Pharmacokinetic and Pharmacodynamic Drug-Drug Interactions: Research Methods and Applications

Because of the high research and development cost of new drugs, the long development process of new drugs, and the high failure rate at later stages, combining past drugs has gradually become a more economical and attractive alternative. However, the ensuing problem of drug-drug interactions (DDIs) urgently need to be solved, and combination has attracted a lot of attention from pharmaceutical researchers. At present, DDI is often evaluated and investigated from two perspectives: pharmacodynamics and pharmacokinetics. However, in some special cases, DDI cannot be accurately evaluated from a single perspective. Therefore, this review describes and compares the current DDI evaluation methods based on two aspects: pharmacokinetic interaction and pharmacodynamic interaction. The methods summarized in this paper mainly include probe drug cocktail methods, liver microsome and hepatocyte models, static models, physiologically based pharmacokinetic models, machine learning models, in vivo comparative efficacy studies, and in vitro static and dynamic tests. This review aims to serve as a useful guide for interested researchers to promote more scientific accuracy and clinical practical use of DDI studies.

In vitro antifungal susceptibility of Fusarium species and Aspergillus fumigatus cultured from eleven horses with fungal keratitis

PURPOSE

To examine the relationship between Minimum Inhibitory Concentration (MICs) and response to therapy of 6 Fusarium spp. and 5 Aspergillus fumigatus isolated from equine ulcerative keratitis cases.

PROCEDURE

Fungi were identified by morphology and Internal Transcribed Spacer (ITS) polymerase chain reaction (PCR) with sequencing and evaluated at the University of Texas Fungal Testing Laboratory for susceptibility to three azole antifungals (miconazole, voriconazole, posaconazole), natamycin, and two echinocandins (anidulafungin, caspofungin). A Mann-Whitney rank sum test was used for the comparison of time to heal between infections of different fungal genera and in vitro susceptibility to the drug administered.

RESULTS

Fusarium spp. were resistant to azole antifungals in 6/6 cases (100%). Fusarium spp. were susceptible to echinocandins and natamycin in all cases. A. fumigatus was resistant to anidulafungin in 1/5 cases (20%) and posaconazole in 1/5 cases (20%) The remainder of A. fumigatus isolates were susceptible to all antifungal agents tested. Fusarium isolates were treated with antifungals to which they were not susceptible; however, all cases of A. fumigatus were treated with antifungals to which they were susceptible. All Fusarium cases and A. fumigatus cases experienced clinical resolution, regardless of surgical intervention. There was no statistical correlation between fungal genus and time to heal (p < .082).

CONCLUSIONS

The in vitro susceptibility indicated that all cases of Fusarium spp. were resistant to azole antifungal drugs which were used as treatment. Clinical outcomes, however, showed that all cases healed despite resistance to antifungals.

Changes in antimicrobial resistance patterns of ocular surface bacteria isolated from horses in the UK: An eight-year surveillance study (2012-2019)

PURPOSE

To identify temporal changes in antimicrobial resistance of ocular surface bacteria isolated from clinically symptomatic equine eyes in the South West of the UK.

STUDY DESIGN

Retrospective.

METHODS

Clinical and laboratory records of horses treated for suspected bacterial ocular surface disease (ulcerative and non-ulcerative) at a single facility between January 2011 and December 2019 were reviewed. Cases were included if they underwent ocular surface sampling, aerobic bacterial culture, and antimicrobial susceptibility testing. Cases were split into two time periods based on when sampling occurred: "early" (2012-2015) and "late" (2016-2019) to enable identification of temporal trends in resistance to chloramphenicol, gentamicin, fusidic acid, neomycin, cloxacillin, ofloxacin, and polymyxin B.

RESULTS

A total of 125 samples from 110 horses were included in analyses. Culture-positive isolates were identified in 76/110 (60.8%) samples. Principal isolates included Staphylococci spp. (n = 45; 64.3%), Streptococci spp. (n = 14; 20%), and Enterobacter spp. (n = 11; 15.7%). There was a significant increase in resistance to chloramphenicol over time (P = .007) and a decrease in resistance to ofloxacin that approached significance (P = .059). Chloramphenicol (100%) and gentamicin (85.7%) had the highest overall in-vitro efficacy during the early and late periods, respectively. There was no significant difference in the type of bacteria isolated across the two time periods.

CONCLUSIONS

These results suggest a potential increase in resistance to chloramphenicol among bacteria isolated from the ocular surface of horses in the South West UK, reinforcing the value of surveillance to guide the empirical use of antimicrobials.

Antifungal Therapy in Equine Ocular Mycotic Infections

Fungi are clinically important causes of ocular infections in the horse. Keratomycosis is the most common; however, a diverse range of mycotic infections, affecting numerous ocular tissues, may be encountered. Many equine mycoses are diagnostic and therapeutic challenges. Prompt and appropriate treatment is essential to minimize morbidity and reduce the likelihood of vision loss. Knowledge of the characteristics and properties of equine ophthalmology antifungal medications is essential to selecting an optimal treatment strategy, including selection of appropriate medication and effective administration route. Newer delivery methods and devices are available and can contribute to an improved outcome in select situations.

Pharmacokinetic analysis of topical tobramycin in equine tears by automated immunoassay

Background

Ophthalmic antibiotic therapy in large animals is often used empirically because of the lack of pharmacokinetics studies. The purpose of the study was to determine the pharmacokinetics of topical tobramycin 0.3% ophthalmic solution in the tears of normal horses using an automated immunoassay analysis.

Results

The mean tobramycin concentrations in the tears at 5, 10, 15, 30 minutes and 1, 2, 4, 6 hours after administration were 759 (±414), 489 (±237), 346 (±227), 147 (±264), 27.6 (±28.4), 14.8 (±66.6), 6.7 (±18.6), and 23.4 (±73.4) mg/L. Mean tobramycin concentration was maintained above the MIC₉₀ for commonly isolated bacteria for 68.5 min.

Conclusion

A single dose of topical tobramycin resulted in therapeutic concentrations of tobramycin in the tears for 1 h after administration. Therapeutic levels of tobramycin remained in equine tears 6 times longer than was reported in rabbit tears.

Establishing a reproducible method for the culture of primary equine corneal cells

OBJECTIVE

To establish a reproducible method for the culture of primary equine corneal epithelial cells, keratocytes, and endothelial cells and to describe each cell's morphologic characteristics, immunocytochemical staining properties and conditions required for cryopreservation.

PROCEDURES

Corneas from eight horses recently euthanized for reasons unrelated to this study were collected aseptically and enzymatically separated into three individual layers for cell isolation. The cells were plated, grown in culture, and continued for several passages. Each cell type was characterized by morphology and immunocytochemical staining.

RESULTS

All three equine corneal cell types were successfully grown in culture. Cultured corneal endothelial cells were large, hexagonal cells with a moderate growth rate. Keratocytes were small, spindloid cells that grew rapidly. Epithelial cells had heterogeneous morphology and grew slowly. The endothelial cells and keratocytes stained positive for vimentin and were morphologically distinguishable from one another. The epithelial cells stained positive for cytokeratin. Keratocytes and endothelial cells were able to be cryopreserved and recovered. The cryopreserved cells maintained their morphological and immunocytochemical features after cryopreservation and recovery.

DISCUSSION

This work establishes reproducible methods for isolation and culture of equine corneal keratocytes and endothelial cells. Cell morphology and cytoskeletal element expression for equine corneal epithelial cells, keratocytes, and endothelial cells are also described. This has not previously been reported for equine corneal cells. This report also demonstrates the ability to preserve equine keratocytes and endothelial cells for extended periods of time and utilize them long after the primary-cell collection, a feature that has not been reported for veterinary corneal cell culture.