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Somogyi Z, Mag P, Simon R, Kerek Á, Szabó P, Albert E, Biksi I, Jerzsele Á. Pharmacokinetics and Pharmacodynamics of Florfenicol in Plasma and Synovial Fluid of Pigs at a Dose of 30 mg/kg bw Following Intramuscular Administration. Antibiotics (Basel) 2023; 12:antibiotics12040758. [PMID: 37107120 PMCID: PMC10135420 DOI: 10.3390/antibiotics12040758] [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: 03/14/2023] [Revised: 04/09/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
A major problem of our time is the ever-increasing resistance to antimicrobial agents in bacterial populations. One of the most effective ways to prevent these problems is to target antibacterial therapies for specific diseases. In this study, we investigated the in vitro effectiveness of florfenicol against S. suis, which can cause severe arthritis and septicemia in swine herds. The pharmacokinetic and pharmacodynamic properties of florfenicol in porcine plasma and synovial fluid were determined. After a single intramuscular administration of florfenicol at 30 mg/kgbw, the AUC0-∞ was 164.45 ± 34.18 µg/mL × h and the maximum plasma concentration was 8.15 ± 3.11 µg/mL, which was reached in 1.40 ± 0.66 h, whereas, in the synovial fluid, these values were 64.57 ± 30.37 µg/mL × h, 4.51 ± 1.16 µg/mL and 1.75 ± 1.16 h, respectively. Based on the MIC values of the 73 S. suis isolates tested, the MIC50 and MIC90 values were 2 µg/mL and 8 µg/mL, respectively. We successfully implemented a killing-time curve in pig synovial fluid as a matrix. Based on our findings, the PK/PD breakpoints of the bacteriostatic (E = 0), bactericidal (E = -3) and eradication (E = -4) effects of florfenicol were determined and MIC thresholds were calculated, which are the guiding indicators for the treatment of these diseases. The AUC24h/MIC values for bacteriostatic, bactericidal and eradication effects were 22.22 h, 76.88 h and 141.74 h, respectively, in synovial fluid, and 22.42 h, 86.49 h and 161.76 h, respectively, in plasma. The critical MIC values of florfenicol against S. suis regarding bacteriostatic, bactericidal and eradication effects in pig synovial fluid were 2.91 ± 1.37 µg/mL, 0.84 ± 0.39 µg/mL and 0.46 ± 0.21 µg/mL, respectively. These values provide a basis for further studies on the use of florfenicol. Furthermore, our research highlights the importance of investigating the pharmacokinetic properties of antibacterial agents at the site of infection and the pharmacodynamic properties of these agents against different bacteria in different media.
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Affiliation(s)
- Zoltán Somogyi
- Department of Pharmacology and Toxicology, University of Veterinary Medicine, 1078 Budapest, Hungary
- National Laboratory of Infectious Animal Diseases, Antimicrobial Resistance, Veterinary Public Health and Food Chain Safety, University of Veterinary Medicine, 1078 Budapest, Hungary
| | - Patrik Mag
- Department of Pharmacology and Toxicology, University of Veterinary Medicine, 1078 Budapest, Hungary
- National Laboratory of Infectious Animal Diseases, Antimicrobial Resistance, Veterinary Public Health and Food Chain Safety, University of Veterinary Medicine, 1078 Budapest, Hungary
| | - Réka Simon
- Department of Pharmacology and Toxicology, University of Veterinary Medicine, 1078 Budapest, Hungary
| | - Ádám Kerek
- Department of Pharmacology and Toxicology, University of Veterinary Medicine, 1078 Budapest, Hungary
- National Laboratory of Infectious Animal Diseases, Antimicrobial Resistance, Veterinary Public Health and Food Chain Safety, University of Veterinary Medicine, 1078 Budapest, Hungary
| | - Pál Szabó
- Research Center for Natural Sciences, Center for Structural Study, MS Metabolomics Laboratory, 1117 Budapest, Hungary
| | - Ervin Albert
- Department of Pathology, University of Veterinary Medicine Budapest, 2225 Üllő, Hungary
- SCG Diagnostics Ltd., 2437 Délegyháza, Hungary
| | - Imre Biksi
- Department of Pathology, University of Veterinary Medicine Budapest, 2225 Üllő, Hungary
- SCG Diagnostics Ltd., 2437 Délegyháza, Hungary
| | - Ákos Jerzsele
- Department of Pharmacology and Toxicology, University of Veterinary Medicine, 1078 Budapest, Hungary
- National Laboratory of Infectious Animal Diseases, Antimicrobial Resistance, Veterinary Public Health and Food Chain Safety, University of Veterinary Medicine, 1078 Budapest, Hungary
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2
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Dalton BR. What Is the Best Vancomycin Therapeutic Drug Monitoring Parameter to Assess Efficacy? A Critical Review of Experimental Data and Assessment of the Need for Individual Patient Minimum Inhibitory Concentration Value. Microorganisms 2023; 11:microorganisms11030567. [PMID: 36985141 PMCID: PMC10051726 DOI: 10.3390/microorganisms11030567] [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: 01/19/2023] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 03/30/2023] Open
Abstract
Therapeutic drug monitoring is recommended for the use of vancomycin, but a recent widely publicized US medical society consensus statement has changed the suggested optimal method(s) of dose adjustment. Specifically, 24 h area under the curve (AUC24)-based monitoring is has been recommended for vancomycin in preference to monitoring of trough concentrations. One reason cited for this change is the claim that AUC24 is a superior correlate to efficacy than trough (Cmin). Evidence from a number of retrospective analyses have been critically reviewed and determined to have weaknesses. This narrative review focuses on the experimental studies performed in vivo in animal models of infection and in vitro to determine the extent to which these data may provide a compelling distinction between pharmacokinetic/pharmacodynamics (PKPD) parameters that may translate to clinical use in therapeutic drug monitoring. Animal in vivo studies have been presented at conferences, but no original peer reviewed studies could be found that compare various PKPD parameters. These conference proceeding findings were supportive but unconvincing, even though they were favorably presented subsequently in review articles and clinical practice guidelines. In vitro data are somewhat conflicting, but the range of concentrations may play a role in the discrepancies found. It has been suggested that MIC may be assumed to have a value of 1 mg/L; however, it can be demonstrated that this assumption may lead to considerable discrepancy from results with an actual MIC value. The AUC24 parameter has been weighed against the percentage of time above the MIC (%T > MIC) as a comparative PKPD parameter, yet this may be an inappropriate comparison for vancomycin since all clinically useful dosing provides 100% T > MIC. Regardless, there is a distinction between clinical TDM parameters and PKPD parameters, so, in practice, the change to AUC24:MIC based on animal experiments and in vitro evidence for vancomycin may be premature.
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Affiliation(s)
- Bruce R Dalton
- Pharmacy Department, Alberta Health Services, Calgary, AB T2N 2T9, Canada
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Landmesser KB, Autry EB, Gardner BM, Bosko KA, Schadler A, Kuhn RJ. Comparison of the predictive value of area under the curve versus maximum serum concentration of intravenous tobramycin in cystic fibrosis patients treated for an acute pulmonary exacerbation. Pediatr Pulmonol 2021; 56:3209-3216. [PMID: 34241975 DOI: 10.1002/ppul.25569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 04/19/2021] [Accepted: 06/21/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The primary objective of this study was to compare the therapeutic predictive value of area under the curve (AUC24 ) versus maximum concentration (Cmax ) in cystic fibrosis (CF) patients receiving intravenous (IV) tobramycin for a Pseudomonas aeruginosa (PsA) acute pulmonary exacerbation (APE). Acute kidney injury (AKI) incidence and the relationship between time undetectable and efficacy were also assessed. METHODS A retrospective review was conducted in patients aged at least 1 month with a diagnosis of CF receiving IV tobramycin for treatment of a PsA APE and admitted to the University of Kentucky between August 2015 and August 2019. Patients were excluded if they had no growth of PsA on sputum culture or if two postdose tobramycin levels were not obtained following a dose adjustment of ≥20%. RESULTS A total of 44 pediatric and 107 adult patient encounters met inclusion criteria. In patients with therapeutic success (n = 91), 75.8% had an AUC24 ≥80% and 80.3% had a Cmax ≥8 times the highest PsA minimal inhibitory concentration. There was a significant correlation between AUC24 and Cmax (r[149] = 0.727; p < 0.001). AKI incidence was significantly higher in patients receiving IV tobramycin dosed multiple times daily versus at least every 24 h (χ2 [1, 151] = 3.9; p = 0.047). CONCLUSIONS The results of this study indicate that both AUC24 and Cmax serve as relatively accurate predictors of tobramycin efficacy. Additionally, given the significant increase in incidence of AKI, multidaily dosing of IV tobramycin should be avoided in pediatric and adult patients with CF.
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Affiliation(s)
| | - Elizabeth B Autry
- Department of Pharmacy, Kentucky Children's Hospital, Lexington, Kentucky, USA.,Department of Pharmacy, The University of Kentucky College of Pharmacy, Lexington, Kentucky, USA
| | - Brian M Gardner
- Department of Pharmacy, Kentucky Children's Hospital, Lexington, Kentucky, USA.,Department of Pharmacy, The University of Kentucky College of Pharmacy, Lexington, Kentucky, USA
| | - Katherine A Bosko
- Department of Pharmacy, The University of Kentucky College of Pharmacy, Lexington, Kentucky, USA
| | - Aric Schadler
- Department of Pharmacy, The University of Kentucky College of Pharmacy, Lexington, Kentucky, USA.,Department of Pediatrics, Kentucky Children's Hospital, Lexington, Kentucky, USA
| | - Robert J Kuhn
- Department of Pharmacy, Kentucky Children's Hospital, Lexington, Kentucky, USA.,Department of Pharmacy, The University of Kentucky College of Pharmacy, Lexington, Kentucky, USA
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4
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Bousquet-Mélou A, Schneider M, El Garch F, Broussou DC, Ferran AA, Lallemand EA, Triboulloy C, Damborg P, Toutain PL. Determination of the pharmacokinetic-pharmacodynamic cut-off values of marbofloxacin in horses to support the establishment of a clinical breakpoint for antimicrobial susceptibility testing. Equine Vet J 2020; 53:1047-1055. [PMID: 33169427 DOI: 10.1111/evj.13385] [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: 04/25/2020] [Revised: 09/29/2020] [Accepted: 10/29/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Marbofloxacin (MBX), a fluoroquinolone (FQ), is considered as a critical antibiotic requiring antimicrobial susceptibility testing (AST) for prudent use. No clinical breakpoint (CBP) currently exists to interpret the results of such tests in horses. OBJECTIVES To compute PK/PD cut-offs (PK/PDCO ) that is one of the three minimum inhibitory concentrations (MICs) considered establishing a CBP for antimicrobial susceptibility test interpretation. STUDY DESIGN A meta-analysis conducted by combining five sets of previously published pharmacokinetic data, obtained in clinical and nonclinical settings. METHODS Horses (n = 131) received MBX intravenously at doses of either 2 or 10 mg/kg BW. They were richly sampled (five or six samples per horse). A population model was built to generate a virtual population of 5000 MBX disposition curves by Monte Carlo simulations (MCS) over 24 hours. The selected PK/PD index was the ratio of Area Under the free plasma concentration-time Curve divided by the MIC (fAUC/MIC). The PK/PDCO , which is the highest MIC for which 90% of horses can achieve an a priori selected critical value for the numerical value of the PK/PD index, was established for Gram-positive and Gram-negative bacteria for a dose of 2 mg/kg. RESULTS The PK/PDCO of MBX in horses was 0.125 mg/L for Gram-positive pathogens and 0.0625 mg/L for Gram-negative pathogens. MBX MICs determined by broth microdilution for 54 Escherichia coli and 189 Streptococcus equi isolates are reported. MAIN LIMITATION No clinical data are taken into account in the determination of a PK/PDco . CONCLUSION The computed PK/PDco predicts that MBX may be efficacious in horses to treat infections associated with Enterobacteriaceae but unlikely to those involving Staphylococcus aureus or Streptococcus equi.
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Affiliation(s)
| | - Marc Schneider
- Vétoquinol, Global Drug Development Division, Lure Cedex, France
| | - Farid El Garch
- Vétoquinol, Global Drug Development Division, Lure Cedex, France
| | - Diane C Broussou
- INTHERES, Université de Toulouse, INRA, ENVT, Toulouse, France.,Vétoquinol, Global Drug Development Division, Lure Cedex, France
| | - Aude A Ferran
- INTHERES, Université de Toulouse, INRA, ENVT, Toulouse, France
| | | | - Cyrielle Triboulloy
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg C, Denmark
| | - Peter Damborg
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg C, Denmark
| | - Pierre-Louis Toutain
- INTHERES, Université de Toulouse, INRA, ENVT, Toulouse, France.,The Royal Veterinary College, Hawkshead Campus, Hatfield, Hertfordshire, UK
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5
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Novel Amino Acid Derivatives of Quinolines as Potential Antibacterial and Fluorophore Agents. Sci Pharm 2020. [DOI: 10.3390/scipharm88040057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
A new series of amino acid derivatives of quinolines was synthesized through the hydrolysis of amino acid methyl esters of quinoline carboxamides with alkali hydroxide. The compounds were purified on silica gel by column chromatography and further characterized by TLC, NMR and ESI-TOF mass spectrometry. All compounds were screened for in vitro antimicrobial activity against different bacterial strains using the microdilution method. Most of the synthesized amino acid-quinolines show more potent or equipotent inhibitory action against the tested bacteria than their correspond esters. In addition, many of them exhibit fluorescent properties and could possibly be utilized as fluorophores. Molecular docking and simulation studies of the compounds at putative bacterial target enzymes suggest that the antimicrobial potency of these synthesized analogues could be due to enzyme inhibition via their favorable binding at the fluoroquinolone binding site at the GyrA subunit of DNA gyrase and/or the ParC subunit of topoisomerase-IV.
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6
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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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7
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Richter A, Feßler AT, Böttner A, Köper LM, Wallmann J, Schwarz S. Reasons for antimicrobial treatment failures and predictive value of in-vitro susceptibility testing in veterinary practice: An overview. Vet Microbiol 2020; 245:108694. [PMID: 32456814 DOI: 10.1016/j.vetmic.2020.108694] [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: 02/13/2020] [Revised: 03/19/2020] [Accepted: 04/14/2020] [Indexed: 10/24/2022]
Abstract
The choice of the most suitable antimicrobial agent for the treatment of an animal suffering from a bacterial infection is a complex issue. The results of bacteriological diagnostics and the in-vitro antimicrobial susceptibility testing (AST) provide guidance of potentially suitable antimicrobials. However, harmonized AST methods, veterinary-specific interpretive criteria and quality control ranges, which are essential to conduct AST in-vitro and to evaluate the corresponding results lege artis, are not available for all antimicrobial compounds, bacterial pathogens, animal species and sites of infection of veterinary relevance. Moreover, the clinical benefit of an antimicrobial agent (defined as its in vivo efficacy) is not exclusively dependent on the in-vitro susceptibility of the target pathogen. Apart from the right choice of an antibacterial drug with suitable pharmacokinetic properties and an appropriate pharmaceutical formulation, the success of treatment depends substantially on its adequate use. Even if this is ensured and in-vitro susceptibility confirmed, an insufficient improvement of clinical signs might be caused by biofilm-forming bacteria, persisters, or specific physicochemical conditions at the site of infection, such as pH value, oxygen partial pressure and perfusion rate. This review summarizes relevant aspects that have an impact on the predictive value of in-vitro AST and points out factors, potentially leading to an ineffective outcome of antibacterial treatment in veterinary practice. Knowing the reasons of inadequate beneficial effects can help to understand possible discrepancies between in-vitro susceptibility and in vivo efficacy and aid in undertaking strategies for an avoidance of treatment failures.
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Affiliation(s)
- Angelika Richter
- Institute of Pharmacology, Pharmacy and Toxicology, Faculty of Veterinary Medicine, University of Leipzig, Leipzig, Germany.
| | - Andrea T Feßler
- Institute of Microbiology and Epizootics, Centre of Infection Medicine, Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | | | | | - Jürgen Wallmann
- Federal Office of Consumer Protection and Food Safety, Berlin, Germany
| | - Stefan Schwarz
- Institute of Microbiology and Epizootics, Centre of Infection Medicine, Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
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Huang L, Maan MK, Xu D, Bakr Shabbir MA, Dai M, Yuan Z. Pharmacokinetic-pharmacodynamic modeling of cyadox against Escherichia coli in swine. Microb Pathog 2019; 135:103650. [PMID: 31376503 DOI: 10.1016/j.micpath.2019.103650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/15/2019] [Accepted: 07/30/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Lingli Huang
- National Reference Laboratory of Veterinary Drug Residues/ MAO Key Laboratory for the Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan, 430070, PR China
| | - Muhammad Kashif Maan
- National Reference Laboratory of Veterinary Drug Residues/ MAO Key Laboratory for the Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan, 430070, PR China
| | - Dongting Xu
- National Reference Laboratory of Veterinary Drug Residues/ MAO Key Laboratory for the Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan, 430070, PR China
| | - Muhammad Abu Bakr Shabbir
- National Reference Laboratory of Veterinary Drug Residues/ MAO Key Laboratory for the Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan, 430070, PR China
| | - Menghong Dai
- National Reference Laboratory of Veterinary Drug Residues/ MAO Key Laboratory for the Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan, 430070, PR China
| | - Zonghui Yuan
- National Reference Laboratory of Veterinary Drug Residues/ MAO Key Laboratory for the Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan, 430070, PR China.
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9
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Westra N, Proost JH, Franssen CFM, Wilms EB, van Buren M, Touw DJ. Vancomycin pharmacokinetic model development in patients on intermittent online hemodiafiltration. PLoS One 2019; 14:e0216801. [PMID: 31086400 PMCID: PMC6516654 DOI: 10.1371/journal.pone.0216801] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 04/29/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Vancomycin is frequently used in hemodialysis (HD) and in hemodiafiltration (HDF) patients and is usually administered in the last 30 or 60 minutes of a dialysis session. Vancomycin pharmacokinetics are not well described in HDF patients. The aim of this study is to develop a population pharmacokinetic (PPK) model and dosing regimen for vancomycin in HDF patients and to evaluate its applicability in low-flux (LF-HD) patients. METHODS Two-compartment PPK models were developed using data from HDF patients (n = 17), and was parameterized as follows: non-renal clearance (CLm), renal clearance as a fraction of creatinine clearance (fr), central volume of distribution (V1), intercompartmental clearance (CL12), peripheral volume of distribution (V2) and extracorporeal extraction ratio (Eec). We evaluated the final model in a cohort of LF-HD patients (n = 21). Dosing schemes were developed for a vancomycin 24-h AUC of 400 mg*h/L. RESULTS Model parameters (± SD) were: CLm = 0.473 (0.271) L/h, fr = 0.1 (fixed value), V1 = 0.278 (0.092) L/kgLBMc, CL12 = 9.96 L/h (fixed value), V2 = 0.686 (0.335) L/kgLBMc and Eec = 0.212 (0.069). The model reliably predicted serum levels of vancomycin in both HDF and LF-HD patients during and between dialysis sessions. The median of the prediction error (MDPE) as a measure of bias is -0.7% (95% CI: -3.4%-1.7%) and the median of the absolute values of the prediction errors (MDAPE) as a measure of precision is 7.9% (95% CI: 6.0%-9.8%). In both HDF and LF-HD, the optimal vancomycin loading dose for a typical patient weighing 70 kg is 1700 mg when administered during the last 60 minutes of the hemodialysis session. Maintenance dose is 700 mg if administered during the last 30 or 60 minutes of the hemodialysis session. CONCLUSION The developed PPK model for HDF is also capable of predicting serum levels of vancomycin in patients on LF-HD. A dosing regimen was developed for the use of vancomycin in HDF and LF-HD.
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Affiliation(s)
- Niels Westra
- University of Groningen, University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands
| | - Johannes H. Proost
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Casper F. M. Franssen
- University of Groningen, University Medical Center Groningen, department of Nephrology, Groningen, The Netherlands
| | - Erik B. Wilms
- Pharmacy Haagse Ziekenhuizen, Den Haag, The Netherlands
| | | | - Daan J. Touw
- University of Groningen, University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands
- * E-mail:
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10
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Hashemian SMR, Farhadi Z, Farhadi T. Fosfomycin: the characteristics, activity, and use in critical care. Ther Clin Risk Manag 2019; 15:525-530. [PMID: 30988619 PMCID: PMC6441553 DOI: 10.2147/tcrm.s199119] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Fosfomycin (C3H7O4P) is a phosphonic acid derivative representing an epoxide class of antibiotics. The drug is a re-emerging bactericidal antibiotic with a wide range of actions against several Gram-positive and Gram-negative bacteria. Among the existing antibacterial agents, fosfomycin has the lowest molecular weight (138 Da), which is not structurally associated with other classes of antibiotics. In intensive care unit (ICU) patients, severe soft tissue infections (STIs) may lead to serious life-threatening problems, and therefore, appropriate antibiotic therapy and often intensive care management (ICM) coupled with surgical intervention are necessary. Fosfomycin is an antibiotic primarily utilized for the treatment of STIs in ICUs. Recently, fosfomycin has attracted renewed interest for the treatment of serious systemic infections caused by multidrug-resistant Enterobacteriaceae. In some countries, intravenous fosfomycin has been prescribed for various serious systemic infections, such as acute osteomyelitis, nosocomial lower respiratory tract infections, complicated urinary tract infections, bacterial meningitis, and bacteremia. Administration of intravenous fosfomycin can result in a sufficient concentration of the drug at different body regions. Dose modification is not required in hepatic deficiency because fosfomycin is not subjected to enterohepatic circulation.
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Affiliation(s)
- Seyed Mohammad Reza Hashemian
- Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran, .,Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zinat Farhadi
- Department of Microbiology, Shiraz Branch, Islamic Azad University, Shiraz, Iran
| | - Tayebeh Farhadi
- Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran,
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11
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Leiberich M, Krebber R, Hewetson M, Marais J, Naidoo V. Pharmacokinetics of an intravenous and oral dose of enrofloxacin in white rhinoceros (Ceratotherium simum). J Vet Pharmacol Ther 2019; 42:346-354. [PMID: 30656701 DOI: 10.1111/jvp.12747] [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: 04/12/2018] [Revised: 11/16/2018] [Accepted: 12/19/2018] [Indexed: 11/30/2022]
Abstract
South Africa currently loses over 1000 white rhinoceros (Ceratotherium simum) each year to poaching incidents, and numbers of severely injured victims found alive have increased dramatically. However, little is known about the antimicrobial treatment of wounds in rhinoceros. This study explores the applicability of enrofloxacin for rhinoceros through the use of pharmacokinetic-pharmacodynamic modelling. The pharmacokinetics of enrofloxacin and its metabolite ciprofloxacin were evaluated in five white rhinoceros after intravenous (i.v.) and after successive i.v. and oral administration of 12.5 mg/kg enrofloxacin. After i.v. administration, the half-life, area under the curve (AUCtot ), clearance and the volume of distribution were 12.41 ± 2.62 hr, 64.5 ± 14.44 μg ml-1 hr-1 , 0.19 ± 0.04 L h-1 kg-1 , and 2.09 ± 0.48 L/kg, respectively. Ciprofloxacin reached 26.42 ± 0.05% of the enrofloxacin plasma concentration. After combined i.v. and oral enrofloxacin administration oral bioavailability was 33.30 ± 38.33%. After i.v. enrofloxacin administration, the efficacy marker AUC24 : MIC exceeded the recommended ratio of 125 against bacteria with an MIC of 0.5 μg/mL. Subsequent intravenous and oral enrofloxacin administration resulted in a low Cmax: MIC ratio of 3.1. The results suggest that intravenous administration of injectable enrofloxacin could be a useful drug with bactericidal properties in rhinoceros. However, the maintenance of the drug plasma concentration at a bactericidal level through additional per os administration of 10% oral solution of enrofloxacin indicated for the use in chickens, turkeys and rabbits does not seem feasible.
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Affiliation(s)
- Marion Leiberich
- Faculty of Veterinary Science, Department of Companion Animal Clinical Studies, University of Pretoria, Pretoria, South Africa
| | - Ralph Krebber
- Research & Development-Regulatory Science-Human Safety-Residue Analysis, Bayer Crop Science AG, Monheim am Rhein, Germany
| | - Michael Hewetson
- Faculty of Veterinary Science, Department of Companion Animal Clinical Studies, University of Pretoria, Pretoria, South Africa
| | - Johan Marais
- Faculty of Veterinary Science, Onderstepoort Veterinary Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Vinny Naidoo
- Faculty of Veterinary Science, Department of Paraclinical Science, University of Pretoria, Pretoria, South Africa
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Tsai YW, Wang YC, Shie SS, Chen MC, Huang YC, Chen CJ. Serum trough level as a postmarketing quality measure of generic vancomycin products. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2018; 53:300-306. [PMID: 29907539 DOI: 10.1016/j.jmii.2018.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/03/2018] [Accepted: 04/27/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND The vancomycin trough level (VTL) is the most widely used pharmacokinetic parameter for monitoring its clinical efficacy. Whether the VTL is affected in patients receiving different vancomycin products has not previously been determined. METHODS From 2005 to 2015, five vancomycin products, including the innovator (designated as VAN-Lilly) and four generic versions (designated as VAN-A, VAN-B, VAN-C and VAN-D), were sequentially used in a teaching hospital. The initial VTLs were compared between patients who received different vancomycin products after propensity score (PS) weighting and matching for clinical covariates. RESULTS Among 8735 patients with initial VTL levels available for analysis, a significant association was identified between the VTL and different vancomycin products in children aged 1 month to 12 years (P < 0.0001). The PS weighting analysis in the paediatric group disclosed children on VAN-C had higher VTL compared to those on other four products (P = 0.0008). PS matching analysis revealed that children who received VAN-C had significantly higher VTLs than those who received VAN-Lily (P = 0.0001), VAN-A (P = 0.0008), VAN-B (P = 0.0002) or VAN-D (P = 0.0015). Furthermore, the coefficient of variation of the VTL was much greater in patients who received VAN-C than in those who received the other four versions, suggesting an unstable quality of this product. CONCLUSION A generic version of vancomycin generated significantly higher concentrations and greater variation of VTLs than the innovator and other generic vancomycin products in children. The VTL can serve as an indicator to monitor the quality of vancomycin products after marketing.
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Affiliation(s)
- Ya-Wen Tsai
- School of Medicine, College of Medicine, Chang Gung University, 333 Taoyuan, Taiwan
| | - Yu-Chiang Wang
- School of Medicine, College of Medicine, Chang Gung University, 333 Taoyuan, Taiwan
| | - Shian-Sen Shie
- School of Medicine, College of Medicine, Chang Gung University, 333 Taoyuan, Taiwan; Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, 333 Taoyuan, Taiwan
| | - Min-Chi Chen
- School of Medicine, College of Medicine, Chang Gung University, 333 Taoyuan, Taiwan
| | - Yhu-Chering Huang
- School of Medicine, College of Medicine, Chang Gung University, 333 Taoyuan, Taiwan; Division of Paediatric Infectious Diseases, Department of Paediatrics, Chang Gung Memorial Hospital, 333 Taoyuan, Taiwan
| | - Chih-Jung Chen
- School of Medicine, College of Medicine, Chang Gung University, 333 Taoyuan, Taiwan; Division of Paediatric Infectious Diseases, Department of Paediatrics, Chang Gung Memorial Hospital, 333 Taoyuan, Taiwan.
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13
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Takoudju E, Bémer P, Touchais S, Asseray N, Corvec S, Khatchatourian L, Serandour N, Boutoille D. Bacteriological relevance of linezolid vs. vancomycin in postoperative empirical treatment of osteoarticular infections: a retrospective single-center study. Int J Antimicrob Agents 2018; 52:663-666. [PMID: 29751119 DOI: 10.1016/j.ijantimicag.2018.04.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 04/18/2018] [Accepted: 04/29/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND In 2015, our center replaced vancomycin with linezolid for the postoperative empirical treatment of osteoarticular infections (OAI). OBJECTIVES To assess the bacteriological relevance of linezolid for orthopedic postoperative probabilistic antibiotic therapy. METHODS Analysis of an observational cohort of patients empirically treated with a combination of linezolid and piperacillin/tazobactam during the immediate postoperative stage for an OAI between July 1st 2015 and July 1st 2016, in a French reference center. RESULTS Seventy-seven of 126 patients who received a probabilistic postoperative combination of linezolid with piperacillin/tazobactam had microbiological proof of infection. Sixty-six of 77 OAI involved material, including an osteosynthesis in 45 cases (68%) and prosthesis in 21 cases (32%). Infection was due to Gram-positive bacteria in 62 cases (80.5%), mostly S. aureus (n=32, 41.6%), and S. epidermidis (n=14, 18.2%) accounting for 74.2% of Gram-positive bacteria. Among 14 OAI due to S. epidermidis, 11 (78.6%) were due to methicillin-resistant strains. All the S. aureus and S. epidermidis strains were susceptible to linezolid (MICs ≤ 4 mg/L), except in one patient previously treated with linezolid who was infected with a linezolid-resistant S. epidermidis strain (MIC > 256 mg/L). CONCLUSION Linezolid can be used empirically in postoperative antibiotic therapy of OAI before obtaining definitive microbial results. Although linezolid resistance is rare in this population, previous oxazolidinone treatment should be documented before initiation of probabilistic postoperative treatment to highlight potential linezolid resistance.
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Affiliation(s)
- E Takoudju
- Bacteriology-Hospital Hygiene Unit, Nantes University Hospital, Nantes, France
| | - P Bémer
- Bacteriology-Hospital Hygiene Unit, Nantes University Hospital, Nantes, France; Nantes study group member of CRIOGO (Centre de Référence des Infections Ostéo-articulaires du Grand Ouest), Nantes, France
| | - S Touchais
- Department of Orthopedic Surgery, Nantes University Hospital, Nantes, France; Nantes study group member of CRIOGO (Centre de Référence des Infections Ostéo-articulaires du Grand Ouest), Nantes, France
| | - N Asseray
- Infectious Diseases Department, Nantes University Hospital, CIC UIC 1413 INSERM, CHU Nantes, France; Nantes study group member of CRIOGO (Centre de Référence des Infections Ostéo-articulaires du Grand Ouest), Nantes, France
| | - S Corvec
- Bacteriology-Hospital Hygiene Unit, Nantes University Hospital, Nantes, France; Nantes study group member of CRIOGO (Centre de Référence des Infections Ostéo-articulaires du Grand Ouest), Nantes, France
| | - L Khatchatourian
- Infectious Diseases Department, Nantes University Hospital, CIC UIC 1413 INSERM, CHU Nantes, France; Nantes study group member of CRIOGO (Centre de Référence des Infections Ostéo-articulaires du Grand Ouest), Nantes, France
| | - N Serandour
- Pharmacy Department, Nantes University Hospital, Nantes, France; Nantes study group member of CRIOGO (Centre de Référence des Infections Ostéo-articulaires du Grand Ouest), Nantes, France
| | - D Boutoille
- Infectious Diseases Department, Nantes University Hospital, CIC UIC 1413 INSERM, CHU Nantes, France; Nantes study group member of CRIOGO (Centre de Référence des Infections Ostéo-articulaires du Grand Ouest), Nantes, France.
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Pan Y, Zhang H, Xi C, Huang L, Xie S, Chen D, Tao Y, Liu Z, Yuan Z. Simultaneous determination of multicomponent of acetylkitasamycin and kitasamycin by LC-MS/MS in swine plasma and its application in a pharmacokinetic study. Biomed Chromatogr 2018; 32:e4268. [PMID: 29722050 DOI: 10.1002/bmc.4268] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/08/2018] [Accepted: 04/18/2018] [Indexed: 11/09/2022]
Abstract
A simple and reliable LC-MS/MS method was established for simultaneous determination of 12 components from acetylkitasamycin and kitasamycin in swine plasma. The analytes were separated on a Shim-pack VP-ODS column with a 25 min gradient elution using 5 mmol/L ammonium acetate and acetonitrile as the mobile phase at a flow rate of 0.2 mL/min. Identification and quantification were accomplished by electrospray ionization) in positive mode using multiple reaction monitoring. The limits of quantitation of acetylkitasamycin A1 A3 , A13 and kitasamycin A3 , A13 were 3 μg/L, and that of the other eight components was 5 μg/L. The mean recoveries of kitasamycin and acetylkitasamycin ranged from 85.3 to 103.5%. The developed method was successfully applied to a pharmacokinetic study in swine after intravenous (i.v.) and oral (p.o.) administration of acetylkitasamycin. The result showed that the plasma concentrations of acetylkitsamycin components were much higher than that of kitasamycin in swine after i.v. and p.o., in which acetylkitsamycin A4 A5 was the highest component at each time point.
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Affiliation(s)
- Yuanhu Pan
- National Reference Laboratory of Veterinary Drug Residues and MOA Key Laboratory for Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan, Hubei, China
- MOA Laboratory for Risk Assessment of Quality and Safety of Livestock and Poultry Products, Huazhong Agricultural University, Wuhan, Hubei, China
| | - Heying Zhang
- National Reference Laboratory of Veterinary Drug Residues and MOA Key Laboratory for Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan, Hubei, China
- MOA Laboratory for Risk Assessment of Quality and Safety of Livestock and Poultry Products, Huazhong Agricultural University, Wuhan, Hubei, China
| | - Chenglong Xi
- MOA Laboratory for Risk Assessment of Quality and Safety of Livestock and Poultry Products, Huazhong Agricultural University, Wuhan, Hubei, China
| | - Lingli Huang
- National Reference Laboratory of Veterinary Drug Residues and MOA Key Laboratory for Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan, Hubei, China
- MOA Laboratory for Risk Assessment of Quality and Safety of Livestock and Poultry Products, Huazhong Agricultural University, Wuhan, Hubei, China
| | - Shuyu Xie
- MOA Laboratory for Risk Assessment of Quality and Safety of Livestock and Poultry Products, Huazhong Agricultural University, Wuhan, Hubei, China
| | - Dongmei Chen
- National Reference Laboratory of Veterinary Drug Residues and MOA Key Laboratory for Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan, Hubei, China
| | - Yanfei Tao
- National Reference Laboratory of Veterinary Drug Residues and MOA Key Laboratory for Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan, Hubei, China
| | - Zhenli Liu
- National Reference Laboratory of Veterinary Drug Residues and MOA Key Laboratory for Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan, Hubei, China
- MOA Laboratory for Risk Assessment of Quality and Safety of Livestock and Poultry Products, Huazhong Agricultural University, Wuhan, Hubei, China
| | - Zonghui Yuan
- National Reference Laboratory of Veterinary Drug Residues and MOA Key Laboratory for Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan, Hubei, China
- MOA Laboratory for Risk Assessment of Quality and Safety of Livestock and Poultry Products, Huazhong Agricultural University, Wuhan, Hubei, China
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Upreti VV, Barbour AM. Antibiotics Development and the Emergence of Resistance: Clinical Pharmacology to the Rescue. J Clin Pharmacol 2018; 58:409-411. [PMID: 29329481 DOI: 10.1002/jcph.1057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 11/08/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Vijay V Upreti
- For the Public Policy Committee of the American College of Clinical Pharmacology
| | - April M Barbour
- For the Public Policy Committee of the American College of Clinical Pharmacology
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Toutain PL, Bousquet-Mélou A, Damborg P, Ferran AA, Mevius D, Pelligand L, Veldman KT, Lees P. En Route towards European Clinical Breakpoints for Veterinary Antimicrobial Susceptibility Testing: A Position Paper Explaining the VetCAST Approach. Front Microbiol 2017; 8:2344. [PMID: 29326661 PMCID: PMC5736858 DOI: 10.3389/fmicb.2017.02344] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 11/15/2017] [Indexed: 01/05/2023] Open
Abstract
VetCAST is the EUCAST sub-committee for Veterinary Antimicrobial Susceptibility Testing. Its remit is to define clinical breakpoints (CBPs) for antimicrobial drugs (AMDs) used in veterinary medicine in Europe. This position paper outlines the procedures and reviews scientific options to solve challenges for the determination of specific CBPs for animal species, drug substances and disease conditions. VetCAST will adopt EUCAST approaches: the initial step will be data assessment; then procedures for decisions on the CBP; and finally the release of recommendations for CBP implementation. The principal challenges anticipated by VetCAST are those associated with the differing modalities of AMD administration, including mass medication, specific long-acting product formulations or local administration. Specific challenges comprise mastitis treatment in dairy cattle, the range of species and within species breed considerations and several other variable factors not relevant to human medicine. Each CBP will be based on consideration of: (i) an epidemiological cut-off value (ECOFF) - the highest MIC that defines the upper end of the wild-type MIC distribution; (ii) a PK/PD breakpoint obtained from pre-clinical pharmacokinetic data [this PK/PD break-point is the highest possible MIC for which a given percentage of animals in the target population achieves a critical value for the selected PK/PD index (fAUC/MIC or fT > MIC)] and (iii) when possible, a clinical cut-off, that is the relationship between MIC and clinical cure. For the latter, VetCAST acknowledges the paucity of such data in veterinary medicine. When a CBP cannot be established, VetCAST will recommend use of ECOFF as surrogate. For decision steps, VetCAST will follow EUCAST procedures involving transparency, consensus and independence. VetCAST will ensure freely available dissemination of information, concerning standards, guidelines, ECOFF, PK/PD breakpoints, CBPs and other relevant information for AST implementation. Finally, after establishing a CBP, VetCAST will promulgate expert comments and/or recommendations associated with CBPs to facilitate their sound implementation in a clinical setting.
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Affiliation(s)
- Pierre-Louis Toutain
- UMR 1331 Toxalim, INRA, ENVT, Toulouse, France
- The Royal Veterinary College, University of London, London, United Kingdom
| | | | - Peter Damborg
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
| | | | - Dik Mevius
- Wageningen Bioveterinary Research, Lelystad, Netherlands
| | - Ludovic Pelligand
- The Royal Veterinary College, University of London, London, United Kingdom
| | - Kees T. Veldman
- National Reference Laboratory on Antimicrobial Resistance in Animals, Lelystad, Netherlands
| | - Peter Lees
- The Royal Veterinary College, University of London, London, United Kingdom
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Pharmacokinetics-based adherence measures for antiretroviral therapy in HIV-infected Kenyan children. J Int AIDS Soc 2017; 20:21157. [PMID: 28605170 PMCID: PMC5515048 DOI: 10.7448/ias.20.1.21157] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Traditional medication adherence measures do not account for the pharmacokinetic (PK) properties of the drugs, potentially misrepresenting true therapeutic exposure. METHODS In a population of HIV-infected Kenyan children on antiretroviral therapy including nevirapine (NVP), we used a one-compartment model with previously established PK parameters and Medication Event Monitoring Systems (MEMS®)-recorded dosing times to estimate the mean plasma concentration of NVP (Cp) in individual patients during 1 month of follow-up. Intended NVP concentration (Cp') was calculated under a perfectly followed dosing regimen and frequency. The ratio between the two (R = Cp/Cp') characterized the patient's NVP exposure as compared to intended level. Smaller R values indicated poorer adherence. We validated R by evaluating its association with MEMS®-defined adherence, CD4%, and spot-check NVP plasma concentrations assessed at 1 month. RESULTS In data from 152 children (82 female), children were mean age 7.7 years (range 1.5-14.9) and on NVP an average of 2.2 years. Mean MEMS® adherence was 79%. The mean value of R was 1.11 (SD 0.37). R was positively associated with MEMS® adherence (p < 0.0001), and lower-than-median R values were significantly associated with lower NVP drug concentrations (p = 0.0018) and lower CD4% (p = 0.0178), confirming a smaller R value showed poorer adherence. CONCLUSION The proposed adherence measures, R, captured patient drug-taking behaviours and PK properties.
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18
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Delattre IK, Taccone FS, Jacobs F, Hites M, Dugernier T, Spapen H, Laterre PF, Wallemacq PE, Van Bambeke F, Tulkens PM. Optimizing β-lactams treatment in critically-ill patients using pharmacokinetics/pharmacodynamics targets: are first conventional doses effective? Expert Rev Anti Infect Ther 2017; 15:677-688. [PMID: 28571493 DOI: 10.1080/14787210.2017.1338139] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The pharmacokinetic/pharmacodynamic index determining β-lactam activity is the percentage of the dosing interval (%T) during which their free serum concentration remains above a critical threshold over the minimum inhibitory concentration (MIC). Regrettably, neither the value of %T nor that of the threshold are clearly defined for critically-ill patients. Areas covered: We review and assess the targets proposed for β-lactams in critical illness by screening the literature since 1997. Depending on the study intention (clinical cure vs. suppression of resistance), targets proposed range from 20%T > 1xMIC to 100%T > 5xMIC. Assessment and comparative analysis of their respective clinical efficacy suggest that a value of 100%T > 4xMIC may be needed. Simulation studies, however, show that this target will not be reached at first dose for the majority of critically-ill patients if using the most commonly recommended doses. Expert commentary: Considering that critically-ill patients are highly vulnerable and likely to experience antibiotic underexposure, and because effective initial treatment is a key determinant of clinical outcome, we support the use of a target of 100%T > 4xMIC, which could not only maximize efficacy but also minimize emergence of resistance. Clinical and microbiological studies are needed to test for the feasibility and effectiveness of reaching such a demanding target.
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Affiliation(s)
- Isabelle K Delattre
- a Louvain Drug Research Institute , Université catholique de Louvain , Brussels , Belgium.,b Department of Clinical Chemistry , Cliniques Universitaires St-Luc , Brussels , Belgium
| | - Fabio S Taccone
- c Department of Intensive Care , Hôpital Erasme , Brussels , Belgium
| | - Frédérique Jacobs
- d Department of Infectious Diseases , Hôpital Erasme , Brussels , Belgium
| | - Maya Hites
- d Department of Infectious Diseases , Hôpital Erasme , Brussels , Belgium
| | - Thierry Dugernier
- e Department of Intensive Care , Clinique St-Pierre , Ottignies , Belgium
| | - Herbert Spapen
- f Department of Intensive Care , Universitair Ziekenhuis Brussel , Brussels , Belgium
| | | | - Pierre E Wallemacq
- b Department of Clinical Chemistry , Cliniques Universitaires St-Luc , Brussels , Belgium
| | - Françoise Van Bambeke
- a Louvain Drug Research Institute , Université catholique de Louvain , Brussels , Belgium
| | - Paul M Tulkens
- a Louvain Drug Research Institute , Université catholique de Louvain , Brussels , Belgium
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Lee HK, DeVito V, Vercelli C, Tramuta C, Nebbia P, Re G, Kovalenko K, Giorgi M. Ex vivo antibacterial activity of levofloxacin against Escherichia coli and its pharmacokinetic profile following intravenous and oral administrations in broilers. Res Vet Sci 2017; 112:26-33. [DOI: 10.1016/j.rvsc.2017.01.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 12/23/2016] [Accepted: 01/11/2017] [Indexed: 11/29/2022]
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20
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Cotrina-Luque J, Gil-Navarro MV, Acosta-García H, Alfaro-Lara ER, Luque-Márquez R, Beltrán-García M, Bautista-Paloma FJ. Continuous versus intermittent piperacillin/tazobactam infusion in infection due to or suspected pseudomonas aeruginosa. Int J Clin Pharm 2016; 38:70-9. [PMID: 26474861 DOI: 10.1007/s11096-015-0208-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 10/06/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is lack of information on the efficacy and safety of piperacillin–tazobactam administered by continuous infusion. OBJECTIVE The aim of this study was to investigate whether continuous infusion of piperacillin–tazobactam is superior in terms of efficacy to a 30 % higher dose administered by intermittent infusion to treat suspected or confirmed infection due to Pseudomonas aeruginosa. Setting Multicenter clinical trial with 11 third level Spanish hospitals. METHOD Randomized, double-blind parallel-group clinical trial, controlled by conventional administration of the drug. Patients randomly assigned in a 1:1 ratio to receive piperacillin–tazobactam as continuous infusion (CI) or intermittent (II). MAIN OUTCOME MEASURE Primary efficacy endpoint was percentage of patients having a satisfactory clinical response at completion of treatment, defined as clinical cure or clinical improvement. Adverse events were reported. Results 78 patients were included, 40 in the CI group and 38 in the II group. Mean (standard deviation) duration of treatment was 7 (±4.44) days. 58 patients (74.4 %) experienced cure or improvement at the end of the treatment. There were no statistical differences in cure rates between the two treatment arms and no adverse events were reported. CONCLUSION Continuous infusion of piperacillin–tazobactam is an alternative administration drug method at least similar in efficacy and safety to conventional intermittent infusion. Multivariate analysis is needed to determine whether continuous administration might be more beneficial than intermittent in certain patient subgroups.
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Waraich GS, Sidhu PK, Daundkar PS, Kaur G, Sharma SK. Pharmacokinetic and pharmacodynamic characterization of ceftiofur crystalline-free acid following subcutaneous administration in domestic goats. J Vet Pharmacol Ther 2016; 40:429-438. [DOI: 10.1111/jvp.12373] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 09/19/2016] [Indexed: 11/30/2022]
Affiliation(s)
- G. S. Waraich
- Department of Veterinary Pharmacology and Toxicology; College of Veterinary Science; Guru Angad Dev Veterinary and Animal Sciences University; Ludhiana India
| | - P. K. Sidhu
- Animal Disease Research Centre; College of Veterinary Science; Guru Angad Dev Veterinary and Animal Sciences University; Ludhiana India
| | - P. S. Daundkar
- Department of Veterinary Pharmacology and Toxicology; College of Veterinary Science; Guru Angad Dev Veterinary and Animal Sciences University; Ludhiana India
| | - G. Kaur
- Department of Veterinary Microbiology; College of Veterinary Science; Guru Angad Dev Veterinary and Animal Sciences University; Ludhiana India
| | - S. K. Sharma
- Department of Veterinary Pharmacology and Toxicology; College of Veterinary Science; Guru Angad Dev Veterinary and Animal Sciences University; Ludhiana India
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Maclayton DO, Hall RG. Infectious Diseases: Pharmacologic Treatment Options for Nosocomial Pneumonia Involving Methicillin-Resistant Staphylococcus aureus. Ann Pharmacother 2016; 41:235-44. [PMID: 17299012 DOI: 10.1345/aph.1h414] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective: To discuss current and potential treatment options for nosocomial pneumonia due to methicillin-resistant Staphylococcus aureus (MRSA). Data Sources: A MEDLINE search (1966–January 2007) was conducted to identify English-language literature on pharmacotherapy of nosocomial pneumonia and the bibliographies of pertinent articles. Programs and abstracts from infectious disease meetings were also searched. Search terms included MRSA, nosocomial pneumonia, pulmonary infections, vancomycin, quinupristin/dalfopristin, linezolid, daptomycin, tigecycline, dalbavancin, oritavancin, and ceftobiprole. Data Selection and Data Extraction: All articles were critically evaluated and all pertinent information was included in this review. Data Synthesis: Vancomycin has been the drug of choice for MRSA infections for many years. Recent data suggest that linezolid may be superior to vancomycin in the treatment of MRSA nosocomial pneumonia. However, there are limitations to the available data. Therefore, prospective, randomized studies are needed before linezolid is recommended as the preferred first-line therapy. Other approved agents for nosocomial MRSA infections, such as quinupristin/dalfopristin and daptomycin, should not be used in the treatment of MRSA pneumonia, as they were inferior in clinical trials. Tigecycline has excellent activity against MRSA in vitro, but should not be routinely used for the treatment of MRSA pneumonia, as clinical data are lacking. In a Phase III clinical trial, an anti-MRSA cephalosporin, ceftobiprole, is being evaluated for effectiveness against nosocomial pneumonia. Investigational glycopeptides may eventually have a role in the treatment of nosocomial pneumonia, but data are currently lacking. Conclusions: Vancomycin is still the drug of choice for treatment of MRSA pneumonia, and linezolid should be used as an alternative agent. Linezolid should carry strong consideration for patients with vancomycin-induced nephrotoxicity or a documented lack of response to vancomycin. Tigecycline and investigational agents with activity against MRSA may be future options for nosocomial pneumonia due to MRSA.
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Affiliation(s)
- Darego O Maclayton
- Texas Southern University College of Pharmacy & Health Sciences, Michael E DeBakey Veterans Affairs Medical Center, Houston, TX 77004, USA.
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Piccinno M, Rizzo A, Cariello G, Staffieri F, Sciorsci R. Oxytocin plus antibiotics: A synergism of potentiation to enhance bovine uterine contractility. Theriogenology 2016; 86:1203-11. [DOI: 10.1016/j.theriogenology.2016.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 04/06/2016] [Accepted: 04/07/2016] [Indexed: 11/30/2022]
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Noreddin AM, Haynes VL, Zhanel GG. Pharmacokinetics and Pharmacodynamics of the New Quinolones. J Pharm Pract 2016. [DOI: 10.1177/0897190005282397] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this review, the authors describe the pharmacokinetic (PK) and pharmacodynamic (PD) characteristics of the new quinolones (levofloxacin, gatifloxacin, moxifloxacin, gemifloxacin, and garenoxacin) and discuss their implications on adequate therapy of patients with respiratory infections. The newer quinolones display excellent bioavailability and have longer serum half-lives than ciprofloxacin. In addition, they have the ability to concentrate in respiratory tract tissues and fluids at levels that exceed serum-drug concentrations. Also, the newer quinolones exhibit broad-spectrum activity against both susceptible and resistant organisms. Those favorable PK/PD properties make the new quinolones an attractive therapeutic alternative to traditional agents for common respiratory infections. Understanding the PK/PD of quinolone antibiotics can facilitate selection of optimal regimens to hasten response, prevent treatment failures, and minimize the development of resistance.
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Affiliation(s)
- Ayman M. Noreddin
- College of Pharmacy, University of Minnesota, Duluth, MNDepartment of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth, Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Virginia L. Haynes
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth
| | - George G. Zhanel
- Department of Medical Microbiology at the University of Manitoba, Winnipeg, Manitoba, Canada
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RUENNARONG N, WONGPANIT K, SAKULTHAEW C, GIORGI M, KUMAGAI S, POAPOLATHEP A, POAPOLATHEP S. Dispositions of enrofloxacin and its major metabolite ciprofloxacin in Thai swamp buffaloes. J Vet Med Sci 2016; 78:397-403. [PMID: 26596287 PMCID: PMC4829506 DOI: 10.1292/jvms.15-0464] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 11/09/2015] [Indexed: 11/29/2022] Open
Abstract
Given the limited information available in this species, the aim of this study was to investigate the pharmacokinetic characteristics of enrofloxacin (ER) and its major metabolite ciprofloxacin (CP) in buffaloes, Bubalus bubalis. ER was administered intravenously (i.v.) or subcutaneously (s.c.) to buffaloes at doses of 5.0 and 7.5 mg/kg BW, and plasma, urine and fecal samples were collected until 48 hr post-administration. The concentrations of ER and CP in the plasma, urine and feces were analyzed using high-performance liquid chromatography equipped with a fluorescence detector. The plasma concentrations of ER and CP could be determined up to 24 hr and 32 hr after i.v. and s.c. administrations at doses of 5.0 and 7.5 mg/kg BW, respectively. CP concentrations were always lower than those of parental drug. The s.c. bioavailability of ER was 52.36 ± 4.24% and 72.12 ± 5.39% at doses of 5.0 and 7.5 mg/kg BW, respectively. Both ER and CP were detectable in urine and feces up to 24 hr. ER and CP were mainly excreted via the urine. Based on the pharmacokinetic data and PK-PD indices, s.c. administration of ER at doses of 5.0 and 7.5 mg/kg BW might be appropriate for the treatment of susceptible bacterial diseases in Thai swamp buffaloes.
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Affiliation(s)
- Nitwarat RUENNARONG
- Department of Pharmacology, Faculty of Veterinary Medicine,
Kasetsart University, Bangkok 10900, Thailand
| | - Kannika WONGPANIT
- Faculty of Natural Resources and Agro-industry,
Chalermphrakiat Sakon Nakhon Province Campus, Kasetsart University, Sakon Nakhon 47000,
Thailand
| | | | - Mario GIORGI
- Department of Veterinary Sciences, University of Pisa, Via
Livornese (lato monte), San Piero a Grado, Italy
| | - Susumu KUMAGAI
- Research Center for Food Safety, Graduated School of
Agricultural and Life Sciences, The University of Tokyo, Tokyo 113–8657, Japan
| | - Amnart POAPOLATHEP
- Department of Pharmacology, Faculty of Veterinary Medicine,
Kasetsart University, Bangkok 10900, Thailand
| | - Saranya POAPOLATHEP
- Department of Pharmacology, Faculty of Veterinary Medicine,
Kasetsart University, Bangkok 10900, Thailand
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26
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Papa V. Penetration of topical chloramphenicol into the anterior chamber. Clin Exp Ophthalmol 2015; 43:493-4. [DOI: 10.1111/ceo.12468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 10/02/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Vincenzo Papa
- Medical Affairs; Società Industria Farmaceutica Italiana SpA; Aci S. Antonio (Catania) Italy
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27
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Azeredo FJ, Dalla Costa T, Derendorf H. Role of microdialysis in pharmacokinetics and pharmacodynamics: current status and future directions. Clin Pharmacokinet 2014; 53:205-212. [PMID: 24452811 DOI: 10.1007/s40262-014-0131-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Diagnostic and therapeutic decisions in medical practice are still generally based on blood concentrations of drugs and/or biomolecules despite the knowledge that biochemical events and pharmacological effects usually take place in tissue rather than in the bloodstream. Microdialysis is a semi-invasive technique that is able to measure concentrations of the free, active drug or endogenous compounds in almost all human tissues and organs. It is currently being used to monitor brain metabolic processes and quantify tissue biomarkers, and determine transdermal drug distribution and tissue pharmacokinetics, confirming its importance as a widely used sampling technique in clinical drug monitoring and drug development as well as therapy and disease follow-up, contributing to rationalizing drug dosing regimens and influencing the clinical decision-making process.
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Affiliation(s)
| | - Teresa Dalla Costa
- Programa de Pós-Graduação em Ciências Farmacêuticas, UFRGS, Porto Alegre, Brazil
| | - Hartmut Derendorf
- Department of Pharmaceutics, College of Pharmacy, University of Florida, 1600 SW Archer Road, Gainesville, FL, 32610, USA.
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28
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An optimized mouse thigh infection model for enterococci and its impact on antimicrobial pharmacodynamics. Antimicrob Agents Chemother 2014; 59:233-8. [PMID: 25348523 DOI: 10.1128/aac.02352-13] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Negligible in vivo growth of enterococci and high-level dispersion of data have led to inaccurate estimations of antibiotic pharmacodynamics (PD). Here we improved an in vivo model apt for PD studies by optimizing the in vitro culture conditions for enterococci. The PD of vancomycin (VAN), ampicillin-sulbactam (SAM), and piperacillin-tazobactam (TZP) against enterococci were determined in vivo, comparing the following different conditions of inoculum preparation: aerobiosis, aerobiosis plus mucin, and anaerobiosis plus mucin. Drug exposure was expressed as the ratio of the area under the concentration-time curve for the free, unbound fraction of the drug to the MIC (fAUC/MIC) (VAN) or the time in a 24-h period that the drug concentration for the free, unbound fraction exceeded the MIC under steady-state pharmacokinetic conditions (fT(>MIC)) (SAM and TZP) and linked to the change in log10 CFU/thigh. Only anaerobiosis plus mucin enhanced the in vivo growth, yielding significant PD parameters with all antibiotics. In conclusion, robust in vivo growth of enterococci was crucial for better determining the PD of tested antibacterial agents, and this was achieved by optimizing the procedure for preparing the inoculum.
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29
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Kitamura Y, Yoshida K, Kusama M, Sugiyama Y. A proposal of a pharmacokinetic/pharmacodynamic (PK/PD) index map for selecting an optimal PK/PD index from conventional indices (AUC/MIC, Cmax/MIC, and TAM) for antibiotics. Drug Metab Pharmacokinet 2014; 29:455-62. [PMID: 25008846 DOI: 10.2133/dmpk.dmpk-14-rg-013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A pharmacokinetic/pharmacodynamic (PK/PD) analysis is important in antibiotic chemotherapy. Basically, the in vivo efficacy of antibiotics that exert concentration-dependent effects can be predicted using conventional PK/PD indices such as the ratio of the area under the curve to the minimum inhibitory concentration (AUC/MIC) and/or the ratio of the maximum plasma concentration to MIC (Cmax/MIC), whereas that of antibiotics with time-dependent effects can be determined using the period of time for which the drug concentration exceeds the MIC (time above MIC [TAM]). However, an optimal PK/PD index remains to be established for some antibiotics. Thus, a PK/PD model which describes the PK profile and effect of an antibiotic was developed, and the results obtained from this model were interpreted to form a PK/PD index map to assess the optimal PK/PD index for the antibiotic. The findings from the map were generally consistent with clinical outcomes even for the antibiotics which proved to be exceptions to the conventional classification. For example, AUC/MIC was an optimal index for azithromycin despite its time-dependent bactericidal activity, and Cmax/MIC was a poor index for arbekacin despite its concentration-dependent profile. Thus, the map would be useful for selecting the appropriate PK/PD index for an antibiotic.
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30
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Jonsson TB, Nilsson TK, Breimer LH, Schneede J, Arfvidsson B, Norgren L. Cloxacillin concentrations in serum, subcutaneous fat, and muscle in patients with chronic critical limb ischemia. Eur J Clin Pharmacol 2014; 70:957-63. [DOI: 10.1007/s00228-014-1695-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 05/02/2014] [Indexed: 12/01/2022]
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31
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Goulenok T, Fantin B. Antimicrobial treatment of febrile neutropenia: pharmacokinetic-pharmacodynamic considerations. Clin Pharmacokinet 2014; 52:869-83. [PMID: 23807657 DOI: 10.1007/s40262-013-0086-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Patients with cancer or hematologic diseases are particularly at risk of infection leading to high morbidity, mortality and costs. Extensive data show that optimization of the administration of antimicrobials according to their pharmacokinetic and pharmacodynamic parameters improves clinical outcome. Evidence is growing that when pharmacokinetic and pharmacodynamic parameters are used to target not only clinical cure but also eradication, the selection resistance is also contained. This is of particular importance in patients with neutropenia in whom increasing rates of drug-resistant Gram-negative bacteria have been reported, particularly Pseudomonas aeruginosa. Based on experimental and clinical studies, pharmacokinetic and pharmacodynamic parameters are discussed in this review for each antibiotic used in febrile neutropenia in order to help physicians improve dosing and optimization of antimicrobial agents.
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Affiliation(s)
- Tiphaine Goulenok
- Internal Medicine Department, Beaujon Hospital, APHP and University Paris Diderot, Sorbonne Paris Cité, Paris, France
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32
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Morimoto K. [Designs of optimized microbial therapy systems of respiratory infections]. YAKUGAKU ZASSHI 2014; 133:81-92. [PMID: 23292024 DOI: 10.1248/yakushi.12-00256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Several respiratory infections are frequently induced by pathogenic microorganisms in lung epithelial lining fluid (ELF) and alveolar macrophages (AM). Then, two studies concerning designs of antimicrobial therapy systems of respiratory infections were carried out; one was the distribution mechanisms of three macrolide and ketolide antibiotics, clarithromycin (CAM), azithromycin (AZM) and telithromycin (TEL) in plasma, ELF and AM, and the other was the efficient drug delivery to AM by pulmonary administration of fluoroquinolone antibiotic, a ciprofloxacin (CPFX) incorporated into liposomes (CPFX-liposome). In the first study, the areas under drug concentration-time curves (AUCs) in ELF following oral administration of three macrolide and ketolide antibiotics to rats were significantly higher than AUCs in plasma, furthermore AUCs in AM significantly higher than AUCs in ELF. The high distribution of these antibiotics to the respiratory infection site is due to the transport from blood to ELF via MDR1 in lung epithelial cells as well as the uptake by AM. These antibiotics were taken up by AM via active transport system and the trapping in organelles. In the second study, drug delivery efficacy of CPFX-liposome to AM was particle size-dependent over the 100-1000 nm and then become constant at over 1000 nm by pulmonary aerosolization to rats. This result indicates that the most effective size is 1000 nm. Furthermore, the drug delivery efficacy of mannosylated CPFX-liposome (particle size: 1000 nm) was highly delivered to AM and antibacterial effects were significantly higher than those of unmodified CPFX-liposome. This review provides useful findings for microbial therapy systems of respiratory infections.
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Affiliation(s)
- Kazuhiro Morimoto
- Hokkaido Pharmaceutical University School of Pharmacy, Otaru, Hokkaido, Japan.
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33
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Britzi M, Mazon Y, Lavy E, Soback S. Intravenous infusion of electrolyte solution changes pharmacokinetics of drugs: pharmacokinetics of ampicillin. J Vet Pharmacol Ther 2014; 37:445-50. [PMID: 24666465 DOI: 10.1111/jvp.12122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 01/29/2014] [Indexed: 11/30/2022]
Abstract
The pharmacokinetics of ampicillin in dogs was determined after intravenous (i.v.) bolus and constant rate infusion. Ampicillin was administered to six beagle dogs as an i.v. bolus at 20 mg/kg and as a constant rate i.v. infusion (CRI) at 20 mg/kg during 8 h (0.042 mL/min/kg) in Ringer's lactate (Hartmann's) solution. The concentrations were determined by an LC/MS/MS method. After i.v. bolus, ampicillin total body clearance, apparent volume of distribution at steady-state, mean residence time (MRT), and half-life were 4.53 ± 0.70 mL/min/kg, 0.275 ± 0.044 L/kg, 61 ± 13 min, and 111 (85-169) min, respectively. The corresponding parameters calculated after CRI were 13.5 ± 1.06 mL/min/kg, 0.993 ± 0.415 L/kg, 73 ± 27 min, and 49 (31-69) min. Ampicillin concentration decreased by 30% in the Ringer's lactate infusion solution mostly during the first hour after preparation of the solution. Constant rate infusion of Ringer's lactate solution during 8 h caused significant changes in ampicillin pharmacokinetics. The results suggested that special attention should be given to drug pharmacokinetics when co-administered intravenously with electrolyte solutions.
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Affiliation(s)
- M Britzi
- National Residue Control Laboratory, Kimron Veterinary Institute, Veterinary Services, Ministry of Agriculture, Beit Dagan, Israel
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34
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Role of microdialysis in pharmacokinetics and pharmacodynamics: current status and future directions. Clin Pharmacokinet 2014. [PMID: 24452811 DOI: 10.1007/s40262–014-0131–8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
Diagnostic and therapeutic decisions in medical practice are still generally based on blood concentrations of drugs and/or biomolecules despite the knowledge that biochemical events and pharmacological effects usually take place in tissue rather than in the bloodstream. Microdialysis is a semi-invasive technique that is able to measure concentrations of the free, active drug or endogenous compounds in almost all human tissues and organs. It is currently being used to monitor brain metabolic processes and quantify tissue biomarkers, and determine transdermal drug distribution and tissue pharmacokinetics, confirming its importance as a widely used sampling technique in clinical drug monitoring and drug development as well as therapy and disease follow-up, contributing to rationalizing drug dosing regimens and influencing the clinical decision-making process.
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35
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Delattre I, Van de Walle P, Van Campenhout C, Hamers-Devleeschouwer N, Wallemacq P. PROMOTION OF AN APPLIED PHARMACOKINETIC SOFTWARE, NAMED PHARMONITOR, DEVELOPED TO OPTIMIZE INDIVIDUAL DOSAGE REGIMEN THROUGH A NATIONAL QUALITY CONTROL PROGRAM. Acta Clin Belg 2014. [DOI: 10.1179/acb.2010.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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36
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Papich MG. Pharmacokinetic-pharmacodynamic (PK-PD) modeling and the rational selection of dosage regimes for the prudent use of antimicrobial drugs. Vet Microbiol 2014; 171:480-6. [PMID: 24513278 DOI: 10.1016/j.vetmic.2013.12.021] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 12/23/2013] [Accepted: 12/24/2013] [Indexed: 10/25/2022]
Abstract
One of the strategies to decrease inappropriate antimicrobial use in veterinary medicine is to apply pharmacokinetic-pharmacodynamic (PK-PD) principles to dosing regimens. If antimicrobials are used appropriately by applying these principles to attain targets for area-under-the-curve to MIC ratio (AUC/MIC), peak concentration to MIC ratio (CMAX/MIC), and time above MIC (T>MIC), more effective antibiotic therapy is possible, thus avoiding ineffective administration. Another mechanism whereby inappropriate antibiotic administration can be avoided is to use accurate Interpretive Criteria established by the Clinical Laboratory Standards Institute (CLSI) for breakpoint selection. Inaccurate breakpoints will encourage antibiotic administration that is likely to be ineffective. For newly approved antimicrobials, three criteria are used for determining breakpoints: PK-PD criteria, MIC distributions, and clinical response. For older (often generic drugs) evaluated by the CLSI, recent clinical data may not be available and breakpoints are derived from PK-PD principles, wild-type distributions, and Monte Carlo simulations. It is the goal of the CLSI subcommittee that these revised breakpoints will encourage more effective antimicrobial use and avoid unnecessary antimicrobial administration.
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Affiliation(s)
- Mark G Papich
- North Carolina State University, College of Veterinary Medicine, 1060 William Moore Drive, Raleigh, NC 27607, USA.
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37
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Denooz R, Frippiat F, Charlier C. SIMULTANEOUS QUANTIFICATION OF FIVE β-LACTAM ANTIBIOTICS IN HUMAN PLASMA BY HPLC-DAD: CLINICAL APPLICATION FOR CEFTAZIDIME TREATMENT IN INTENSIVE CARE UNITS. Acta Clin Belg 2014. [DOI: 10.1179/acb.2010.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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38
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Gupta SK, Nayak RP. Dry antibiotic pipeline: Regulatory bottlenecks and regulatory reforms. J Pharmacol Pharmacother 2014; 5:4-7. [PMID: 24554902 PMCID: PMC3917165 DOI: 10.4103/0976-500x.124405] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sandeep Kumar Gupta
- Department of Pharmacology, Dhanalakshmi Srinivasan Medical College and Hospital, Siruvachur, Perambalur, Tamil Nadu, India
| | - Roopa P. Nayak
- Department of Pharmacology, Dhanalakshmi Srinivasan Medical College and Hospital, Siruvachur, Perambalur, Tamil Nadu, India
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39
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Mazzei T, Novelli A. Pharmacological Rationale for Antibiotic Treatment of Intra-abdominal Infections. J Chemother 2013; 21 Suppl 1:19-29. [DOI: 10.1179/joc.2009.21.supplement-1.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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40
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Balaje R, Sidhu P, Kaur G, Rampal S. Mutant prevention concentration and PK–PD relationships of enrofloxacin for Pasteurella multocida in buffalo calves. Res Vet Sci 2013; 95:1114-24. [DOI: 10.1016/j.rvsc.2013.07.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 07/15/2013] [Accepted: 07/16/2013] [Indexed: 12/01/2022]
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41
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Zhang L, Li L, Shi W, Liu S, Liang X, Ye Z, Wang WJ, Zhang B, Li R, Chen Y, Yu C, Zhuo L, Wang X. Pharmacokinetics of moxifloxacin in critically ill patients with impaired renal function undergoing pulse high-volume haemofiltration. Int J Antimicrob Agents 2013; 42:244-9. [DOI: 10.1016/j.ijantimicag.2013.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 06/10/2013] [Accepted: 06/12/2013] [Indexed: 11/29/2022]
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42
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Asín-Prieto E, Rodríguez-Gascón A, Trocóniz IF, Soraluce A, Maynar J, Sánchez-Izquierdo JÁ, Isla A. Population pharmacokinetics of piperacillin and tazobactam in critically ill patients undergoing continuous renal replacement therapy: application to pharmacokinetic/pharmacodynamic analysis. J Antimicrob Chemother 2013; 69:180-9. [PMID: 23908259 DOI: 10.1093/jac/dkt304] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES To evaluate the pharmacokinetics of piperacillin/tazobactam in critically ill patients undergoing continuous renal replacement therapy (CRRT) and to assess the success of the therapy against susceptible bacteria. PATIENTS AND METHODS Sixteen patients undergoing CRRT with different degrees of renal function were included in the study. Blood and ultrafiltrate samples were drawn after administration of piperacillin/tazobactam (4/0.5 g) every 4, 6 or 8 h. The data were analysed by a population approach using NONMEM 7.2. The probability of target attainment (PTA) of maintaining free piperacillin levels above the MIC during the entire dosing interval was estimated by simulation of intermittent and continuous infusions. RESULTS The pharmacokinetics of piperacillin and tazobactam were best described by two-compartment models where the elimination of both drugs was conditioned by renal [dependent on creatinine clearance (CLCR)], non-renal and extracorporeal clearances. A 20 min infusion of piperacillin/tazobactam administered every 6 h provided high PTAs against MICs ≤ 32 mg/L in patients with severe renal failure. In patients with normal or moderate renal function PTAs ≥ 90% were only obtained up to MICs ≤ 8 mg/L with short infusions. However, simulating continuous infusion, higher probabilities of success were obtained against MICs of 32 and 16 mg/L when CLCR was 50 and 100 mL/min, respectively. CONCLUSIONS Population pharmacokinetic models have been developed and validated for piperacillin and tazobactam. Based on the pharmacokinetic/pharmacodynamic analysis, dosing recommendations are given considering the residual renal function of the patient and the MIC for the isolated bacteria.
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Affiliation(s)
- Eduardo Asín-Prieto
- Pharmacokinetics, Nanotechnology and Gene Therapy Group, Faculty of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
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Breilh D, Jougon J, Djabarouti S, Gordien JB, Xuereb F, Velly JF, Arvis P, Landreau V, Saux MC. Diffusion of Oral and Intravenous 400 mg Once-Daily Moxifloxacin into Lung Tissue at Pharmacokinetic Steady-State. J Chemother 2013; 15:558-62. [PMID: 14998080 DOI: 10.1179/joc.2003.15.6.558] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The degree of penetration of an antibiotic into the infection site is an important factor for its therapeutic efficacy, particularly in respiratory tract infections. In the present study, we examined the lung tissue diffusion of moxifloxacin at a dose of 400 mg administered intravenously or orally once-daily, and the results were correlated to microbiological data to estimate the clinical efficacy of moxifloxacin in lower community-acquired respiratory infections. This was a prospective, randomized, parallel-group trial, open-label, single-center study. Patients undergoing lung surgery for bronchial cancer which necessitates the removal of an anatomical piece of lung tissue were randomized into twelve treatment groups, dependent upon the time of surgery and the moxifloxacin formulation, i.v. or oral, administered. During surgery, one blood sample was taken at the time of tissue collection to determine moxifloxacin plasma concentration. At the same time, tissue samples were taken by pulmonary exeresis. A validated new high performance liquid chromatography assay was used to determine moxifloxacin concentrations in plasma and lung tissue. A total of 49 patients (25 for i.v. administration, 24 for oral administration, 44 men and 5 women, mean age, 61 years, mean body weight, 72 kg, mean creatinine clearance was 84 ml/min/1.73 m2) were enrolled. The mean +/- SD steady-state moxifloxacin ratios between lung and plasma concentrations were respectively: 3.53 +/- 1.89 and 4.36 +/- 1.48 for i.v. and oral administration. The mean steady-state moxifloxacin maximal lung concentrations (Cmax) were respectively 12.37 microg/g and 16.21 microg/g for i.v. and oral administration. Moxifloxacin both intravenously and orally exhibits high penetration in lung tissue, with tissue concentrations far above the MIC90s for most of the susceptible pathogens commonly involved, thus underlining its suitability for the treatment of community-acquired, lower respiratory tract infections.
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Affiliation(s)
- D Breilh
- Pharmacokinetic and Clinical Pharmacy Department, Haut-Lévêque Hospital, Pessac, France.
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44
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Arzuaga A, Maynar J, Gascón AR, Isla A, Corral E, Fonseca F, Sánchez-Izquierdo JA, Rello J, Canut A, Pedraz JL. Influence of Renal Function on the Pharmacokinetics of Piperacillin/Tazobactam in Intensive Care Unit Patients During Continuous Venovenous Hemofiltration. J Clin Pharmacol 2013; 45:168-76. [PMID: 15647409 DOI: 10.1177/0091270004269796] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The pharmacokinetics of piperacillin/tazobactam (4 g/0.5 g every 6 or 8 hours, by 20-minute intravenous infusion) were studied in 14 patients with acute renal failure who underwent continuous venovenous hemofiltration with AN69 membranes. Patients were grouped according to severity (CL(CR) < or =10 mL/min, 10 < CL(CR) < or =50 mL/min, and CL(CR) > 50 mL/min). A noncompartmental analysis was performed. The sieving coefficient (0.78 +/- 0.28) was similar to the unbound fraction (0.65 +/- 0.24) for tazobactam, but it was significantly different (0.34 +/- 0.25) from the unbound fraction (0.78 +/- 0.14) for piperacillin. Extracorporeal clearance was 37.0% +/- 28.8%, 12.7% +/- 12.6%, and 2.8% +/- 3.2% for piperacillin in each group and 62.5% +/- 44.9%, 35.4% +/- 17.0%, and 13.1% +/- 8.0% for tazobactam. No patients presented tazobactam accumulation. In patients with CL(CR) < 50 mL/min, t(%)ss >MIC90 values were 100% for a panel of 19 pathogens, but in those with CL(CR) > 50 mL/min, t(%)ss >MIC90 indexes were 55.5% and 16.6% for pathogens with MIC90 values of 32 and 64. The extracorporeal clearance of piperacillin/tazobactam is clinically significant in patients with CL(CR) > 50 mL/min, in which the risk of underdosing and clinical failure is important and extra doses are required.
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Affiliation(s)
- Alazne Arzuaga
- Laboratorio de Farmacia y Tecnología Farmacéutica, Facultad de Farmacia, Paseo de la Universidad no. 7, 01006 Vitoria-Gasteiz, Spain
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45
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Burkhardt O, Majcher-Peszynska J, Borner K, Mundkowski R, Drewelow B, Derendorf H, Welte T. Penetration of Ertapenem Into Different Pulmonary Compartments of Patients Undergoing Lung Surgery. J Clin Pharmacol 2013; 45:659-65. [PMID: 15901747 DOI: 10.1177/0091270005276117] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ertapenem is approved for the treatment of community-acquired pneumonia (CAP), but its in vivo penetration into lung tissue (LT), epithelial lining fluid (ELF), and alveolar cells (AC) is unknown. Fifteen patients undergoing thoracotomy were treated with 1 g intravenously for perioperative prophylaxis. Bronchoalveolar lavage was performed 1, 3, and 5 hours after ertapenem infusion. Normal LT was sampled at the time of lung extraction. Blood was collected before and at different time points up to 24 hours after infusion. Mean concentrations of ertapenem in plasma, ELF, and AC were at 1.0 hour, 63.1, 4.06, 0.004 mg/L; at 3.0 hours, 39.7, 2.59, 0.003 mg/L; and at 5.0 hours, 27.2, 2.83, 0.007 mg/L. Mean (range) concentration in LT was 7.60 (2.5-19.4) mg/kg tissue 1.5 to 4.5 hours after infusion. In plasma, ertapenem exhibited a Cmax of 94.7 +/- 23.3 mg/L and an AUC(0-last) of 501.1 +/- 266.3 mg x h/L. These results, combined with the reported (MIC)90 of most CAP bacteria, support the previously observed clinical efficacy of ertapenem in the treatment of CAP.
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Affiliation(s)
- Olaf Burkhardt
- Department of Pulmonary and Critical Care Medicine, University Otto-von-Guericke, Magdeburg, Germany
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Dowell JA, Goldstein BP, Buckwalter M, Stogniew M, Damle B. Pharmacokinetic-Pharmacodynamic Modeling of Dalbavancin, a Novel Glycopeptide Antibiotic. J Clin Pharmacol 2013; 48:1063-8. [DOI: 10.1177/0091270008321273] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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López Cadenas C, Fernández Martínez N, Sierra Vega M, Diez Liébana MJ, Gonzalo Orden JM, Sahagún Prieto AM, García Vieitez JJ. Tissue distribution of enrofloxacin after intramammary or simulated systemic administration in isolated perfused sheep udders. Am J Vet Res 2012; 73:1728-34. [PMID: 23106457 DOI: 10.2460/ajvr.73.11.1728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the tissue distribution of enrofloxacin after intramammary or simulated systemic administration in isolated perfused sheep udders by measuring its concentration at various sample collection sites. SAMPLE 26 udders (obtained following euthanasia) from 26 healthy lactating sheep. PROCEDURES For each isolated udder, 1 mammary gland was perfused with warmed, gassed Tyrode solution. Enrofloxacin (1 g of enrofloxacin/5 g of ointment) was administered into the perfused gland via the intramammary route or systemically via the perfusion fluid (equivalent to a dose of 5 mg/kg). Samples of the perfusate were obtained every 30 minutes for 180 minutes; glandular tissue samples were obtained at 2, 4, 6, and 8 cm from the teat base after 180 minutes. The enrofloxacin content of the perfusate and tissue samples was analyzed via high-performance liquid chromatography with UV detection. RESULTS After intramammary administration, maximun perfusate enrofloxacin concentration was detected at 180 minutes and, at this time, mean tissue enrofloxacin concentration was detected and mean tissue enrofloxacin concentration was 123.80, 54.48, 36.72, and 26.42 μg/g of tissue at 2, 4, 6, and 8 cm from the teat base, respectively. Following systemic administration, perfusate enrofloxacin concentration decreased with time and, at 180 minutes, tissue enrofloxacin concentrations ranged from 40.38 to 35.58 μg/g of tissue. CONCLUSIONS AND CLINICAL RELEVANCE By 180 minutes after administration via the intramammary or systemic route in isolated perfused sheep mammary glands, mean tissue concentration of enrofloxacin was greater than the minimum inhibitory concentration required to inhibit growth of 90% of many common mastitis pathogens in sheep. Use of either route of administration (or in combination) appears suitable for the treatment of acute mastitis in sheep.
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Affiliation(s)
- Cristina López Cadenas
- Division of Pharmacology, Department of Biomedical Sciences, Institute of Biomedicine, University of León, Campus de Vegazana s/n, 24071 León, Spain.
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Abstract
INTRODUCTION Ceftazidime is a third-generation cephalosporin that has activity against Gram-negative bacilli, including Pseudomonas aeruginosa. The increasing prevalence of antimicrobial resistance and the limited number of antimicrobial agents in development have necessitated a review of the current status of treatments involving ceftazidime. AREAS COVERED This review focuses on studies examining the in vitro antibacterial activity of ceftazidime against recent clinical isolates and recent randomized controlled trials studying the clinical efficacy of ceftazidime, and discusses strategies for the optimal use of ceftazidime for treating respiratory tract infections, mainly hospital-acquired pneumonia (HAP). EXPERT OPINION Although ceftazidime remains an important option for HAP treatment, its role as an effective antimicrobial agent has been compromised by the sharp increase in resistance rates over the last decade, especially in P. aeruginosa and Acinetobacter baumannii. To maintain or improve the clinical use of ceftazidime in patients with severe HAP, it will be essential to gain a thorough understanding of local resistance patterns, reserve ceftazidime use when pathogens are susceptible to other third-generation cephalosporins, optimize ceftazidime therapy using prolonged or continuous infusion, determine the effectiveness of the combination of ceftazidime with inhibitors of broad-spectrum β-lactamases and role of combination therapy for P. aeruginosa infections, and judiciously use antimicrobial agents through individualization of antimicrobial therapy for HAP.
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Affiliation(s)
- Sang-Ho Choi
- University of Ulsan College of Medicine, Asan Medical Center, Department of Infectious Diseases, Seoul, Republic of Korea
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Takahashi N, Kobayashi M, Itagaki S, Hirano T, Takekuma Y, Sugawara M, Iseki K. [Basic investigation for classification of anticancer drugs by pharmacological effects]. YAKUGAKU ZASSHI 2012; 132:777-83. [PMID: 22687737 DOI: 10.1248/yakushi.132.777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The most effective drugs based on the type of cancer are chosen for chemotherapy. Tumor cells can be targeted at the DNA, RNA or protein level, and most of the classical anticancer drugs interact with tumor DNA in a time-dependent manner or a concentration-dependent manner. However, it has been unclear to date whether a combination therapy is carried out by using exact classification. Thus it is necessary to reclassify a great number of anticancer drugs. We propose a new classification system based on pharmacological effects of anticancer drugs. Classification of four anticancer drugs (cisplatin, carboplatin, paclitaxel and gemcitabine) was performed by the 3-(4,5-Dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay. The four anticancer drugs were grouped by IC50 values (inhibitory concentration, 50%) in a time-dependent manner and a concentration-dependent manner. The present approach may be combined to enhance the chemosensitivity, improve the dose of cytotoxic drugs and evaluate the effects of novel anticancer drugs.
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