000650] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Therapeutic drug monitoring (TDM) is increasingly used to optimize the dosing of beta-lactam antibiotics in critically ill patients. However, beta-lactams are inherently unstable and degrade over time. Hence, patient samples need to be appropriately handled and stored before analysis to generate valid results for TDM. The appropriate handling and storage conditions are not established, with few and conflicting studies on the stability of beta-lactam antibiotics in clinical samples. The aim of this study was to assess the preanalytical stability of piperacillin, tazobactam, meropenem, and ceftazidime in human plasma and whole blood using a liquid chromatography-tandem mass spectrometry method for simultaneous quantification. METHODS A reverse phase liquid chromatography-tandem mass spectrometry method for the quantification of piperacillin, tazobactam, meropenem, and ceftazidime in plasma after protein precipitation was developed and validated. The preanalytical stability of these beta-lactams was assessed in EDTA- and citrate-anticoagulated plasma at 24, 4, and -20°C. The whole blood stability of the analytes in EDTA-anticoagulated tubes was assessed at 24°C. Stability was determined by nonlinear regression analysis defined by the lower limit of the 95th confidence interval of the time to 15% of degradation. RESULTS Based on the lower limit of the 95th confidence interval of the time to 15% of degradation, piperacillin, tazobactam, meropenem, and ceftazidime were stable in EDTA-anticoagulated plasma for at least 6 hours at 24°C, 3 days at 4°C, and 4 days at -20°C. Stability in EDTA- and citrate-anticoagulated plasma was similar. Stability in whole blood was similar to plasma at 24°C. CONCLUSIONS Plasma samples for the TDM of piperacillin, tazobactam, meropenem, and ceftazidime should be processed within 6 hours if kept at room temperature and within 3 days if kept at 4°C. All long-term storage of samples should be at -80°C.
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Moorthy GS, Vedar C, Zane NR, Downes KJ, Prodell JL, DiLiberto MA, Zuppa AF. Development and validation of a volumetric absorptive microsampling- liquid chromatography mass spectrometry method for the analysis of cefepime in human whole blood: Application to pediatric pharmacokinetic study. J Pharm Biomed Anal 2019; 179:113002. [PMID: 31785929 DOI: 10.1016/j.jpba.2019.113002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 11/18/2019] [Accepted: 11/19/2019] [Indexed: 01/07/2023]
Abstract
Cefepime is a fourth-generation cephalosporin antibiotic with an extended spectrum of activity against many Gram-positive and Gram-negative bacteria. There is a growing need to develop sensitive, small volume assays, along with less invasive sample collection to facilitate pediatric pharmacokinetic clinical trials and therapeutic drug monitoring. The volumetric absorptive microsampling (VAMS™) approach provides an accurate and precise collection of a fixed volume of blood (10 μL), reducing or eliminating the volumetric blood hematocrit assay-bias associated with the dried blood spotting technique. We developed a high-performance liquid chromatographic method with tandem mass spectrometry detection for quantification of cefepime. Sample extraction from VAMS™ devices, followed by reversed-phase chromatographic separation and selective detection using tandem mass spectrometry with a 4 min runtime per sample was employed. Standard curves were linear between 0.1-100 μg/mL for cefepime. Intra- and inter-day accuracies were within 95.4-113% and precision (CV) was < 15 % based on a 3-day validation study. Recoveries ranged from 40.8 to 62.1% and the matrix effect was within 89.5-96.7% for cefepime. Cefepime was stable in human whole blood under assay conditions (3 h at room temperature, 24 h in autosampler post-extraction). Cefepime was also stable for at least 1 week (7 days) at 4 °C, 1 month (39 days) at -20 °C and 3 months (91 days) at -78 °C as dried microsamples. This assay provides an efficient quantitation of cefepime and was successfully implemented for the analysis of whole blood microsamples in a pediatric clinical trial.
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Affiliation(s)
- Ganesh S Moorthy
- Center for Clinical Pharmacology, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, United States; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, United States.
| | - Christina Vedar
- Center for Clinical Pharmacology, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, United States
| | - Nicole R Zane
- Center for Clinical Pharmacology, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, United States
| | - Kevin J Downes
- Center for Clinical Pharmacology, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, United States; Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, United States; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, United States
| | - Janice L Prodell
- Center for Clinical Pharmacology, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, United States; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, United States
| | - Mary Ann DiLiberto
- Center for Clinical Pharmacology, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, United States; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, United States
| | - Athena F Zuppa
- Center for Clinical Pharmacology, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, United States; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, United States
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A validated LC-MSMS method for the simultaneous quantification of meropenem and vaborbactam in human plasma and renal replacement therapy effluent and its application to a pharmacokinetic study. Anal Bioanal Chem 2019; 411:7831-7840. [DOI: 10.1007/s00216-019-02184-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 09/12/2019] [Accepted: 10/01/2019] [Indexed: 02/06/2023]
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Mameli M, Vezzelli A, Verze' S, Biondi S, Motta P, Greco A, Michi M, Breda M. Liquid chromatography-tandem mass spectrometry for the simultaneous quantitation of enmetazobactam and cefepime in human plasma. J Pharm Biomed Anal 2019; 174:655-662. [PMID: 31288188 DOI: 10.1016/j.jpba.2019.06.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 06/27/2019] [Accepted: 06/28/2019] [Indexed: 10/26/2022]
Abstract
A simple ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method was developed and validated for the simultaneous analysis enmetazobactam (also known as AAI101) and cefepime in human plasma. Sample preparation was based on protein precipitation with acetonitrile. Separation was performed on Acquity BEH HILIC column (50 mm × 2.1 mm, 1.7 μm) with a mobile phase containing ammonium formate in water and acetonitrile. The analytes were analyzed with the corresponding isotopically labeled internal standards and were detected in multiple reactions monitoring (MRM) using API 5000 triple-quadrupole mass spectrometer with electrospray (ESI) source operating in positive ion mode. The calibration curves were linear over the selected ranges (r > 0.9970 for both analytes). The intra and inter-assay precision of the Quality Control samples showed CV ≤ 15% and the accuracy was within 85 and 115% in all cases for both compounds. The lower limit of quantification was 0.05 μg/mL for enmetazobactam and 0.5 μg/mL for cefepime.
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Affiliation(s)
- M Mameli
- Aptuit (Verona) S.r.l., an Evotec Company, Bioanalytical Group, Verona, Italy
| | - A Vezzelli
- Aptuit (Verona) S.r.l., an Evotec Company, Bioanalytical Group, Verona, Italy
| | - S Verze'
- Aptuit (Verona) S.r.l., an Evotec Company, Bioanalytical Group, Verona, Italy
| | - S Biondi
- Allecra Therapeutics SAS, 10 rue Alexandre Freund, 68300, Saint Louis, France
| | - P Motta
- Allecra Therapeutics SAS, 10 rue Alexandre Freund, 68300, Saint Louis, France
| | - A Greco
- Aptuit (Verona) S.r.l., an Evotec Company, Bioanalytical Group, Verona, Italy
| | - M Michi
- Aptuit (Verona) S.r.l., an Evotec Company, Bioanalytical Group, Verona, Italy
| | - M Breda
- Aptuit (Verona) S.r.l., an Evotec Company, Bioanalytical Group, Verona, Italy.
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Yin L, Feng Y, Tong J, Guo Z, Zhang Y, Zhang Q, Sun Y, Fawcett JP, Gu J. Ultrahigh-throughput absolute quantitative analysis of linezolid in human plasma by direct analysis in real time mass spectrometry without chromatographic separation and its application to a pharmacokinetic study. Anal Bioanal Chem 2019; 411:5139-5148. [PMID: 31179528 DOI: 10.1007/s00216-019-01891-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/27/2019] [Accepted: 05/02/2019] [Indexed: 12/11/2022]
Abstract
Therapeutic drug monitoring (TDM) is necessary in the clinical management of linezolid to improve its efficacy and reduce the risk of time- and dose-dependent toxicity. A novel and ultrahigh-throughput analytical method for the determination of linezolid in human plasma was developed based on direct analysis in real-time tandem mass spectrometry (DART-MS/MS) without chromatographic separation. After solid-phase extraction with Waters Oasis HLB, the linezolid and internal standard linezolid-d3 were detected by positive ion electrospray ionization followed by multiple reaction monitoring (MRM) of the transition at m/z 338.1 → 296.2 and 341.2 → 297.3, respectively. The use of DART-MS obviates the need for chromatographic separation and allowed determination of linezolid in a total run time of only 24 s per sample. The method was linear in the concentration range 0.20-25 μg mL-1 with intraday and interday precision <14.5% and accuracy ranging from -3.85% to 12.7%. The method was successfully applied to a pharmacokinetic study of linezolid in healthy male volunteers after oral administration of a 600 mg tablet. DART-MS/MS provides a rapid and sensitive method for the determination of linezolid that does not require chromatographic separation. It is eminently suitable to meet the high-throughput challenge of clinical TDM. Graphical abstract.
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Affiliation(s)
- Lei Yin
- Research Institute of Translational Medicine, The First Hospital of Jilin University, Jilin University, Dongminzhu Street, Changchun, 130061, Jilin, China.,Research Center for Drug Metabolism, School of Life Science, Jilin University, Qianjin Street, Changchun, 130012, Jilin, China.,College of Pharmacy, University of Arizona, Tucson, AZ, 85721, USA
| | - Yixuan Feng
- Research Center for Drug Metabolism, School of Life Science, Jilin University, Qianjin Street, Changchun, 130012, Jilin, China
| | - Jin Tong
- Research Center for Drug Metabolism, School of Life Science, Jilin University, Qianjin Street, Changchun, 130012, Jilin, China
| | - Zhiqiong Guo
- Research Center for Drug Metabolism, School of Life Science, Jilin University, Qianjin Street, Changchun, 130012, Jilin, China
| | - Yuyao Zhang
- Research Center for Drug Metabolism, School of Life Science, Jilin University, Qianjin Street, Changchun, 130012, Jilin, China
| | - Qi Zhang
- Research Center for Drug Metabolism, School of Life Science, Jilin University, Qianjin Street, Changchun, 130012, Jilin, China
| | - Yantong Sun
- School of Pharmaceutical Sciences, Jilin University, Changchun, 130012, Jilin, China
| | - J Paul Fawcett
- School of Pharmacy, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - Jingkai Gu
- Research Institute of Translational Medicine, The First Hospital of Jilin University, Jilin University, Dongminzhu Street, Changchun, 130061, Jilin, China. .,Research Center for Drug Metabolism, School of Life Science, Jilin University, Qianjin Street, Changchun, 130012, Jilin, China. .,Beijing Institute of Modern Drug Metabolism, Beijing, 102209, China.
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Martens-Lobenhoffer J, Monastyrski D, Tröger U, Bode-Böger SM. Stability of meropenem in plasma versus dried blood spots (DBS). J Pharm Biomed Anal 2019; 170:279-284. [DOI: 10.1016/j.jpba.2019.03.055] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/21/2019] [Accepted: 03/24/2019] [Indexed: 12/21/2022]
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Fernandes GFDS, Salgado HRN, Santos JLD. A critical review of HPLC-based analytical methods for quantification of Linezolid. Crit Rev Anal Chem 2019; 50:196-211. [PMID: 31017000 DOI: 10.1080/10408347.2019.1605876] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Linezolid is a synthetic antimicrobial agent belonging to the oxazolidinone class. Since its approval in the year 2000 until now, linezolid remains the main representative drug for the oxazolidinone class of drugs, which is used in therapy due to its unique mode of action, which involves inhibition of protein synthesis. As linezolid holds great importance in antimicrobial therapy, it is necessary to compile the various analytical methods that have been reported in the literature for its analysis. Analytical techniques used for pharmaceutical analyses and therapeutic drug monitoring play an important role in comprehending the aspects regarding bioavailability, bioequivalence, and therapeutic monitoring during patient follow-ups. Even though linezolid has had the approval for clinical use for more than 18 years now, most of the analytical methods for its determination reported in the scientific literature are the ones which utilize HPLC. Therefore, the present review provides a summary of the HPLC-based methods used in the determination and quantification of linezolid in different matrices since the time of its discovery.
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Affiliation(s)
- Guilherme Felipe Dos Santos Fernandes
- Institute of Chemistry, São Paulo State University, Araraquara, Brazil.,School of Pharmaceutical Sciences, São Paulo State University, Araraquara, Brazil
| | | | - Jean Leandro Dos Santos
- Institute of Chemistry, São Paulo State University, Araraquara, Brazil.,School of Pharmaceutical Sciences, São Paulo State University, Araraquara, Brazil
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Zheng Y, Wang Z, Lui G, Hirt D, Treluyer J, Benaboud S, Aboura R, Gana I. Simultaneous quantification of levofloxacin, pefloxacin, ciprofloxacin and moxifloxacin in microvolumes of human plasma using high‐performance liquid chromatography with ultraviolet detection. Biomed Chromatogr 2019; 33:e4506. [DOI: 10.1002/bmc.4506] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 12/22/2018] [Accepted: 02/05/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Yi Zheng
- Service de Pharmacologie Clinique, Hôpital Cochin, Assistance Publique des Hôpitaux de ParisGroupe Hospitalier Paris Centre Paris France
- EA 7323Université Paris Descartes Paris France
- Unité de Recherche Clinique Paris Descartes Necker CochinAssistance Publique des Hôpitaux de Paris Paris France
| | - Ziqing Wang
- EA 7323Université Paris Descartes Paris France
| | - Gabrielle Lui
- Service de Pharmacologie Clinique, Hôpital Cochin, Assistance Publique des Hôpitaux de ParisGroupe Hospitalier Paris Centre Paris France
- EA 7323Université Paris Descartes Paris France
- Unité de Recherche Clinique Paris Descartes Necker CochinAssistance Publique des Hôpitaux de Paris Paris France
| | - Déborah Hirt
- Service de Pharmacologie Clinique, Hôpital Cochin, Assistance Publique des Hôpitaux de ParisGroupe Hospitalier Paris Centre Paris France
- EA 7323Université Paris Descartes Paris France
- Unité de Recherche Clinique Paris Descartes Necker CochinAssistance Publique des Hôpitaux de Paris Paris France
| | - Jean‐Marc Treluyer
- Service de Pharmacologie Clinique, Hôpital Cochin, Assistance Publique des Hôpitaux de ParisGroupe Hospitalier Paris Centre Paris France
- EA 7323Université Paris Descartes Paris France
- Unité de Recherche Clinique Paris Descartes Necker CochinAssistance Publique des Hôpitaux de Paris Paris France
| | - Sihem Benaboud
- Service de Pharmacologie Clinique, Hôpital Cochin, Assistance Publique des Hôpitaux de ParisGroupe Hospitalier Paris Centre Paris France
- EA 7323Université Paris Descartes Paris France
- Unité de Recherche Clinique Paris Descartes Necker CochinAssistance Publique des Hôpitaux de Paris Paris France
| | - Radia Aboura
- Service de Pharmacologie Clinique, Hôpital Cochin, Assistance Publique des Hôpitaux de ParisGroupe Hospitalier Paris Centre Paris France
- Unité de Recherche Clinique Paris Descartes Necker CochinAssistance Publique des Hôpitaux de Paris Paris France
| | - Inès Gana
- Service de Pharmacologie Clinique, Hôpital Cochin, Assistance Publique des Hôpitaux de ParisGroupe Hospitalier Paris Centre Paris France
- Unité de Recherche Clinique Paris Descartes Necker CochinAssistance Publique des Hôpitaux de Paris Paris France
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40
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Ferrari D, Ripa M, Premaschi S, Banfi G, Castagna A, Locatelli M. LC-MS/MS method for simultaneous determination of linezolid, meropenem, piperacillin and teicoplanin in human plasma samples. J Pharm Biomed Anal 2019; 169:11-18. [PMID: 30826487 DOI: 10.1016/j.jpba.2019.02.037] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/19/2019] [Accepted: 02/20/2019] [Indexed: 01/09/2023]
Abstract
Antibiotic therapy is a crucial aspect of the management of hospitalized patients, however, current standard dosing protocols have been shown to often attain inadequate plasmatic concentrations which may impair the clinical outcome and promote the selection of multidrug-resistant bacteria. The aim of this study is to establish and validate a robust and fast liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for the simultaneous analysis of four commonly used antibiotics (Meropenem, Piperacillin, Linezolid and Teicoplanin) in human plasma according to the European Medicines Agency (EMA) guidelines. Samples preparation was performed using a commercially available extraction kit which needs a very small amount of sample (50 μl). Antibiotics were detected, following a 7 min gradient separation, in multiple reactions monitoring (MRM) mode using a Qtrap 5500 triple quadrupole instrument equipped with an electrospray source operating in positive ion mode. The method, covering the antibiotics' clinically relevant concentration ranges, is also able to quantify, individually, the major teicoplanin components. The high reproducibility and the need of a small amount of sample, associated with the use of a commercial kit, together with a short chromatographic time, makes the method particularly suited for high-throughput routine analysis. Monitoring of plasma antibiotic levels, as part of the clinical routine, would result in a quick therapy adjustment leading to a higher probability of eradicating the infection as well as a potential reduction of multidrug-resistance prevalence. The method was successfully applied to monitor the antibiotic concentration of 49 patients under therapy.
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Affiliation(s)
- Davide Ferrari
- SCVSA Department, University of Parma, Parma, Italy; Laboratory Medicine Service, San Raffaele Hospital, Milano, Italy.
| | - Marco Ripa
- Clinic of Infectious Diseases, San Raffaele Hospital, Milano, Italy
| | - Simone Premaschi
- Laboratory Medicine Service, San Raffaele Hospital, Milano, Italy
| | - Giuseppe Banfi
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy; Vita-Salute San Raffaele University, Milano, Italy
| | - Antonella Castagna
- Clinic of Infectious Diseases, San Raffaele Hospital, Milano, Italy; Vita-Salute San Raffaele University, Milano, Italy
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41
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Ferrone V, Cotellese R, Cichella A, Raimondi P, Carlucci M, Palumbo P, Carlucci G. Meropenem and ciprofloxacin in complicated gastric surgery for cancer patients: A simple SPE–UHPLC–PDA method for their determination in human plasma. Biomed Chromatogr 2019; 33:e4450. [DOI: 10.1002/bmc.4450] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 11/15/2018] [Accepted: 11/27/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Vincenzo Ferrone
- Dipartimento di FarmaciaOrali e Biotecnologiche ‐ Università degli Studi “G. d'Annunzio” Chieti‐Pescara Chieti Italy
| | - Roberto Cotellese
- Dipartimento di Scienze MedicheOrali e Biotecnologiche ‐ Università degli Studi “G. d'Annunzio” Chieti‐Pescara Chieti Italy
| | - Annadomenica Cichella
- Dipartimento di Scienze MedicheOrali e Biotecnologiche ‐ Università degli Studi “G. d'Annunzio” Chieti‐Pescara Chieti Italy
| | - Paolo Raimondi
- Dipartimento di Scienze MedicheOrali e Biotecnologiche ‐ Università degli Studi “G. d'Annunzio” Chieti‐Pescara Chieti Italy
| | - Maura Carlucci
- Dipartimento di Scienze MedicheOrali e Biotecnologiche ‐ Università degli Studi “G. d'Annunzio” Chieti‐Pescara Chieti Italy
| | - Paola Palumbo
- Dipartimento di Medicina Clinica, Sanità PubblicaScienze della Vita e dell'Ambiente ‐ Università degli studi di L'Aquila L'Aquila Italy
| | - Giuseppe Carlucci
- Dipartimento di FarmaciaOrali e Biotecnologiche ‐ Università degli Studi “G. d'Annunzio” Chieti‐Pescara Chieti Italy
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42
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Li X, Zoller M, Fuhr U, Huseyn-Zada M, Maier B, Vogeser M, Zander J, Taubert M. Ciprofloxacin in critically ill subjects: considering hepatic function, age and sex to choose the optimal dose. J Antimicrob Chemother 2018; 74:682-690. [DOI: 10.1093/jac/dky485] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 10/24/2018] [Accepted: 11/05/2018] [Indexed: 12/14/2022] Open
Affiliation(s)
- Xia Li
- Department I of Pharmacology, Clinical Pharmacology, Cologne University Hospital, Cologne, Germany
| | - Michael Zoller
- Department of Anesthesiology, Hospital of the Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Uwe Fuhr
- Department I of Pharmacology, Clinical Pharmacology, Cologne University Hospital, Cologne, Germany
| | - Mikayil Huseyn-Zada
- Department of Anesthesiology, Hospital of the Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Barbara Maier
- Institute of Laboratory Medicine, Hospital of the Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Michael Vogeser
- Institute of Laboratory Medicine, Hospital of the Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Johannes Zander
- Institute of Laboratory Medicine, Hospital of the Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Max Taubert
- Department I of Pharmacology, Clinical Pharmacology, Cologne University Hospital, Cologne, Germany
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43
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Schuster C, Sterz S, Teupser D, Brügel M, Vogeser M, Paal M. Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses. J Vis Exp 2018:58148. [PMID: 30222156 PMCID: PMC6235066 DOI: 10.3791/58148] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
There is an ever-increasing demand for the therapeutic drug monitoring of antibiotics in many clinical facilities, particularly with regard to the implementation of hospital antibiotic stewardship programs. In the current work, we present a multiplex high-performance liquid chromatography-tandem mass spectrometry (HPCL-MS/MS) protocol for the quantification of cefepime, meropenem, ciprofloxacin, moxifloxacin, linezolid, and piperacillin, commonly used antibiotics in intensive care units. The method was previously comprehensively validated according to the guideline of the European Medicines Agency. After a rapid sample cleanup, the analytes are separated on a C8 reverse-phase HPLC column within 4 minutes and quantified with the corresponding stable isotope-labeled internal standards in electrospray ionization (ESI+) mass spectrometry in multiple reaction time monitoring (MRM). The presented method uses a simple instrumentation setting with uniform chromatographic conditions, allowing for the daily and robust antibiotic therapeutic drug monitoring in clinical laboratories. The calibration curve spans the pharmacokinetic concentration range, thereby including antibiotic amounts close to the minimal inhibitory concentration (MIC) of susceptible bacteria and peak concentrations (Cmax) that are obtained with bolus administration regimens. Without the necessity of the serum dilution before the sample cleanup, the area under the curve for an administered antibiotic can be obtained through multiple measurements.
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Affiliation(s)
- Carina Schuster
- Institute of Laboratory Medicine, University Hospital, LMU Munich
| | - Sebastian Sterz
- Institute of Laboratory Medicine, University Hospital, LMU Munich
| | - Daniel Teupser
- Institute of Laboratory Medicine, University Hospital, LMU Munich
| | - Mathias Brügel
- Institute of Laboratory Medicine, University Hospital, LMU Munich
| | - Michael Vogeser
- Institute of Laboratory Medicine, University Hospital, LMU Munich
| | - Michael Paal
- Institute of Laboratory Medicine, University Hospital, LMU Munich;
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44
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Quantification of Cefepime, Meropenem, Piperacillin, and Tazobactam in Human Plasma Using a Sensitive and Robust Liquid Chromatography-Tandem Mass Spectrometry Method, Part 1: Assay Development and Validation. Antimicrob Agents Chemother 2018; 62:AAC.00859-18. [PMID: 29941654 DOI: 10.1128/aac.00859-18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 05/20/2018] [Indexed: 11/20/2022] Open
Abstract
The highly variable pharmacokinetics of β-lactam antibiotics and β-lactamase inhibitors poses a significant challenge to clinicians in ensuring appropriate antibiotic doses in critically ill patients. Therefore, routine monitoring of plasma concentrations is important for individualization of antimicrobial therapy. Accordingly, a simple and robust analytical method for the simultaneous measurement of multiple β-lactam antibiotics and β-lactamase inhibitors is highly desirable to ensure quick decisions on dose adjustments. In this study, a sensitive, simple, and robust method for the simultaneous quantification of cefepime, meropenem, piperacillin, and tazobactam in human plasma was developed and rigorously validated according to FDA guidance. Sample extraction was accomplished by simple protein precipitation. Chromatographic separation of analytes was achieved using stepwise gradient elution. Analytes were monitored using tandem mass spectrometry (MS/MS) with a turbo ion spray source in positive multiple-reaction-monitoring mode. The calibration curve ranged from 0.5 to 150 μg/ml for cefepime, 0.1 to 150 μg/ml for meropenem and piperacillin, and 0.25 to 150 μg/ml for tazobactam. Inter- and intraday precision and accuracy, sensitivity, selectivity, dilution integrity, matrix effect, extraction recovery, and hemolysis effect were investigated for all four analytes, and the results met the acceptance criteria. Compared to other reported methods, our method is more robust because of the combination of the following features: (i) a simple sample extraction procedure, (ii) a short sample run time, (iii) a wide dynamic range, and (iv) the small plasma sample volume needed. Since our method already covers β-lactams and a β-lactamase inhibitor with highly heterogeneous physicochemical properties, further antibiotic candidates may easily be incorporated into this multianalyte method.
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Quantification of Cefepime, Meropenem, Piperacillin, and Tazobactam in Human Plasma Using a Sensitive and Robust Liquid Chromatography-Tandem Mass Spectrometry Method, Part 2: Stability Evaluation. Antimicrob Agents Chemother 2018; 62:AAC.00861-18. [PMID: 29941653 DOI: 10.1128/aac.00861-18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 06/20/2018] [Indexed: 11/20/2022] Open
Abstract
Although the stability of β-lactam antibiotics is a known issue, none of the previously reported bioanalytical methods had an adequate evaluation of the stability of these drugs. In the current study, the stability of cefepime, meropenem, piperacillin, and tazobactam under various conditions was comprehensively evaluated. The evaluated parameters included stock solution stability, short-term stability, long-term stability, freeze-thaw stability, processed sample stability, and whole-blood stability. When stored at -20°C, the stock solution of meropenem in methanol was stable for up to 3 weeks, and the stock solutions of cefepime, piperacillin, and tazobactam were stable for up to 6 weeks. All four antibiotics were stable in human plasma for up to 3 months when stored at -80°C and were stable in whole blood for up to 4 h at room temperature. Short-term stability results indicated that all four β-lactams were stable at room temperature for 2 h, but substantial degradation was observed when the plasma samples were stored at room temperature for 24 h, with the degradation rates for cefepime, meropenem, piperacillin, and tazobactam being 30.1%, 75.6%, 49.0%, and 37.7%, respectively. Because the stability information is method independent, our stability results can be used as a reference by other research groups that work with these antibiotics.
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46
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Shi M, Zhao X, Wang T, Yin L, Li Y. A LC–MS-MS assay for simultaneous determination of two glycopeptides and two small molecule compounds in human plasma. J Chromatogr Sci 2018; 56:828-834. [PMID: 29905845 DOI: 10.1093/chromsci/bmy060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Meiyun Shi
- School of Life Science and Medicine, Dalian University of Technology, No. 2 Dagong Road, New District of Liaodong Bay, Panjin, China
| | - Xiaojun Zhao
- The First Hospital of Jilin University, Changchun, Jilin, China
| | - Tingting Wang
- The First Hospital of Jilin University, Changchun, Jilin, China
- School of Life Science, Jilin University, Qianjin Street, Changchun, China
| | - Lei Yin
- The First Hospital of Jilin University, Changchun, Jilin, China
- School of Life Science, Jilin University, Qianjin Street, Changchun, China
| | - Yanyan Li
- The First Hospital of Jilin University, Changchun, Jilin, China
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Patil K, Tambe H, Zope V, Chavan R, Yeole R, Patel M. Simultaneous determination of zidebactam and cefepime in dog plasma by LC-MS/MS and its application to pre-clinical pharmacokinetic study. Biomed Chromatogr 2018; 32:e4249. [PMID: 29577355 DOI: 10.1002/bmc.4249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/09/2018] [Accepted: 03/16/2018] [Indexed: 11/07/2022]
Abstract
A precise and accurate liquid chromatography-tandem mass spectrometric (LC-MS/MS) bioanalytical method has been developed and validated for the simultaneous quantification of zidebactam (ZID) and cefepime (FEP) in dog plasma. Ceftazidime was used as an internal standard. Protein precipitation method was used as sample preparation approach. The calibration curve obtained was linear (r ≥ 0.99) over the concentration range 0.156-80 μg/mL for ZID and 0.312-160 μg/mL for FEP. The method was validated as per US Food and Drug Administration guidelines and the results met the acceptance criteria. A run time of 3.5 min for each sample made it possible to analyze the maximum number of samples per day. The proposed method was successfully applied for pharmacokinetic study in beagle dogs.
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Affiliation(s)
- Kiran Patil
- Wockhardt Research Centre, D-4, MIDC, Aurangabad, India
| | - Harshad Tambe
- Wockhardt Research Centre, D-4, MIDC, Aurangabad, India
| | - Vineet Zope
- Wockhardt Research Centre, D-4, MIDC, Aurangabad, India
| | - Rajesh Chavan
- Wockhardt Research Centre, D-4, MIDC, Aurangabad, India
| | | | - Mahesh Patel
- Wockhardt Research Centre, D-4, MIDC, Aurangabad, India
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48
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Ferrone V, Cotellese R, Carlucci M, Di Marco L, Carlucci G. Air assisted dispersive liquid-liquid microextraction with solidification of the floating organic droplets (AA-DLLME-SFO) and UHPLC-PDA method: Application to antibiotics analysis in human plasma of hospital acquired pneumonia patients. J Pharm Biomed Anal 2018; 151:266-273. [DOI: 10.1016/j.jpba.2017.12.039] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 12/18/2017] [Accepted: 12/19/2017] [Indexed: 10/18/2022]
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49
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Simultaneous quantification of cefepime, meropenem, ciprofloxacin, moxifloxacin, linezolid and piperacillin in human serum using an isotope-dilution HPLC-MS/MS method. J Pharm Biomed Anal 2018; 152:102-110. [PMID: 29414000 DOI: 10.1016/j.jpba.2018.01.031] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 01/12/2018] [Accepted: 01/17/2018] [Indexed: 01/08/2023]
Abstract
The aim of the current study was to develop and validate a robust multi-analyte high performance liquid chromatography tandem mass spectrometry (HPLC-MS/MS) method for simultaneous quantification of cefepime, meropenem, ciprofloxacin, moxifloxacin, linezolid and piperacillin, which are the most commonly used antibiotics in intensive care units. Sample clean-up included a protein precipitation protocol, followed by chromatographic separation on a C8 reverse phase HPLC column within 4 min, using a formic acid-ammonium formiate methanol step-elution gradient. All compounds were detected with electrospray ionization (ESI+) mass spectrometry in multiple reaction time monitoring. The method was validated according to the protocol from the European Medicines Agency and was thoroughly evaluated for interferences and quantification linearity. Linear relationships between peak area responses and drug concentrations were obtained in the range of 0.25-200 mg/l for cefepime, 0.25-120 mg/l for meropenem, 0.05-10 mg/l for ciprofloxacin, 0.125-10 mg/l for moxifloxacin, 0.125-50 mg/l for linezolid and 0.5-400 mg/l for piperacillin with an R2 > 0.997. Imprecision and inaccuracy values (both intra- and inter-assay) were ≤ 6.8% and ≤10.9% for all analytes in quality control samples, respectively. The assay proved to be selective for the study antibiotics, and the internal standards consistently compensated for matrix effects. The described simple and reliable HPLC-MS/MS assay is a powerful tool for routine TDM of cefepime, meropenem, ciprofloxacin, moxifloxacin, linezolid and piperacillin in human serum in clinical laboratories. With a total process time of approximately 30 min, it allows for accurate and selective quantification up to the expected pharmacokinetic peak concentrations.
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50
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Naicker S, Guerra Valero YC, Ordenez Meija JL, Lipman J, Roberts JA, Wallis SC, Parker SL. A UHPLC-MS/MS method for the simultaneous determination of piperacillin and tazobactam in plasma (total and unbound), urine and renal replacement therapy effluent. J Pharm Biomed Anal 2017; 148:324-333. [PMID: 29080413 DOI: 10.1016/j.jpba.2017.10.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 09/29/2017] [Accepted: 10/22/2017] [Indexed: 11/17/2022]
Abstract
Piperacillin-tazobactam is a beta-lactam/beta-lactamase combination antibiotic used in patients with moderate to severe infection. Dosing of piperacillin-tazobactam requires an understanding of this patient group to maximise the effectiveness of this antibiotic and limit a further emergence of resistant pathogens. This is the first method that measures piperacillin and tazobactam simultaneously, across this range of clinically-relevant biological matrices. The calibration line was linear across the concentration range of 0.5-500μg/mL for piperacillin and 0.625-62.5μg/mL for tazobactam. All validation testing for matrix effects, precision and accuracy, specificity and stability were within 15%. A calibration equivalence study was performed to investigate the suitability of applying calibration curves prepared in an alternative matrix, with a mean bias of -10.8% identified for the application of a calibration line prepared for tazobactam in plasma only. Bias for all other calibration lines prepared in alternate matrices was within the 5% acceptance criteria. The method was successfully applied to a pharmacokinetic study of a critically ill patient receiving renal replacement therapy, with the results included.
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Affiliation(s)
- Saiyuri Naicker
- Burns, Trauma and Critical Care Research Centre, UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia; Centre of Translational Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane, Australia.
| | - Yarmarly C Guerra Valero
- Burns, Trauma and Critical Care Research Centre, UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - Jenny L Ordenez Meija
- Burns, Trauma and Critical Care Research Centre, UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - Jeffrey Lipman
- Burns, Trauma and Critical Care Research Centre, UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia; Department of Intensive Care Medicine, Royal Brisbane & Women's Hospital, Brisbane, Australia; Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Jason A Roberts
- Burns, Trauma and Critical Care Research Centre, UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia; Department of Intensive Care Medicine, Royal Brisbane & Women's Hospital, Brisbane, Australia; Department of Pharmacy, Royal Brisbane & Women's Hospital, Brisbane, Australia; Centre of Translational Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane, Australia
| | - Steven C Wallis
- Burns, Trauma and Critical Care Research Centre, UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - Suzanne L Parker
- Burns, Trauma and Critical Care Research Centre, UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
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