Comparative assessment of the pharmacokinetics and pharmacodynamics of ciprofloxacin after single i.v. doses of 200 and 400mg

A Physiologically-Based Pharmacokinetic Model to Describe Ciprofloxacin Pharmacokinetics Over the Entire Span of Life

Background

Physiologically-based pharmacokinetic (PBPK) modeling has received growing interest as a useful tool for the assessment of drug pharmacokinetics by continuous knowledge integration.

Objective

The objective of this study was to build a ciprofloxacin PBPK model for intravenous and oral dosing based on a comprehensive literature review, and evaluate the predictive performance towards pediatric and geriatric patients.

Methods

The aim of this report was to establish confidence in simulations of the ciprofloxacin PBPK model along the development process to facilitate reliable predictions outside of the tested adult age range towards the extremes of ages. Therefore, mean data of 69 published clinical trials were identified and integrated into the model building, simulation and verification process. The predictive performance on both ends of the age scale was assessed using individual data of 258 subjects observed in own clinical trials.

Results

Ciprofloxacin model verification demonstrated no concentration-related bias and accurate simulations for the adult age range, with only 4.8% of the mean observed data points for intravenous administration and 12.1% for oral administration being outside the simulated twofold range. Predictions towards the extremes of ages for the area under the plasma concentration–time curve (AUC) and the maximum plasma concentration (C_max) over the entire span of life revealed a reliable estimation, with only two pediatric AUC observations outside the 90% prediction interval.

Conclusion

Overall, this ciprofloxacin PBPK modeling approach demonstrated the predictive power of a thoroughly informed middle-out approach towards age groups of interest to potentially support the decision-making process.

Electronic supplementary material

The online version of this article (10.1007/s40262-018-0661-6) contains supplementary material, which is available to authorized users.

Do high doses of quinolones decrease the emergence of antibacterial resistance? A systematic review of data from comparative clinical trials

OBJECTIVE

To evaluate whether the use of high doses of quinolones may reduce the development of antimicrobial resistance.

DATA SOURCES

Relevant studies were identified from PubMed and the Cochrane Central Register of Controlled Trials (until June 2006).

STUDY SELECTION AND DATA EXTRACTION

We performed a systematic review of the available data from comparative clinical studies reporting on the emergence of resistance when using different daily doses of quinolones.

DATA SYNTHESIS

Twelve studies reported comparative data regarding the emergence of antimicrobial resistance. Development of resistance occurred in patients of 5/12 studies included in the review, with no statistical difference between the compared arms.

CONCLUSIONS

Although data from laboratory studies are indicative of a benefit from using high daily doses of quinolones in order to minimize the emergence of antimicrobial resistance, the data from the reviewed trials are limited and can neither support nor reject this finding. However, it seems that if a true benefit exists this is rather small and regards mainly isolates with initially high minimum inhibitory concentrations. Further comparative clinical studies focusing on this issue are justified.