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Nejima R, Eguchi H, Todokoro D, Inoue T, Kaji Y, Suzuki T, Hattori T, Hoshi S, Sasaki Y, Inoue Y. Analysis of treatment protocols using azithromycin eye drops for bacterial blepharitis: second report-bacteriological investigation. Jpn J Ophthalmol 2022; 66:579-589. [PMID: 36181644 DOI: 10.1007/s10384-022-00947-8] [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: 01/26/2022] [Accepted: 08/15/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To gain new insights into the etiology of blepharitis, we investigated the causative bacteria in patients with blepharitis and the effects of 1% azithromycin ophthalmic solution. STUDY DESIGN A multicenter, prospective observational study. METHODS After the subjects were diagnosed as having blepharitis they were administered 1% azithromycin ophthalmic solution for up to 14 days. Bacterial cultures and smear microscopic examinations of the eyelid margin were conducted at the initial visit, after administering eye drops, and 1 month after the end of eye drop administration. The minimum inhibitory concentrations (MICs) of azithromycin were measured. RESULTS At the initial visit, the bacterial morphology determined by smear microscopic examinations coincided with that of strains isolated by culture taken from 22 of 45 patients. All detected bacteria were gram-positive, and Corynebacterium spp., Cutibacterium acnes, Staphylococcus epidermidis, Streptococcus spp., and Enterococcus faecalis were isolated most commonly. Compared with the initial visit the number of isolated strains per eye decreased significantly at 7 days after the start of eye drop administration and 1 month after the end of eye drop administration. The azithromycin MICs were temporarily increased after the start of eye drops but then decreased. CONCLUSION Our study suggests that in blepharitis pathogenicity is characterized by increased strain numbers and amounts of indigenous bacteria. Administering a 1% azithromycin ophthalmic solution suppresses the number of bacterial strains within 1 month after the end of eye drop administration without increasing drug resistance.
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Affiliation(s)
- Ryohei Nejima
- Miyata Eye Hospital, 6-3 Kurahara-cho, Miyakonojo, Miyazaki, 885-0051, Japan.
| | - Hiroshi Eguchi
- Department of Ophthalmology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Daisuke Todokoro
- Department of Ophthalmology, Graduate School of Medicine, Gunma University, Gunma, Japan
| | | | | | | | | | | | - Yumi Sasaki
- Research Institute for Microbial Diseases, Osaka University, Osaka, Japan
| | - Yoshitsugu Inoue
- Division of Ophthalmology and Visual Science, Faculty of Medicine, Tottori University, Tottori, Japan
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Zhang L, Xie H, Wang Y, Wang H, Hu J, Zhang G. Pharmacodynamic Parameters of Pharmacokinetic/Pharmacodynamic (PK/PD) Integration Models. Front Vet Sci 2022; 9:860472. [PMID: 35400105 PMCID: PMC8989418 DOI: 10.3389/fvets.2022.860472] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 02/24/2022] [Indexed: 01/09/2023] Open
Abstract
Pharmacokinetic/pharmacodynamic (PK/PD) integration models are used to investigate the antimicrobial activity characteristics of drugs targeting pathogenic bacteria through comprehensive analysis of the interactions between PK and PD parameters. PK/PD models have been widely applied in the development of new drugs, optimization of the dosage regimen, and prevention and treatment of drug-resistant bacteria. In PK/PD analysis, minimal inhibitory concentration (MIC) is the most commonly applied PD parameter. However, accurately determining MIC is challenging and this can influence the therapeutic effect. Therefore, it is necessary to optimize PD indices to generate more rational results. Researchers have attempted to optimize PD parameters using mutant prevention concentration (MPC)-based PK/PD models, multiple PD parameter-based PK/PD models, kill rate-based PK/PD models, and others. In this review, we discuss progress on PD parameters for PK/PD models to provide a valuable reference for drug development, determining the dosage regimen, and preventing drug-resistant mutations.
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Affiliation(s)
- Longfei Zhang
- Postdoctoral Research Station, Henan Agriculture University, Zhengzhou, China
- College of Animal Science and Veterinary Medicine, Henan Institute of Science and Technology, Xinxiang, China
- Postdoctoral Research Base, Henan Institute of Science and Technology, Xinxiang, China
| | - Hongbing Xie
- College of Animal Science and Veterinary Medicine, Henan Institute of Science and Technology, Xinxiang, China
| | - Yongqiang Wang
- College of Animal Science and Veterinary Medicine, Henan Institute of Science and Technology, Xinxiang, China
| | - Hongjuan Wang
- College of Animal Science and Veterinary Medicine, Henan Institute of Science and Technology, Xinxiang, China
| | - Jianhe Hu
- College of Animal Science and Veterinary Medicine, Henan Institute of Science and Technology, Xinxiang, China
- Postdoctoral Research Base, Henan Institute of Science and Technology, Xinxiang, China
- *Correspondence: Jianhe Hu ;
| | - Gaiping Zhang
- Postdoctoral Research Station, Henan Agriculture University, Zhengzhou, China
- Gaiping Zhang
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3
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Zhao M, Chen Y, Yang D, Lyu C, Bian X, Li X, Qiu W, Huang Z, Hu Z, Zhang J. Regulatory utility of pharmacometrics in the development and evaluation of antimicrobial agents and its recent progress in China. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2021; 10:1466-1478. [PMID: 34651458 PMCID: PMC8674004 DOI: 10.1002/psp4.12716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/24/2021] [Accepted: 09/20/2021] [Indexed: 11/08/2022]
Abstract
Pharmacometrics is an emerging science that interprets drug, disease, and trial information in a mathematical fashion to inform and facilitate efficient drug development and/or regulatory decisions. Pharmacometrics study is increasingly adopted in the regulatory review of new antimicrobial agents. We summarized the 31 antimicrobial agents approved by the US Food and Drug Administration (FDA) and the 26 antimicrobial agents approved by European Medicines Agency (EMA) from January 2001 to May 2019. We also reviewed recent examples of utilizing pharmacometrics to support antimicrobial agent's registration in China, including modeling and simulation methods, effects of internal/external factors on pharmacokinetic (PK) parameters, safety and efficacy evaluation in terms of exposure-response analysis, refinement of the wording of product labeling and package leaflet, and possible postmarketing clinical trial. Ongoing communication among regulator, academia, and industry regarding pharmacometrics is encouraged to streamline and facilitate the development of new antimicrobial agents. The industry can maximize its benefit in drug development through continued pharmacometrics education/training.
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Affiliation(s)
- Ming Zhao
- Office of Clinical Evaluation II, Center for Drug Evaluation, National Medical Products Administration, Beijing, China
| | - Yuancheng Chen
- Phase I Unit, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Dong Yang
- Covance Pharmaceutical Research and Development (Beijing) Co., Ltd., Beijing, China
| | - Cheng Lyu
- Department of Translational Medicine, Clinical Development Business Unit, CSPC Zhongqi Pharmaceutical Technology (Shijiazhuang) Co., Ltd., Shanghai, China.,Institute of Antibiotics, Huashan Hospital Affiliated to Fudan University, Shanghai, China.,Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission, Shanghai, China
| | - Xingchen Bian
- Institute of Antibiotics, Huashan Hospital Affiliated to Fudan University, Shanghai, China.,Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission, Shanghai, China
| | - Xin Li
- Institute of Antibiotics, Huashan Hospital Affiliated to Fudan University, Shanghai, China.,Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission, Shanghai, China
| | - Weiyi Qiu
- Beijing Institute of Biotechnology, Beijing, China
| | - Zhiwei Huang
- Institute of Antibiotics, Huashan Hospital Affiliated to Fudan University, Shanghai, China.,Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission, Shanghai, China
| | - Zijian Hu
- Department of Translational Medicine, Clinical Development Business Unit, CSPC Zhongqi Pharmaceutical Technology (Shijiazhuang) Co., Ltd., Shanghai, China
| | - Jing Zhang
- Institute of Antibiotics, Huashan Hospital Affiliated to Fudan University, Shanghai, China.,Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission, Shanghai, China
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4
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Friberg LE. Pivotal Role of Translation in Anti‐Infective Development. Clin Pharmacol Ther 2021; 109:856-866. [DOI: 10.1002/cpt.2182] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/08/2021] [Indexed: 12/12/2022]
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5
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Population pharmacokinetic model development and exposure-response analysis of vincristine in patients with malignant lymphoma. Cancer Chemother Pharmacol 2021; 87:501-511. [PMID: 33416909 DOI: 10.1007/s00280-020-04220-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/25/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Vincristine (VCR) is a key drug for treating various malignancies. However, few data are available on the pharmacokinetics of VCR, especially in adult patients. The objective of this study was to clarify the population pharmacokinetics and exposure-response relationships of VCR in adult malignant lymphoma patients. METHODS Blood samples were collected from patients who were administered R-CHOP-like regimens, and the VCR plasma concentration was determined using liquid chromatography-mass spectrometry. Using NONMEM software, population pharmacokinetic parameters were estimated, and covariates were evaluated. The relationships between the individual parameters and adverse events or therapeutic effects were also investigated. RESULTS Plasma concentrations were measured in 30 patients. In the final population pharmacokinetics model, body surface area and age were incorporated into clearance as significant covariates. The inter-individual variations in clearance and volume of distribution in the central and third compartments were 17.0, 26.6, and 66.3%, respectively, and the residual variability in the plasma concentration was 23.8%. Although the variability observed in the volume of distribution was large, good predictability was obtained in the individual estimation. The severity of anemia and peripheral neuropathy was correlated with clearance and peak concentration, respectively (adjusted P = 0.040 and 0.024, respectively). In diffuse large B cell lymphoma patients, those with higher area under the curve and dose experienced longer progression-free survival (P = 0.023 and 0.013, respectively). CONCLUSION The population pharmacokinetics of VCR were evaluated in adult malignant lymphoma patients. VCR pharmacokinetic data could explain in part the adverse events and prognosis of these patients.
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6
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Sou T, Hansen J, Liepinsh E, Backlund M, Ercan O, Grinberga S, Cao S, Giachou P, Petersson A, Tomczak M, Urbas M, Zabicka D, Vingsbo Lundberg C, Hughes D, Hobbie SN, Friberg LE. Model-Informed Drug Development for Antimicrobials: Translational PK and PK/PD Modeling to Predict an Efficacious Human Dose for Apramycin. Clin Pharmacol Ther 2020; 109:1063-1073. [PMID: 33150591 PMCID: PMC8048880 DOI: 10.1002/cpt.2104] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/18/2020] [Indexed: 12/12/2022]
Abstract
Apramycin represents a subclass of aminoglycoside antibiotics that has been shown to evade almost all mechanisms of clinically relevant aminoglycoside resistance. Model-informed drug development may facilitate its transition from preclinical to clinical phase. This study explored the potential of pharmacokinetic/pharmacodynamic (PK/PD) modeling to maximize the use of in vitro time-kill and in vivo preclinical data for prediction of a human efficacious dose (HED) for apramycin. PK model parameters of apramycin from four different species (mouse, rat, guinea pig, and dog) were allometrically scaled to humans. A semimechanistic PK/PD model was developed from the rich in vitro data on four Escherichia coli strains and subsequently the sparse in vivo efficacy data on the same strains were integrated. An efficacious human dose was predicted from the PK/PD model and compared with the classical PK/PD index methodology and the aminoglycoside dose similarity. One-compartment models described the PK data and human values for clearance and volume of distribution were predicted to 7.07 L/hour and 26.8 L, respectively. The required fAUC/MIC (area under the unbound drug concentration-time curve over MIC ratio) targets for stasis and 1-log kill in the thigh model were 34.5 and 76.2, respectively. The developed PK/PD model predicted the efficacy data well with strain-specific differences in susceptibility, maximum bacterial load, and resistance development. All three dose prediction approaches supported an apramycin daily dose of 30 mg/kg for a typical adult patient. The results indicate that the mechanistic PK/PD modeling approach can be suitable for HED prediction and serves to efficiently integrate all available efficacy data with potential to improve predictive capacity.
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Affiliation(s)
- Tomás Sou
- Pharmacometrics, Department of Pharmacy, Uppsala University, Uppsala, Sweden
| | - Jon Hansen
- Department of Bacteria, Parasites and Fungi, Statens Serum Institute, Copenhagen, Denmark
| | | | - Maria Backlund
- Department of Pharmacy, Uppsala University Drug Optimization and Pharmaceutical Profiling, Uppsala University, Uppsala, Sweden
| | - Onur Ercan
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | | | - Sha Cao
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Paraskevi Giachou
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Anna Petersson
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Magdalena Tomczak
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
| | - Malgorzata Urbas
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
| | - Dorota Zabicka
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
| | | | - Diarmaid Hughes
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Sven N Hobbie
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Lena E Friberg
- Pharmacometrics, Department of Pharmacy, Uppsala University, Uppsala, Sweden
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Toutain PL, Pelligand L, Lees P, Bousquet-Mélou A, Ferran AA, Turnidge JD. The pharmacokinetic/pharmacodynamic paradigm for antimicrobial drugs in veterinary medicine: Recent advances and critical appraisal. J Vet Pharmacol Ther 2020; 44:172-200. [PMID: 33089523 DOI: 10.1111/jvp.12917] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 08/16/2020] [Accepted: 09/22/2020] [Indexed: 12/12/2022]
Abstract
Pharmacokinetic/pharmacodynamic (PK/PD) modelling is the initial step in the semi-mechanistic approach for optimizing dosage regimens for systemically acting antimicrobial drugs (AMDs). Numerical values of PK/PD indices are used to predict dose and dosing interval on a rational basis followed by confirmation in clinical trials. The value of PK/PD indices lies in their universal applicability amongst animal species. Two PK/PD indices are routinely used in veterinary medicine, the ratio of the area under the curve of the free drug plasma concentration to the minimum inhibitory concentration (MIC) (fAUC/MIC) and the time that free plasma concentration exceeds the MIC over the dosing interval (fT > MIC). The basic concepts of PK/PD modelling of AMDs were established some 20 years ago. Earlier studies have been reviewed previously and are not reconsidered in this review. This review describes and provides a critical appraisal of more recent, advanced PK/PD approaches, with particular reference to their application in veterinary medicine. Also discussed are some hypotheses and new areas for future developments.First, a brief overview of PK/PD principles is presented as the basis for then reviewing more advanced mechanistic considerations on the precise nature of selected indices. Then, several new approaches to selecting PK/PD indices and establishing their numerical values are reviewed, including (a) the modelling of time-kill curves and (b) the use of population PK investigations. PK/PD indices can be used for dose determination, and they are required to establish clinical breakpoints for antimicrobial susceptibility testing. A particular consideration is given to the precise nature of MIC, because it is pivotal in establishing PK/PD indices, explaining that it is not a "pharmacodynamic parameter" in the usual sense of this term.
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Affiliation(s)
- Pierre-Louis Toutain
- INTHERES, INRA, ENVT, Université de Toulouse, Toulouse, France.,Royal Veterinary College, University of London, London, UK
| | | | - Peter Lees
- Royal Veterinary College, University of London, London, UK
| | | | - Aude A Ferran
- INTHERES, INRA, ENVT, Université de Toulouse, Toulouse, France
| | - John D Turnidge
- School of Biological Sciences, University of Adelaide, Adelaide, SA, Australia
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8
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Chen H, Yu L, Yu Z. Prolonged infusion with β-lactam antibiotics for treatment of infection caused by non-susceptible bacteria: a study protocol for a systemic review and meta-analysis. BMJ Open 2019; 9:e027509. [PMID: 31122992 PMCID: PMC6538082 DOI: 10.1136/bmjopen-2018-027509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 03/27/2019] [Accepted: 04/30/2019] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Prolonged infusion with β-lactam antibiotics should theoretically produce a better clinical efficacy than intermittent infusion in severe infection and infection caused by non-susceptible micro-organisms. The efficacy of prolonged infusion in severe infection has been well illustrated recently, but is still confusing in non-susceptible microbial infection. The objective of this meta-analysis is to determine the clinical effects of prolonged infusion with β-lactams for patients infected by microbes non-susceptible to the given drug. METHODS AND ANALYSIS Literature searches will be performed with Medline, the Cochrane database, EMBASE database, Cumulative Index to Nursing and Allied Health Literature database, the Chinese National Knowledge Infrastructure and Wanfang database. Two reviewers will screen and select studies according to a priori defined eligibility criteria, and then the data from the included studies will be extracted. The quality will be evaluated based on a modified Jadad score and the Newcastle-Ottawa system for randomised controlled trials and observational studies, respectively. Data synthesis will be performed with Review Manager 5.3 software. Sensitivity analysis and publication bias will also be investigated. ETHICS AND DISSEMINATION No ethics approval is required. The full article will be published in a peer-reviewed journal and presented at international conferences. PROSPERO REGISTRATION NUMBER CRD42018105111.
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Affiliation(s)
- Huadong Chen
- Department of Pharmacy, Dongyang People’s Hospital, Dongyang, Zhejiang, China
| | - Lingyan Yu
- Department of Pharmacy, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Zhenwei Yu
- Department of Pharmacy, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Mendoza J, Gutierrez L, Gutiérrez JÁ, Bustos FA, Sumano H. Pharmacokinetics of enrofloxacin HCl-2H 2 O (ENRO-C), PK/PD, and Monte Carlo modeling vs. Leptospira spp. in cows. J Vet Pharmacol Ther 2019; 42:300-308. [PMID: 30714169 DOI: 10.1111/jvp.12748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 12/10/2018] [Accepted: 12/21/2018] [Indexed: 12/16/2022]
Abstract
The pharmacokinetics, PK/PD ratios, and Monte Carlo modeling of enrofloxacin HCl-2H2 O (Enro-C) and its reference preparation (Enro-R) were determined in cows. Fifty-four Jersey cows were randomly assigned to six groups receiving a single IM dose of 10, 15, or 20 mg/kg of Enro-C (Enro-C10 , Enro-C15 , Enro-C20 ) or Enro-R. Serial serum samples were collected and enrofloxacin concentrations quantified. A composite set of minimum inhibitory concentrations (MIC) of Leptospira spp. was utilized to calculate PK/PD ratios: maximum serum concentration/MIC (Cmax /MIC90 ) and area under the serum vs. time concentration of enrofloxacin/MIC (AUC0-24 /MIC90 ). Monte Carlo simulations targeted Cmax /MIC = 10 and AUC0-24 /MIC = 125. Mean Cmax obtained were 6.17 and 2.46 μg/ml; 8.75 and 3.54 μg/ml; and 13.89 and 4.25 μg/ml, respectively for Enro-C and Enro-R. Cmax /MIC90 ratios were 6.17 and 2.46, 8.75 and 3.54, and 13.89 and 4.25 for Enro-C and Enro-R, respectively. Monte Carlo simulations based on Cmax /MIC90 = 10 indicate that only Enro-C15 and Enro-C20 may be useful to treat leptospirosis in cows, predicting a success rate ≥95% when MIC50 = 0.5 μg/ml, and ≥80% when MIC90 = 1.0 μg/ml. Although Enro-C15 and Enro-C20 may be useful to treat leptospirosis in cattle, clinical trials are necessary to confirm this proposal.
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Affiliation(s)
- Jesús Mendoza
- Department of Physiology and Pharmacology, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Lilia Gutierrez
- Department of Physiology and Pharmacology, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - José Á Gutiérrez
- Department of Microbiology, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Felipe A Bustos
- Department of Statistics, Autonomous Technological Institute of Mexico (ITAM), Mexico City, Mexico
| | - Hector Sumano
- Department of Physiology and Pharmacology, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
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10
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Wu F, Zhao X, Li X, Cui Y. Population Pharmacokinetic Modeling of Azithromycin Eyedrops in Tears Following Single-Dose Topical Administration in Healthy Volunteers. Eur J Drug Metab Pharmacokinet 2018; 44:371-378. [PMID: 30357610 DOI: 10.1007/s13318-018-0522-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES The disposition of azithromycin in the human eye following topical administration has not been fully explored. Population pharmacokinetic (PopPK) modeling can allow useful conclusions to be drawn based on limited tear sampling data. The aim of this study was therefore to develop and evaluate a PopPK model of azithromycin eyedrops in tears, investigate typical model parameters, and identify potential covariates following single-dose ocular instillation. METHODS A total of 84 tear samples were obtained from 42 healthy volunteers at seven time points over 24 h following topical administration of azithromycin eyedrops (2.5 mL/25 mg). Azithromycin concentrations in the tears were determined using a validated LC-MS/MS assay. PopPK analysis was performed using nonlinear mixed-effects modeling. Intraocular pressure, tear secretion measurement, age, and gender were evaluated as possible covariates. Bootstrap and visual predictive checks were used simultaneously to evaluate the PopPK model. The dosage regimen was further estimated based on Monte Carlo simulation and the area under the curve/minimal inhibitory concentration. RESULTS A linear two-compartment first-order elimination model was found to best describe the pharmacokinetic profile of azithromycin in tears. None of the covariates had a significant influence on the typical model parameters. The final PopPK model was demonstrated to be suitable and effective according to bootstrap and visual predictive checks. Twice-daily instillation of azithromycin eyedrops would appear to provide the required antibacterial activity. CONCLUSION A proposed linear two-compartment PopPK model of azithromycin eyedrops was found to be effective at describing the disposition of azithromycin in tears after ocular instillation.
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Affiliation(s)
- Feng Wu
- Department of Pharmacy, Peking University First Hospital, Beijing, China
- National Institute of Drug Clinical Trial, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiuli Zhao
- National Institute of Drug Clinical Trial, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xingang Li
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yimin Cui
- Department of Pharmacy, Peking University First Hospital, Beijing, China.
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Singh R, Almutairi M, Alm RA, Lahiri SD, San Martin M, Chen A, Ambler JE. Ceftaroline efficacy against high-MIC clinical Staphylococcus aureus isolates in an in vitro hollow-fibre infection model. J Antimicrob Chemother 2017; 72:2796-2803. [PMID: 29091195 DOI: 10.1093/jac/dkx214] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 06/08/2017] [Indexed: 12/16/2023] Open
Abstract
Objectives The current CLSI and EUCAST clinical susceptible breakpoint for 600 mg q12h dosing of ceftaroline (active metabolite of ceftaroline fosamil) for Staphylococcus aureus is ≤1 mg/L. Efficacy data for S. aureus infections with ceftaroline MIC ≥2 mg/L are limited. This study was designed to generate in-depth pharmacokinetic/pharmacodynamics (PK/PD) understanding of S. aureus isolates inhibited by ≥ 2 mg/L ceftaroline using an in vitro hollow-fibre infection model (HFIM). Methods The PK/PD target of ceftaroline was investigated against 12 diverse characterized clinical MRSA isolates with ceftaroline MICs of 2 or 4 mg/L using q8h dosing for 24 h. These isolates carried substitutions in the penicillin-binding domain (PBD) and/or the non-PBD. Additionally, PD responses of mutants with ceftaroline MICs ranging from 2 to 32 mg/L were evaluated against the mean 600 mg q8h human-simulated dose over 72 h. Results The mean stasis, 1 log10-kill and 2 log10-kill PK/PD targets were 29%, 32% and 35% f T>MIC, respectively. In addition, these data suggest that the PK/PD target for MRSA is not impacted by the presence of substitutions in the non-PBD commonly found in isolates with ceftaroline MIC values of ≤ 2 mg/L. HFIM studies with 600 mg q8h dosing demonstrated a sustained long-term bacterial suppression for isolates with ceftaroline MICs of 2 and 4 mg/L. Conclusions Overall, efficacy was demonstrated against a diverse collection of clinical isolates using HFIM indicating the utility of 600 mg ceftaroline fosamil for S. aureus isolates with MIC ≤4 mg/L using q8h dosing.
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Affiliation(s)
- Renu Singh
- Infection Innovative Medicines Unit, AstraZeneca R&D Boston, Waltham, MA 02451, USA
| | - Mashal Almutairi
- Infection Innovative Medicines Unit, AstraZeneca R&D Boston, Waltham, MA 02451, USA
| | - Richard A Alm
- Infection Innovative Medicines Unit, AstraZeneca R&D Boston, Waltham, MA 02451, USA
| | - Sushmita D Lahiri
- Infection Innovative Medicines Unit, AstraZeneca R&D Boston, Waltham, MA 02451, USA
| | - Maryann San Martin
- Infection Innovative Medicines Unit, AstraZeneca R&D Boston, Waltham, MA 02451, USA
| | - April Chen
- Infection Innovative Medicines Unit, AstraZeneca R&D Boston, Waltham, MA 02451, USA
| | - Jane E Ambler
- Infection Innovative Medicines Unit, AstraZeneca R&D Boston, Waltham, MA 02451, USA
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12
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Mohamed AF, Kristoffersson AN, Karvanen M, Nielsen EI, Cars O, Friberg LE. Dynamic interaction of colistin and meropenem on a WT and a resistant strain of Pseudomonas aeruginosa as quantified in a PK/PD model. J Antimicrob Chemother 2016; 71:1279-90. [PMID: 26850719 DOI: 10.1093/jac/dkv488] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 12/19/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Combination therapy can be a strategy to ensure effective bacterial killing when treating Pseudomonas aeruginosa, a Gram-negative bacterium with high potential for developing resistance. The aim of this study was to develop a pharmacokinetic/pharmacodynamic (PK/PD) model that describes the in vitro bacterial time-kill curves of colistin and meropenem alone and in combination for one WT and one meropenem-resistant strain of P. aeruginosa. METHODS In vitro time-kill curve experiments were conducted with a P. aeruginosa WT (ATCC 27853) (MICs: meropenem 1 mg/L; colistin 1 mg/L) and a meropenem-resistant type (ARU552) (MICs: meropenem 16 mg/L; colistin 1.5 mg/L). PK/PD models characterizing resistance were fitted to the observed bacterial counts in NONMEM. The final model was applied to predict the bacterial killing of ARU552 for different combination dosages of colistin and meropenem. RESULTS A model with compartments for growing and resting bacteria, where the bacterial killing by colistin reduced with continued exposure and a small fraction (0.15%) of the start inoculum was resistant to meropenem, characterized the bactericidal effect and resistance development of the two antibiotics. For a typical patient, a loading dose of colistin combined with a high dose of meropenem (2000 mg q8h) was predicted to result in a pronounced kill of the meropenem-resistant strain over 24 h. CONCLUSIONS The developed PK/PD model successfully described the time course of bacterial counts following exposures to colistin and meropenem, alone and in combination, for both strains, and identified a dynamic drug interaction. The study illustrates the application of a PK/PD model and supports high-dose combination therapy of colistin and meropenem to overcome meropenem resistance.
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Affiliation(s)
- Ami F Mohamed
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden Institute for Medical Research, Kuala Lumpur, Malaysia
| | | | - Matti Karvanen
- Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden
| | - Elisabet I Nielsen
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Otto Cars
- Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden
| | - Lena E Friberg
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
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Kristoffersson AN, David-Pierson P, Parrott NJ, Kuhlmann O, Lave T, Friberg LE, Nielsen EI. Simulation-Based Evaluation of PK/PD Indices for Meropenem Across Patient Groups and Experimental Designs. Pharm Res 2016; 33:1115-25. [PMID: 26786016 DOI: 10.1007/s11095-016-1856-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 01/06/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE Antibiotic dose predictions based on PK/PD indices rely on that the index type and magnitude is insensitive to the pharmacokinetics (PK), the dosing regimen, and bacterial susceptibility. In this work we perform simulations to challenge these assumptions for meropenem and Pseudomonas aeruginosa. METHODS A published murine dose fractionation study was replicated in silico. The sensitivity of the PK/PD index towards experimental design, drug susceptibility, uncertainty in MIC and different PK profiles was evaluated. RESULTS The previous murine study data were well replicated with fT > MIC selected as the best predictor. However, for increased dosing frequencies fAUC/MIC was found to be more predictive and the magnitude of the index was sensitive to drug susceptibility. With human PK fT > MIC and fAUC/MIC had similar predictive capacities with preference for fT > MIC when short t1/2 and fAUC/MIC when long t1/2. CONCLUSIONS A longitudinal PKPD model based on in vitro data successfully predicted a previous in vivo study of meropenem. The type and magnitude of the PK/PD index were sensitive to the experimental design, the MIC and the PK. Therefore, it may be preferable to perform simulations for dose selection based on an integrated PK-PKPD model rather than using a fixed PK/PD index target.
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Affiliation(s)
- Anders N Kristoffersson
- Department of Pharmaceutical Biosciences, Uppsala Universitet, Box 591, Uppsala, SE-751 24, Sweden.
| | - Pascale David-Pierson
- F. Hoffmann-La Roche Ltd., Innovation Center Basel, Pharmaceuticals Sciences, Basel, Switzerland
| | - Neil J Parrott
- F. Hoffmann-La Roche Ltd., Innovation Center Basel, Pharmaceuticals Sciences, Basel, Switzerland
| | - Olaf Kuhlmann
- F. Hoffmann-La Roche Ltd., Innovation Center Basel, Pharmaceuticals Sciences, Basel, Switzerland
| | - Thierry Lave
- F. Hoffmann-La Roche Ltd., Innovation Center Basel, Pharmaceuticals Sciences, Basel, Switzerland
| | - Lena E Friberg
- Department of Pharmaceutical Biosciences, Uppsala Universitet, Box 591, Uppsala, SE-751 24, Sweden
| | - Elisabet I Nielsen
- Department of Pharmaceutical Biosciences, Uppsala Universitet, Box 591, Uppsala, SE-751 24, Sweden
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