High-performance liquid chromatographic determination of ciprofloxacin in plasma samples

A new bioanalytical high-performance liquid chromatographic (HPLC) method for the determination of ciprofloxacin with norfloxacin as an internal standard was developed and validated for plasma samples. Norfloxacin is structural homologue of ciprofloxacin and exhibits similar retention properties. The quality of respective peak separation is strongly influenced by amphoteric character of ciprofloxacin and norfloxacin as well. In previously published HPLC methods on conventional C18 reversed-phase [F. Belal, A.A. Al-Majed, A.M. Al-Obaid, Talanta 50 (1999) 765-786; G. Carlucci, J. Chromatogr. A 812 (1998) 343-367], ion pair reagents were added into the mobile phase to suppress peak tailing. In comparison with endcapped and high purity silica reversed-phase sorbent (Purospher RP-18e, Merck), which yielded symmetrical peaks, separation efficiency was further enhanced in our method. Gradient elution mode using acetonitrile and phosphate buffer pH 3 on the pentafluorophenylpropyl stationary phase (250-4.6 mm Discovery HS F5, 5 microm, Supelco) was carried out. The resolution of 4.1 for ciprofloxacin-norfloxacin peaks was achieved. Sample preparation by SPE C18 (Supelclean) with recovery 72% was performed. Fluorescence detection with lambda(excit)=280 nm, lambda(emis)=446 nm was used. After the validation, the bioanalytical HPLC method was applied to pharmacokinetic studies.

[24-hour ambulatory blood pressure monitoring]

24-hour ambulatory blood pressure monitoring (ABPM) is the exact, fully automatic and noninvasive method for evaluation of the 24-hour hemodynamic profile of the subject by multiple and regular blood pressure and heart rate measurement. In comparison with causal blood pressure measurement, ABPM allows the definition of daytime and nighttime blood pressure averages, diurnal changes of blood pressure, localization of periods of the most frequent appearance of hypertensive values, specification of hypertensive load, percent time elevation and diagnosing of white coat phenomenon. The use of all mentioned findings leads to the improvement of blood pressure control in patients with resistant hypertension, polymorbidity, helps to analyze paroxysmal hypertension, verify diagnosis of the hypertension in patients with borderline or high normal blood pressure. The final profit is the reduction of the target organ damage and reduction of cardiovascular morbidity and mortality. Definite diagnosis of the white coat phenomenon markedly decreases consumption of the antihypertensive drugs. In addition, this method enables better evaluation of hypotensive syndromes and is very helpful in the investigation of physiology of blood pressure regulation, biorhythms and in pharmacodynamical studies of the new antihypertensives.

Improvement in exercise tolerance and symptoms of congestive heart failure during treatment with candesartan cilexetil. Symptom, Tolerability, Response to Exercise Trial of Candesartan Cilexetil in Heart Failure (STRETCH) Investigators

BACKGROUND

The renin-angiotensin system plays an important part in the pathogenesis of congestive heart failure (CHF). This study evaluated the effect of an angiotensin II type 1 receptor antagonist on exercise tolerance and symptoms of CHF.

METHODS AND RESULTS

In this multicenter, double-blind, parallel-group study, 844 patients with CHF were randomized to 12 weeks' treatment with placebo (n=211) or candesartan cilexetil 4 mg (n=208), 8 mg (n=212), or 16 mg (n=213) after a 4-week placebo run-in period. Changes in exercise time, Dyspnea Fatigue Index score, NYHA functional class, and cardiothoracic ratio were determined. Candesartan cilexetil produced a dose-related improvement in exercise time. For the intention-to-treat population, the increase produced by candesartan cilexetil 16 mg was significantly greater than that produced by placebo (47.2 versus 30.8 seconds, P=0.0463). All doses of candesartan cilexetil significantly improved the Dyspnea Fatigue Index score relative to placebo. NYHA class improved more frequently in the candesartan cilexetil groups; the differences relative to placebo were not significant. The decrease in cardiothoracic ratio with candesartan 4 to 16 mg was small but statistically significant compared with placebo (all P<0.05). In all candesartan cilexetil groups, plasma renin activity and angiotensin II levels increased from baseline and aldosterone levels decreased in the 8- and 16-mg treatment groups. Candesartan cilexetil was well tolerated at all doses.

CONCLUSIONS

In summary, treatment with candesartan cilexetil demonstrated significant improvements in exercise tolerance, cardiothoracic ratio, and symptoms and signs of CHF and was well tolerated.

[Lactic acidosis as a complication of treatment with biguanides]

In the course of two and a half years we treated six diabetic women on account of lactate acidosis during concurrent biguanide administration. The patients were given an average dose of 290 mg Buformin/24 hours. Their mean age was 71 years. Three patients died, i.e. the mortality was 50%. All patients reported nausea, vomiting and abdominal pain. Two suffered from diarrhoea. Two patients suffered from renal failure and one from cardiac weakness. One patient was in coma. The mean lactate concentration was 14.7 mmol/l, pH on admission was 6.84. The patients were given on average 550 mmol bicarbonate. In two instances bicarbonate dialysis was used. The authors discuss the pathophysiology, clinical aspects and importance for treatment and prevention of lactate acidosis during biguanide treatment.

[Acute ischemia of the extremities in the puerperal period]

The development of pharmacotherapy implies great advantages for patients, at the same time it is, however, also the source of more frequent side-effects of drugs, which may result also from mutual interactions of commonly used drugs. The authors describe a case of ergotism which developed as a result of drug interaction between the ergot uterotonic Cornutamine and the marcolid antibiotic Erythromycin. This interaction could have seriously damaged the health of the young woman. At the same time the authors remind of the clinical picture of ergotism and the possible way of its treatment. In the Czechoslovak literature no report on this interaction was published during the past three years.