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Rodríguez-Báez AS, Jiménez-Meseguer M, Milán-Segovia RDC, Romano-Moreno S, Barcia E, Ortiz-Álvarez A, García-Díaz B, Medellín-Garibay SE. Comparison of pharmacokinetics software for therapeutic drug monitoring of piperacillin in patients with severe infections. Eur J Hosp Pharm 2024; 31:201-206. [PMID: 36126967 DOI: 10.1136/ejhpharm-2022-003367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 09/05/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate the predictive performance of population pharmacokinetic models for piperacillin (PIP) available in the software MwPharm, TDMx and ID-ODs for initial dosing selection and therapeutic drug monitoring (TDM) purposes. METHODS This is a prospective observational study in adult patients with severe infections receiving PIP treatment. Plasma concentrations were quantified by ultra-high performance liquid chromatography coupled to tandem mass spectrometry. The differences between predicted and observed PIP concentrations were evaluated with Bland-Altman plots; additionally, the relative and absolute bias and precision of the models were determined. RESULTS A total of 145 PIP plasma concentrations from 42 patients were analysed. For population prediction, MwPharm showed the best predictive performance with a mean relative difference of 34.68% (95% CI -197% to 266%) and a root mean square error (RMSE) of 60.42 µg/mL; meanwhile TDMx and ID-ODs under-predicted PIP concentrations. For individual prediction, the TDMx model was found to be the most precise with a mean relative difference of 7.61% (95% CI -57.63 to 72.86%), and RMSE of 17.86 µg/mL. CONCLUSION Current software for TDM is a valuable tool, but it may also include different population pharmacokinetic models in patients with severe infections, and should be evaluated before performing a model-based TDM in clinical practice. Considering the heterogeneous characteristics of patients with severe infections, this study demonstrates the need for therapy personalisation for PIP to improve pharmacokinetic/pharmacodynamic target attainment.
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Affiliation(s)
| | | | | | - Silvia Romano-Moreno
- Facultad de Ciencias Químicas, Universidad Autónoma de San Luis Potosí, San Luis Potosi, SLP, Mexico
| | - Emilia Barcia
- Facultad de Farmacia, Universidad Complutense de Madrid, Madrid, Comunidad de Madrid, Spain
| | | | - Benito García-Díaz
- Servicio de Farmacia, Hospital Universitario Severo Ochoa, Leganés, Spain
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Liu H, Yang H, Guo X, Bai Y, SiRi G. Clinical benefits of therapeutic drug monitoring of vancomycin therapy in patients with postoperative intracerebral hemorrhage: a retrospective cohort study. Eur J Hosp Pharm 2024; 31:240-246. [PMID: 36207132 DOI: 10.1136/ejhpharm-2022-003455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/21/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE The objective of this study was to investigate the clinical efficacy and safety of conducting therapeutic drug monitoring (TDM) of vancomycin in patients with postoperative intracerebral haemorrhage. METHODS We conducted a retrospective analysis of 435 patients who experienced postoperative cerebral haemorrhage and were treated with vancomycin in the Department of Neurosurgery of Inner Mongolia Autonomous Region People's Hospital from January 2017 to December 2021. Patients were then matched using the propensity score matching method in a ratio of 1:1. Ninety-two pairs of cases were successfully matched, and the data before and after performing vancomycin TDM were analysed. RESULTS After PSM, the baseline data of the two groups were balanced. There were no significant differences in the 14-day mortality and length of hospital stay (p>0.05) between the two groups. Compared with the non-TDM group, the TDM group had a higher proportion of patients with normal white blood cells (83.7% vs 56.5%, p=0.000), neutrophil count (57.6% vs 25.0%, p=0.000) and attaining desirable reductions of 80% in procalcitonin (65.2% vs 10.9%, p=0.000) and C-reactive protein (78.3% vs 41.3%, p=0.000) levels. At US$15.82 per additional TDM, TDM significantly promoted patient outcomes, as seen in improvements in the proportion of patients attaining desirable levels of white blood cells, neutrophil count, procalcitonin and C-reactive protein. CONCLUSIONS Vancomycin TDM is a safe and effective approach for the treatment of patients with postoperative intracerebral haemorrhage. The empirical use of TDM of vancomycin significantly improved normal values of white blood cells and neutrophil count, achieved desirable reductions of 80% in procalcitonin and C-reactive protein, and reduced nephrotoxicity in patients with postoperative intracerebral haemorrhage.
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Affiliation(s)
- Huanhuan Liu
- Department of Pharmacy, Inner Mongolia Autonomous Region People's Hospital, Hohhot, Inner Mongolia, China
- Department of Pharmacy, Baotou Medical College, Baotou, Inner Mongolia, China
| | - Hongxin Yang
- Department of Pharmacy, Inner Mongolia Autonomous Region People's Hospital, Hohhot, Inner Mongolia, China
| | - Xiaobin Guo
- Department of Pharmacy, Inner Mongolia Autonomous Region People's Hospital, Hohhot, Inner Mongolia, China
| | - Yingchun Bai
- Department of Pharmacy, Baotou Medical College, Baotou, Inner Mongolia, China
| | - Guleng SiRi
- Department of Pharmacy, Inner Mongolia Autonomous Region People's Hospital, Hohhot, Inner Mongolia, China
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Garg K, Bhandari RK, Shafiq N, Jain S, Jaswal S, Chawla D, Mallayasamy S, Khurana S, Batcha JSD. Population pharmacokinetics of ciprofloxacin in newborns with early onset neonatal sepsis and suspected meningitis. Pediatr Res 2024; 95:1273-1278. [PMID: 38062257 DOI: 10.1038/s41390-023-02941-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 10/20/2023] [Accepted: 11/14/2023] [Indexed: 04/24/2024]
Abstract
BACKGROUND Neonatal Sepsis accounts for significant proportion of neonatal mortality globally. Ciprofloxacin can be used as an effective antimicrobial against common causative agents of neonatal sepsis. However, there is only limited information about its pharmacokinetic distribution in plasma and Cerebrospinal fluid (CSF) of neonates. METHODS Plasma and CSF samples were taken using a sparse sampling technique from neonates who received at least one dose of intravenous ciprofloxacin. Ciprofloxacin levels were analysed using high-performance liquid chromatography (HPLC). Population pharmacokinetic analysis was conducted using a non-linear mixed-effects modelling using Pumas® (Pharmaceutical Modelling and Simulation) package (Version 2.0). RESULTS 53 neonates were enroled in the study of whom; 9 (17%) had meningitis. The median concentration of ciprofloxacin in CSF was 1.4 (0.94-2.06) ug/ml and plasma was 2.94 (1.8-5.0) ug/ml. A one-compartment model with first-order elimination fitted the data. Body weight was found to be a significant covariate on volume of distribution (Vd). Simulations based on the final model suggest that dose of 10 mg/kg, intravenous b.d may not be able to achieve the desirable indices. CONCLUSIONS One compartment model with weight as a covariate explained the available data. Further studies with modified sampling strategy, larger sample size and variable dose levels are needed.
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Affiliation(s)
- Kunal Garg
- Department of Neonatology, Government Medical College and Hospital, Chandigarh, India
| | - Ritika Kondel Bhandari
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nusrat Shafiq
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Suksham Jain
- Department of Neonatology, Government Medical College and Hospital, Chandigarh, India
| | - Shivani Jaswal
- Department of Biochemistry, Government Medical College and Hospital, Chandigarh, India
| | - Deepak Chawla
- Department of Neonatology, Government Medical College and Hospital, Chandigarh, India
| | - Surulivelrajan Mallayasamy
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Supreet Khurana
- Department of Neonatology, Government Medical College and Hospital, Chandigarh, India.
| | - Jaya Shree Dilli Batcha
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Wang F, Zhou M, Wang W, Zhu Z, Yan Y. Age-associated augmented renal clearance and low BMI trigger suboptimal vancomycin trough concentrations in children with haematologic diseases: data of 1453 paediatric patients from 2017 to 2022. BMC Pediatr 2023; 23:528. [PMID: 37880633 PMCID: PMC10601245 DOI: 10.1186/s12887-023-04288-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/05/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND It is usually difficult for the trough concentration of vancomycin to reach the recommended lower limit of 10 mg/L per the label dose in the paediatric population. Moreover, children with haematologic diseases who suffer from neutropenia are more likely to have lower exposure of vancomycin, and the risk factors have been poorly explored. METHOD We reviewed and analysed the initial trough concentration of vancomycin and synchronous cytometry and biochemical parameters in the blood of 1453 paediatric patients with haematologic diseases over a 6 year period, from 2017 to 2022. RESULTS Forty-five percent of the enrolled children had vancomycin trough concentrations below 5 mg/L after receiving a dose of 40 mg/kg/day, and the multiple regression showed that age (OR = 0.881, 95% CI 0.855 to 0.909, P < 0.001), BMI (OR = 0.941, 95% CI 0.904 to 0.980, P = 0.003) and the glomerular filtration rate (OR = 1.006, 95% CI 1.004 to 1.008, P < 0.001) were independent risk factors. A total of 79.7% of the children experienced augmented renal clearance, which was closely correlated to age-associated levels of serum creatinine. The vancomycin trough concentration was higher in children with aplastic anaemia than in those with other haematologic diseases due to a higher BMI and a lower glomerular filtration rate. CONCLUSION Age-associated augmented renal clearance and low BMI values contributed to suboptimal trough concentrations of vancomycin in children with haematologic diseases, and the effects of long-term use of cyclosporine and glucocorticoids need to be taken into account.
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Affiliation(s)
- Fengjiao Wang
- Department of Pharmacy, Children's Hospital of Soochow University, 92# Street Zhongnan, Suzhou, 215025, Jiangsu, China
| | - Mi Zhou
- Department of Pharmacy, Children's Hospital of Soochow University, 92# Street Zhongnan, Suzhou, 215025, Jiangsu, China
| | - Wenjuan Wang
- Department of Pharmacy, Children's Hospital of Soochow University, 92# Street Zhongnan, Suzhou, 215025, Jiangsu, China
| | - Zengyan Zhu
- Department of Pharmacy, Children's Hospital of Soochow University, 92# Street Zhongnan, Suzhou, 215025, Jiangsu, China.
| | - Yinghui Yan
- Department of Pharmacy, Children's Hospital of Soochow University, 92# Street Zhongnan, Suzhou, 215025, Jiangsu, China.
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Nguyen T, Spriet I, Quintens C, Thi Thanh Ha P, Van Schepdael A, Adams E. Simultaneous determination of ceftazidime and pyridine in human plasma by LC-UV. J Pharm Biomed Anal 2023; 228:115319. [PMID: 36858005 DOI: 10.1016/j.jpba.2023.115319] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/03/2023] [Accepted: 02/24/2023] [Indexed: 02/27/2023]
Abstract
A sensitive, accurate and precise liquid chromatography (LC) method for the simultaneous determination of ceftazidime and pyridine in human plasma has been developed and validated. Acetonitrile (ACN) was employed to precipitate the proteins in the plasma samples. Chromatographic separation was performed with a Kinetex® C18 (150 mm × 3 mm, 2.6 µm) column with gradient elution. Ammonium formate 20 mM and ACN were mixed in a ratio of 98:2 (v/v) for mobile phase A and 85:15 (v/v) for mobile phase B. Both were adjusted to pH 4.5 with formic acid. The flow rate was 0.4 mL/min. UV detection was performed at 254 nm. Calibration curves were linear in the range from 0.3 to 225 μg/mL for ceftazidime and from 0.2 to 10 μg/mL for pyridine with correlation coefficients ≥ 0.999. Within- and between-run precision and accuracy were satisfactory with coefficients of variation (CV) ≤ 8.0% and deviations ≤ 7.0%, respectively. The method fulfilled all validation criteria prescribed by the European Medicines Agency guidelines. Next, it has been used successfully to analyze plasma samples of patients who received ceftazidime under intermittent and continuous administration. With intermittent administration, the concentration of the antibiotics reached a peak and then dropped quickly, which may be below the minimal inhibitory concentration (MIC). With continuous administration, the concentration of the antibiotics remained stable over 24 h, certainly above the MIC. Although the same tendency in ceftazidime concentration changes over time was observed, a difference in concentration amongst the patients was noticeable. The concentration of pyridine in plasma was negligible.
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Affiliation(s)
- Tam Nguyen
- KU Leuven, Department of Pharmaceutical and Pharmacological Sciences, Pharmaceutical Analysis, Herestraat 49, O&N2, PB 923, 3000 Leuven, Belgium
| | - Isabel Spriet
- Hospital Pharmacy Department, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Charlotte Quintens
- Hospital Pharmacy Department, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Pham Thi Thanh Ha
- Hanoi University of Pharmacy, Analytical Chemistry and Toxicology, 13-15 Le Thanh Tong, Hoan Kiem, Hanoi, Viet Nam
| | - Ann Van Schepdael
- KU Leuven, Department of Pharmaceutical and Pharmacological Sciences, Pharmaceutical Analysis, Herestraat 49, O&N2, PB 923, 3000 Leuven, Belgium
| | - Erwin Adams
- KU Leuven, Department of Pharmaceutical and Pharmacological Sciences, Pharmaceutical Analysis, Herestraat 49, O&N2, PB 923, 3000 Leuven, Belgium.
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Attia TZ, Abdelmajed MA, Omar MA, El-Din KMB. Selective Spectrofluorimetric Protocol for Determination of Commonly Used Gram-negative Bactericidal Drug in Combined Pharmaceutical Dosage Forms and Human Plasma. J Fluoresc 2022; 32:603-612. [PMID: 35013853 DOI: 10.1007/s10895-021-02862-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022]
Abstract
Gram-negative bacteria cause infections such as skin infection, meningitis, and pneumonia in human being. Gram-negative bacteria are highly resistant to most availaible bactericidal drugs. One of the most commonly used Gram-negative bactericidal drug is Polymyxin B sulfate (PMS). In addition, it is used in cases of highly resistant Gram-negative bacterial infections. The widespread of PMS necessitate the development of an exceedingly sensitive and selective fluorimetric assay for its determination in pure form, different pharmaceutical dosage forms, and human plasma. The presented method is used to determine PMS in their dosage form (vials) and combined pharmaceutical formulations (skin and eye ointments) with a high degree of accuracy and selectivity. The described procedure relies on the structure of a derivative of a high degree of fluorescence called dihydropyridine, via the condensation of the amino moiety of PMS with two equivalents of acetylacetone in the presence of formaldehyde and Teorell buffer (pH = 3). The fluorescent product was measured at 471 nm (λex = 402 nm). The linearity ranged from 100-3000 ng mL-1 of PMS with an excellent r2 of 0.9998. LOD and LOQ were 27.16 ng mL-1 and 82.30 ng mL-1, respectively. Owing to the developed method's high selectivity, it was successfully utilized for assay of PMS, in the ointment, in the presence of oxytetracycline as an active ingredient. Furthermore, the procedure applied for the estimation of parenteral PMS in human plasma with very good mean recovery 97.42 ± 1.46.
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Affiliation(s)
- Tamer Z Attia
- Analytical Chemistry Department, Faculty of Pharmacy, Minia University, Minia, Egypt.
| | - Mahmoud A Abdelmajed
- Analytical Chemistry Department, Faculty of Pharmacy, Deraya University, New Minia, Egypt
| | - Mahmoud A Omar
- Analytical Chemistry Department, Faculty of Pharmacy, Minia University, Minia, Egypt
- Department of Pharmacognosy and Pharmaceutical Chemistry, College of Pharmacy, Taibah University, Medinah, Saudi Arabia
| | - Khalid M Badr El-Din
- Analytical Chemistry Department, Faculty of Pharmacy, Minia University, Minia, Egypt
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Akunne OO, Mugabo P, Argent AC. Pharmacokinetics of Vancomycin in Critically Ill Children: A Systematic Review. Eur J Drug Metab Pharmacokinet 2021; 47:31-48. [PMID: 34750740 PMCID: PMC8574943 DOI: 10.1007/s13318-021-00730-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2021] [Indexed: 11/26/2022]
Abstract
Background and Objective Vancomycin is often used in the ICU for the treatment of Gram-positive bacterial infection. In critically ill children, there are pathophysiologic changes that affect the pharmacokinetics of vancomycin. A systematic review of vancomycin pharmacokinetics and pharmacodynamics in critically ill children was performed. Methods Pharmacokinetic studies of vancomycin in critically ill children published up to May 2021 were included in the review provided they included children aged > 1 month. Studies including neonates were excluded. A search was performed using the PubMed, Scopus, and Google Scholar databases. The Risk of Bias Assessment Tool for Systematic Reviews (ROBIS) was used to check for quality and reduce bias. Data on study characteristics, patient demographics, clinical parameters, pharmacokinetic parameters, outcomes, and study limitations were collected. Results Thirteen studies were included in this review. A wide variety of dosing and sampling strategies were used in the studies. Methods for estimating vancomycin pharmacokinetics, especially the area under the curve over 24 h, varied. Vancomycin doses of 20–60 mg/kg were given daily. This resulted in high variability in pharmacokinetic parameters. Vancomycin trough level was less than 15 μg/mL in most of the studies. Vancomycin clearance ranged from 0.05 to 0.38 L/h/kg. Volume of distribution ranged from 0.1 to 1.16 L/kg. Half-life was between 2.4 and 23.6 h. Patients in the study receiving continuous vancomycin infusion had AUC24 < 400 µg·h/mL. Conclusion There is large variability in the pharmacokinetics of vancomycin among critically ill patients. Studies to assess the factors responsible for this variability in vancomycin pharmacokinetics are needed.
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Affiliation(s)
- Onyinye Onyeka Akunne
- Discipline of Pharmacology, School of Pharmacy, University of the Western Cape, Bellville, Cape Town, 7535 South Africa
| | - Pierre Mugabo
- Discipline of Pharmacology, School of Pharmacy, University of the Western Cape, Bellville, Cape Town, 7535 South Africa
| | - Andrew C Argent
- Paediatrics and Child Health, University of Cape Town, Rondebosch, Cape Town, 7700 South Africa
- Paediatric Intensive Care Unit, Red Cross War Memorial Children Hospital, Rondebosch, Cape Town, 7700 South Africa
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Akhtar M, Gul S, Shamim S, Siddiqui R. Simultaneous determination of moxifloxacin with NSAIDs in API, dosage and serum by reverse phase high-performance liquid chromatography: Application to in vitro drug interactions. Pak J Pharm Sci 2021; 34:2091-2099. [PMID: 35034869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Experimental design is a significant tool for optimization and validation for the development of HPLC methods to determine API in both human serum and pharmaceutical formulations. In this study, RP-HPLC method is developed and validated for the simultaneous determination of moxifloxacin and NSAIDs. In this experiment, Purospher STAR C18 column with optimum assay conditions (10:90, v/v, water: methanol, pH 2.75) used as mobile phase having flow rate of 1.5mL min-1 and screened at 240 nm. The experimental results exhibit reliability through accuracy (98-102%), precision (0.011-1.85%) and linearity (R2>0.999) in range of 0.15-40μgmL-1. The LOD and LOQ limits for moxifloxacin and NSAIDs are found to be 0.015 and 0.046 μgmL-1 respectively. The significant outcomes conclude that the developed method for assay is effectively suitable to human serum and pharmaceutical formulations and there is no interference from excipients of tablets and serum. The proposed method is useful for drug-interaction and investigation of moxifloxacin with NSAIDs.
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Affiliation(s)
- Mahwish Akhtar
- Department of Pharmaceutical Chemistry, Dow College of Pharmacy, Faculty of Pharmaceutical Sciences, Dow University of Health Sciences, Karachi, Pakistan
| | - Somia Gul
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Jinnah University for Women, Karachi, Pakistan
| | - Sana Shamim
- Department of Pharmaceutical Chemistry, Dow College of Pharmacy, Faculty of Pharmaceutical Sciences, Dow University of Health Sciences, Karachi, Pakistan
| | - Rubina Siddiqui
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, Pakistan
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Isoda K, Nakade J, Suga Y, Fujita A, Shimada T, Sai Y. Initial Serum C-reactive Protein Level as a Predictor of Increasing Serum Vancomycin Concentration During Treatment. Ther Drug Monit 2021; 43:652-656. [PMID: 33538550 DOI: 10.1097/ftd.0000000000000870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/05/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Vancomycin has a narrow therapeutic window, and an increase in its serum concentration-to-dose ratio during treatment can cause renal toxicity. Therefore, this study was aimed at finding a marker to identify patients at risk of increasing serum vancomycin during treatment. METHODS This was a retrospective cohort study of patients treated with vancomycin at Kanazawa University Hospital, Japan, from April 2012 to May 2015. Spearman correlation coefficients were calculated to determine the correlations between changes in vancomycin concentration-to-dose ratio and initial values or changes in laboratory data and other parameters. In addition, a multiple regression analysis was conducted. RESULTS One hundred ninety-nine patients for whom 2 or more points of data on therapeutic drug monitoring (TDM) of intravenous vancomycin treatment were available and did not undergo dialysis were included in the study. Changes in vancomycin concentration-to-dose ratio were associated with C-reactive protein (CRP) and sodium (Na) levels on the initial day of TDM and with changes in white blood cell count, Na, and estimated glomerular filtration rates (eGFRs). Multiple regression analysis helped identify CRP and Na levels on the initial day of TDM and change in eGFR as independent influencing variables. CONCLUSIONS A high serum CRP level on the initial day of TDM is an independent predictor of increasing vancomycin concentration-to-dose ratio in patients receiving intravenous vancomycin treatment, even if eGFR remains unchanged.
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Affiliation(s)
- Kazuya Isoda
- Department of Clinical Pharmacokinetics, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
- Department of Hospital Pharmacy, University Hospital, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Junya Nakade
- Department of Hospital Pharmacy, University Hospital, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Yukio Suga
- Department of Clinical Drug Informatics, Faculty of Pharmacy, Institute of Medical, Pharmaceutical and Health Science, Kanazawa University, Kanazawa, Ishikawa, Japan; and
| | - Arimi Fujita
- Department of Clinical Pharmacokinetics, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
- Department of Hospital Pharmacy, University Hospital, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Tsutomu Shimada
- Department of Clinical Pharmacokinetics, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
- Department of Hospital Pharmacy, University Hospital, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Yoshimichi Sai
- Department of Clinical Pharmacokinetics, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
- Department of Hospital Pharmacy, University Hospital, Kanazawa University, Kanazawa, Ishikawa, Japan
- AI Hospital/Macro Signal Dynamics Research and Development Center, Institute of Medical, Pharmaceutical and Health Science, Kanazawa University, Kanazawa, Ishikawa, Japan
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Mitton B, Paruk F, Gous A, Chausse J, Milne M, Becker P, Said M. Investigating the need for therapeutic drug monitoring of imipenem in critically ill patients: Are we getting it right? S Afr Med J 2021; 111:903-909. [PMID: 34949257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND The drug levels and clearances of imipenem in critically ill patients are not comprehensively described in current literature, yet it is vital that adequate levels be achieved for therapeutic success. OBJECTIVES To determine the proportion of critically ill patients treated with imipenem/cilastatin with sub-therapeutic imipenem plasma levels, and to compare the clinical outcomes of those patients with therapeutic levels with those who had sub-therapeutic levels. METHODS Trough imipenem plasma levels of 68 critically ill patients from a surgical intensive care unit were measured using a validated high-performance liquid chromatography method. Imipenem trough levels were compared with the minimum inhibitory concentration (MIC) of the causative bacterial agents, based on a target value of 100% time above MIC (¦T >MIC). RESULTS The proportion of participants with sub-therapeutic imipenem levels was 22% (95% confidence interval (CI) 13% - 34%). The 14- and 28-day mortality rates in the sub-therapeutic group were 33% and 40%, respectively, compared with 19% (p=0.293) and 26% (p=0.346), respectively, in the therapeutic group. Sub-therapeutic imipenem plasma levels are associated with adjusted hazard ratio of 1.47 (95% CI 0.55 - 3.91). CONCLUSIONS The lower proportion of critically ill patients with sub-therapeutic imipenem plasma levels in this study compared with previous studies may be attributed to the practice of higher dosages and the administration method of extended infusions of imipenem/cilastatin in our setting. The results demonstrate a trend of higher mortality in patients with sub-therapeutic imipenem levels, although the results were not statistically significant at this sample size.
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Affiliation(s)
- B Mitton
- Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, South Africa; Tshwane Academic Division, National Health Laboratory Service, Pretoria, South Africa.
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Chan PL, McFadyen L, Quaye A, Leister‐Tebbe H, Hendrick VM, Hammond J, Raber S. The use of extrapolation based on modeling and simulation to support high-dose regimens of ceftaroline fosamil in pediatric patients with complicated skin and soft-tissue infections. CPT Pharmacometrics Syst Pharmacol 2021; 10:551-563. [PMID: 33687148 PMCID: PMC8213416 DOI: 10.1002/psp4.12608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/29/2021] [Accepted: 01/31/2021] [Indexed: 12/14/2022] Open
Abstract
A model-informed drug development approach was used to select ceftaroline fosamil high-dose regimens for pediatric patients with complicated skin and soft-tissue infections caused by Staphylococcus aureus with a ceftaroline minimum inhibitory concentration (MIC) of 2 or 4 mg/L. Steady-state ceftaroline concentrations were simulated using a population pharmacokinetics (PK) model for ceftaroline fosamil and ceftaroline including data from 304 pediatric subjects and 944 adults. Probability of target attainment (PTA) for various simulated pediatric high-dose regimens and renal function categories were calculated based on patients achieving 35% fT>MIC (S. aureus PK/pharmacodynamic target for 2-log10 bacterial killing). For extrapolation of efficacy, simulated exposures and PTA were compared to adults with normal renal function receiving high-dose ceftaroline fosamil (600 mg 2-h infusions every 8 h). For safety, predicted ceftaroline exposures were compared with observed pediatric and adult data. Predicted ceftaroline exposures for the approved pediatric high-dose regimens (12, 10, or 8 mg/kg by 2-h infusions every 8 h for patients aged >2 to <18 years with normal/mild, moderate, or severe renal impairment, respectively; 10 mg/kg by 2-h infusions every 8 h for patients aged ≥2 months to <2 years with normal renal function/mild impairment) were well matched to adults with normal renal function. Median predicted maximum concentration at steady state (Cmax,ss ) and area under the plasma concentration-time curve over 24 h at steady state pediatric to adult ratios were 0.907-1.33 and 0.940-1.41, respectively. PTAs (>99% and ≥81% for MICs of 2 and 4 mg/L, respectively) matched or exceeded the adult predictions. Simulated Cmax,ss values were below the maximum observed data in other indications, including a high-dose pediatric pneumonia trial, which reported no adverse events related to high exposure.
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Schießer S, Hitzenbichler F, Kees MG, Kratzer A, Lubnow M, Salzberger B, Kees F, Dorn C. Measurement of Free Plasma Concentrations of Beta-Lactam Antibiotics: An Applicability Study in Intensive Care Unit Patients. Ther Drug Monit 2021; 43:264-270. [PMID: 33086362 DOI: 10.1097/ftd.0000000000000827] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/29/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The antibacterial effect of antibiotics is linked to the free drug concentration. This study investigated the applicability of an ultrafiltration method to determine free plasma concentrations of beta-lactam antibiotics in ICU patients. METHODS Eligible patients included adult ICU patients treated with ceftazidime (CAZ), meropenem (MEM), piperacillin (PIP)/tazobactam (TAZ), or flucloxacillin (FXN) by continuous infusion. Up to 2 arterial blood samples were drawn at steady state. Patients could be included more than once if they received another antibiotic. Free drug concentrations were determined by high-performance liquid chromatography with ultraviolet detection after ultrafiltration, using a method that maintained physiological conditions (pH 7.4/37°C). Total drug concentrations were determined to calculate the unbound fraction. In a post-hoc analysis, free concentrations were compared with the target value of 4× the epidemiological cut-off value (ECOFF) for Pseudomonas aeruginosa as a worst-case scenario for empirical therapy with CAZ, MEM or PIP/tazobactam and against methicillin-sensitive Staphylococcus aureus for targeted therapy with FXN. RESULTS Fifty different antibiotic treatment periods in 38 patients were evaluated. The concentrations of the antibiotics showed a wide range because of the fixed dosing regimen in a mixed population with variable kidney function. The mean unbound fractions (fu) of CAZ, MEM, and PIP were 102.5%, 98.4%, and 95.7%, with interpatient variability of <6%. The mean fu of FXN was 11.6%, with interpatient variability of 39%. It was observed that 2 of 12 free concentrations of CAZ, 1 of 40 concentrations of MEM, and 11 of 23 concentrations of PIP were below the applied target concentration of 4 × ECOFF for P. aeruginosa. All concentrations of FXN (9 samples from 6 patients) were >8 × ECOFF for methicillin-sensitive Staphylococcus aureus. CONCLUSIONS For therapeutic drug monitoring purposes, measuring total or free concentrations of CAZ, MEM, or PIP is seemingly adequate. For highly protein-bound beta-lactams such as FXN, free concentrations should be favored in ICU patients with prevalent hypoalbuminemia.
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Affiliation(s)
- Selina Schießer
- Departments of Infection Prevention and Infectious Diseases and
| | | | | | | | - Matthias Lubnow
- Department of Internal Medicine II, University Hospital Regensburg
| | | | - Frieder Kees
- Institute of Pharmacy, University of Regensburg, Regensburg, Germany
| | - Christoph Dorn
- Institute of Pharmacy, University of Regensburg, Regensburg, Germany
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13
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Usmani MT, Shoaib MH, Siddiqui F, Ahmed FR, Jabeen S, Saeed R, Ahmed K, Farooqi S, Hussain T, Imran SM. Modification and validation of liquid chromatographic method for the quantification of ciprofloxacin in human plasma and its application to a bioavailability study. Pak J Pharm Sci 2021; 34:767-772. [PMID: 34275813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
A new simple, accurate, precise and sensitive liquid chromatographic method for the analysis of Ciprofloxacin in human plasma, suitable for quantification of drug was developed and validated using HPLC-UV method. The analyte was chromatographically separated from endogenous plasma components on a C-18 reversed phase column (5µm, 25cm × 0.46cm) and detected at 278nm. The sample pretreatment was carried out with acetonitrile on 200µl of plasma. The Lower limit of quantification (LLOQ) was 0.04 µg/ml with linearity in the range 0.04-4 µg/ml and coefficient of correlation value (R2)>0.995. The method was successfully validated as per current FDA guidance for necessary parameters and applied to a pilot bioavailability study conducted on six healthy volunteers with marketed Ciprofloxacin 250mg immediate release tablets. The plasma concentrations were subjected to non-compartmental analysis for calculation of pharmacokinetic parameters like Cmax, Tmax, AUCo-t, AUC 0-∞ and t½ etc. The mean values of Cmax and Tmax were found to be 1.35±0.09µg/ml and 1.25±0.27h respectively while for other pharmacokinetic parameters including AUCo-t, AUC0-∞ were found to be 5.98±0.96 μg/ml×h and 6.34±1.07μg/ml×h. The drug exhibited half-life (t½) of 3.94±0.33h. The obtained results proved the suitability of the method for routine pharmacokinetic studies of Ciprofloxacin.
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Affiliation(s)
- Muhammad Talha Usmani
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, Pakistan
| | - Muhammad Harris Shoaib
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, Pakistan
| | - Fahad Siddiqui
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, Pakistan
| | - Farrukh Rafiq Ahmed
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, Pakistan
| | - Sabahat Jabeen
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, Pakistan
| | - Rehana Saeed
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, Pakistan
| | - Kamran Ahmed
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, Pakistan
| | - Sadaf Farooqi
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, Pakistan
| | - Tazeen Hussain
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, Pakistan
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Choi JS, Kim JM, Kim D, Kim SH, Cho H, Park HD, Lee SY, Kang CI, Kim YJ. Therapeutic Drug Level Monitoring of Teicoplanin in Korean Pediatric Patients with Normal versus Impaired Renal Function. J Korean Med Sci 2020; 35:e376. [PMID: 33258328 PMCID: PMC7707924 DOI: 10.3346/jkms.2020.35.e376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/14/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Teicoplanin is used to treat serious gram-positive infections. Optimal teicoplanin trough levels are considered to be ≥ 10 μg/mL. Despite its wide use in various clinical settings, data on teicoplanin trough level in pediatric patients are limited. Therefore, the aim of this study was to investigate the therapeutic drug level monitoring of teicoplanin in Korean pediatric patients, including those with impaired renal function. METHODS A retrospective study was performed in pediatric patients (age ≤ 18 years old) who received teicoplanin from September 2014 to April 2018. The regimen included a loading dose of 10 mg/kg/dose at 12 hours' interval three times in a row, and a maintenance dose of 10 mg/kg/dose commenced at 24 hours of interval after the loading dose, with a maximum of 400 mg/dose, respectively. The first therapeutic drug levels were measured. Distribution and characteristics of trough levels in patients with decreased renal function and those with bacteremia were also assessed. RESULTS A total of 187 trough levels were collected from 143 patients. Hematologic and oncologic diseases were the most common underlying diseases (83.2%, n = 119). One hundred eighty trough levels were first measured, and their median value was 16.2 μg/mL (range, 2.3-100 μg/mL) and the median interval between initial teicoplanin injection and 1st trough level was 96.5 hours (range 47.6-179.3 hours). Lower steady-state levels were observed in younger age group (median, 13.5 vs. 18.0 μg/mL, P = 0.038). Median trough levels were higher in patients with decreased renal functions (P < 0.001). In addition, among eight with gram-positive bacteremia, seven of them had a favorable outcome. CONCLUSION This study provides additive information on trough level monitoring of teicoplanin in children with impaired renal function and treatment effect in patients with gram-positive bacteremia. Careful monitoring for steady state trough levels of teicoplanin is warranted.
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Affiliation(s)
- Joon Sik Choi
- Department of Pediatrics, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea
- Department of Pediatrics, Yonsei University of Medicine, Yongin Severance Hospital, Yongin, Korea
| | - Jong Min Kim
- Department of Pediatrics, Myongji Hospital, Goyang, Korea
| | - Dongsub Kim
- Department of Pediatrics, Kyungpook National University Hospital, Daegu, Korea
| | - Si Ho Kim
- Department of Infectious Diseases, Samsung Changwon Hospital, Changwon, Korea
| | - Heeyeon Cho
- Department of Pediatrics, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Hyung Doo Park
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Soo Youn Lee
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Cheol In Kang
- Department of Infectious Diseases, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Yae Jean Kim
- Department of Pediatrics, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea.
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Thompson EJ, Wu H, Maharaj A, Edginton AN, Balevic SJ, Cobbaert M, Cunningham AP, Hornik CP, Cohen-Wolkowiez M. Physiologically Based Pharmacokinetic Modeling for Trimethoprim and Sulfamethoxazole in Children. Clin Pharmacokinet 2020; 58:887-898. [PMID: 30840200 DOI: 10.1007/s40262-018-00733-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aims of this study were to (1) determine whether opportunistically collected data can be used to develop physiologically based pharmacokinetic (PBPK) models in pediatric patients; and (2) characterize age-related maturational changes in drug disposition for the renally eliminated and hepatically metabolized antibiotic trimethoprim (TMP)-sulfamethoxazole (SMX). METHODS We developed separate population PBPK models for TMP and SMX in children after oral administration of the combined TMP-SMX product and used sparse and opportunistically collected plasma concentration samples to validate our pediatric model. We evaluated predictability of the pediatric PBPK model based on the number of observed pediatric data out of the 90% prediction interval. We performed dosing simulations to target organ and tissue (skin) concentrations greater than the methicillin-resistant Staphylococcus aureus (MRSA) minimum inhibitory concentration (TMP 2 mg/L; SMX 9.5 mg/L) for at least 50% of the dosing interval. RESULTS We found 67-87% and 71-91% of the observed data for TMP and SMX, respectively, were captured within the 90% prediction interval across five age groups, suggesting adequate fit of our model. Our model-rederived optimal dosing of TMP at the target tissue was in the range of recommended dosing for TMP-SMX in children in all age groups by current guidelines for the treatment of MRSA. CONCLUSION We successfully developed a pediatric PBPK model of the combination antibiotic TMP-SMX using sparse and opportunistic pediatric pharmacokinetic samples. This novel and efficient approach has the potential to expand the use of PBPK modeling in pediatric drug development.
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Affiliation(s)
| | - Huali Wu
- Duke Clinical Research Institute, 300 West Morgan Street, Suite 800, Durham, NC, 27701, USA
| | - Anil Maharaj
- Duke Clinical Research Institute, 300 West Morgan Street, Suite 800, Durham, NC, 27701, USA
| | - Andrea N Edginton
- Duke Clinical Research Institute, 300 West Morgan Street, Suite 800, Durham, NC, 27701, USA
| | - Stephen J Balevic
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
- Duke Clinical Research Institute, 300 West Morgan Street, Suite 800, Durham, NC, 27701, USA
| | - Marjan Cobbaert
- Duke Clinical Research Institute, 300 West Morgan Street, Suite 800, Durham, NC, 27701, USA
| | - Anthony P Cunningham
- Duke Clinical Research Institute, 300 West Morgan Street, Suite 800, Durham, NC, 27701, USA
| | - Christoph P Hornik
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
- Duke Clinical Research Institute, 300 West Morgan Street, Suite 800, Durham, NC, 27701, USA
| | - Michael Cohen-Wolkowiez
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA.
- Duke Clinical Research Institute, 300 West Morgan Street, Suite 800, Durham, NC, 27701, USA.
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Rairat T, Kuo YS, Chang CC, Hsieh CY, Chou CC. Bath immersion pharmacokinetics of florfenicol in Nile tilapia (Oreochromis niloticus). J Vet Pharmacol Ther 2020; 43:520-526. [PMID: 32573800 DOI: 10.1111/jvp.12887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/02/2020] [Accepted: 06/04/2020] [Indexed: 11/26/2022]
Abstract
Drug administration by immersion can be a preferable method in certain conditions especially for treating small-sized, anorexic, or valuable fish. Pharmacokinetic information regarding bath treatment is considerably lacking in comparison to other common administration routes. The current study aimed to investigate if immersion can be an effective route to administer florfenicol (FF) for treatment in Nile tilapia. Nile tilapia reared at 28°C were immersed with FF solution at concentrations of 50, 100, 200, 500, and 500/200 (3 hr/117 hr) ppm for 120 hr and moved to drug-free freshwater for another 24 hr. The serum FF concentration in 100, 200, and 500/200 ppm groups reached steady-state at 12 hr with concentrations of 2.44, 3.04, and 5.26 µg/ml, respectively, which were about 2% of the bathing concentrations. The target therapeutic levels of 1-4 µg/ml were attained and maintained within 1-12 hr, depending on the immersion concentration and the target MIC. Serum FF reached the target with shorter time at higher bathing concentration. Following the 120-hr bath, the serum FF declined with the first-order half-life of approximately 10 hr. A minimum of 100 ppm FF is required for treatment purpose, and an initial high loading concentration followed by maintenance concentration is a plausible way to reach in vivo therapeutic level in short time. Greater than 99% of the residual FF in the bathing water could be removed within 15 min by 0.05% NaOCl. Our results indicated that bath immersion is a promising potential route for FF administration in Nile tilapia.
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Affiliation(s)
- Tirawat Rairat
- Department of Veterinary Medicine, College of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Yu-Shin Kuo
- Department of Veterinary Medicine, College of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Chao-Chia Chang
- Department of Veterinary Medicine, College of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Chia-Yu Hsieh
- Department of Veterinary Medicine, College of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Chi-Chung Chou
- Department of Veterinary Medicine, College of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan
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Gómez-Ramírez P, Blanco G, García-Fernández AJ. Validation of Multi-Residue Method for Quantification of Antibiotics and NSAIDs in Avian Scavengers by Using Small Amounts of Plasma in HPLC-MS-TOF. Int J Environ Res Public Health 2020; 17:ijerph17114058. [PMID: 32517231 PMCID: PMC7313014 DOI: 10.3390/ijerph17114058] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 05/28/2020] [Accepted: 06/03/2020] [Indexed: 12/22/2022]
Abstract
Pharmaceuticals are still considered emerging pollutants affecting both aquatic and terrestrial ecosystems. Scavenging bird species may be exposed to veterinary drugs when they feed on livestock carcasses provided at supplementary feeding stations, as these are often stocked with ailing and/or recently medicated animals. Because those animals may be a source of several different pharmaceutical compounds, analytical methods to evaluate residue levels and exposure potential should enable detection and quantification of as many different compounds as possible, preferably from small sample volumes. Four different extraction methods were tested to conduct HPLC-MS-TOF analysis of some of the most common veterinary drugs used in livestock in Spain. The method deemed most viable was a simple extraction, using methanol and 100 µL of plasma, that allowed quantification of seven antibiotics (tetracycline, oxytetracycline, ciprofloxacin, enrofloxacin, nalidixic acid, trimethoprim, sulfadiazine) and five nonsteroidal anti-inflammatory drugs (NSAIDs) (meloxicam, flunixin, carprofen, tolfenamic acid, phenylbutazone). The method was then applied to analysis of 29 Eurasian griffon vulture (Gyps fulvus) nestling samples, wherein enrofloxacin and tolfenamic acid were most commonly detected (69% and 20%, respectively). To our knowledge, this is the first study including NSAIDs in the exposure assessment of different classes of veterinary pharmaceuticals in live avian scavengers.
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Affiliation(s)
- Pilar Gómez-Ramírez
- Toxicology and Forensic Veterinary Service, Dept. of Socio-Health Sciences, Faculty of Veterinary, University of Murcia, Campus de Espinardo, 30100 Murcia, Spain;
- Toxicology and Risk Assessment Group, Biomedical Research Institute of Murcia (IMIB-Arrixaca), University of Murcia, Campus de Espinardo, 30100 Murcia, Spain
- Correspondence: ; Tel.: +34-86-888-9327
| | - Guillermo Blanco
- Department of Evolutionary Ecology, Museo Nacional de Ciencias Naturales, CSIC, José Gutiérrez Abascal 2, 28006 Madrid, Spain;
| | - Antonio Juan García-Fernández
- Toxicology and Forensic Veterinary Service, Dept. of Socio-Health Sciences, Faculty of Veterinary, University of Murcia, Campus de Espinardo, 30100 Murcia, Spain;
- Toxicology and Risk Assessment Group, Biomedical Research Institute of Murcia (IMIB-Arrixaca), University of Murcia, Campus de Espinardo, 30100 Murcia, Spain
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Wang J, Li SC, Ye Q, Gao LL, Nie YM, Xu H, Wu M, Cao P, Wang Y. Population Pharmacokinetics and Pharmacodynamics of Norvancomycin in Children With Malignant Hematological Disease. J Clin Pharmacol 2020; 60:1220-1230. [PMID: 32488878 DOI: 10.1002/jcph.1618] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 03/18/2020] [Indexed: 12/24/2022]
Abstract
Knowledge of pharmacokinetic (PK) behavior of norvancomycin (NVCM) in pediatric patients is lacking, which leads to empirical therapy in clinical practice. This study developed a population PK model of children aged 0-15 years; 112 opportunistic samples in total from 90 children were analyzed. The stability and prediction of the final model were evaluated by goodness-of-fit plots, nonparametric bootstrap, visual predictive check, and normalized prediction distribution errors. The PKs of NVCM in children was described by a 2-compartment model with first-order elimination along with body weight and estimated glomerular filtration rate as significant covariates on clearance. The population typical values of the PK parameters were as follows: clearance 0.12 L/kg/h, central compartment distribution volume 0.17 L/kg, peripheral compartment distribution volume 0.38 L/kg, and intercompartmental clearance 0.35 L/kg/h. Logistic analysis showed that the ratio of area under the concentration-time curve over 24 hours (AUC0-24 ) to minimum inhibitory concentration (MIC) had the strongest correlation with clinical efficacy, and at least 80% clinical efficiency could be achieved when AUC0-24 /MIC ≥ 221.06 was defined as the target. Monte Carlo simulation results suggested that a higher dose was required for this pediatric population in order to reach the target. The dosing regimen was optimized based on the final model. A population PK model of NVCM was first characterized in children with hematologic malignancy, and an evidence-based approach for NVCM dosage individualization was provided.
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Affiliation(s)
- Jun Wang
- Department of Clinical Pharmacy, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Si-Chan Li
- Department of Clinical Pharmacy, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Qi Ye
- Department of Clinical Pharmacy, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Liu-Liu Gao
- Department of Clinical Pharmacy, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Ying-Ming Nie
- Department of Hematology-Oncology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Hua Xu
- Department of Clinical Pharmacy, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Mo Wu
- Clinical laboratory, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Peng Cao
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Yang Wang
- Department of Clinical Pharmacy, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
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Thang VV, Bao TQQ, Tuyen HD, Krumkamp R, Hai LH, Dang NH, Chu CM, Blessmann J. Incidence of snakebites in Can Tho Municipality, Mekong Delta, South Vietnam-Evaluation of the responsible snake species and treatment of snakebite envenoming. PLoS Negl Trop Dis 2020; 14:e0008430. [PMID: 32555599 PMCID: PMC7323996 DOI: 10.1371/journal.pntd.0008430] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 06/29/2020] [Accepted: 05/29/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Data on incidence of snakebites and the responsible snake species are largely missing in Vietnam and comprehensive national guidelines for management of snakebite envenoming are not yet available. They are needed to estimate the scope of this health problem, to assess the demand for snake antivenom and to ensure the best possible treatment for snakebite victims. METHODOLOGY/PRINCIPLE FINDINGS A cross-sectional community-based survey was conducted from January to April 2018. Multistage cluster sampling was applied and snakebite incidence in Can Tho municipality, excluding two central districts of Can Tho city, was calculated at 48 (95%-confidence interval (CI): 20.5-99.8) snakebites per 100,000 person-years. Seven snakebite victims found during the survey reported 3 bites from green pit vipers and 4 bites from non-venomous snakes. In 2017 two treatment centres for snakebite envenoming in Can Tho city, the Military Hospital 121 and the Paediatric Hospital, received 520 admissions of snakebite victims. Two hundred sixty-seven came from Can Tho Municipality and 253 from neighbouring provinces. According to these data, the incidence of snakebites for Can Tho municipality was calculated at 21 (95%-CI: 18.5-23.7) snakebites per 100,000 person-years. Incidence was 14 (95%-CI: 12-17) snakebites per 100,000 person years in those 7 districts of the municipality which were part of the community survey. Green pit vipers were responsible for 92% of snakebite envenoming. Antivenom, antibiotics and corticosteroids were administered to 405 (90%), 379 (84%), and 310 (69%) out of 450 patients, respectively. CONCLUSIONS Incidence of snakebites in Can Tho Municipality is relatively low and green pit vipers are responsible for the vast majority of bites. Approximately one third of snakebite patients sought medical care in hospitals and although hospital data still underestimate the real incidence of snakebites, these statistics are valuable and can be obtained fast and inexpensively. Evaluation of patients' records indicates the need for development of guidelines for management of snakebite envenoming in Vietnam to ensure a rational use of antivenom and ancillary treatments.
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Affiliation(s)
- Vo Van Thang
- Institute for Community Health Research, College of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Truong Quy Quoc Bao
- Institute for Community Health Research, College of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Hoang Dinh Tuyen
- Institute for Community Health Research, College of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Ralf Krumkamp
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg – Lübeck – Borstel – Riems, Germany
| | | | | | | | - Joerg Blessmann
- Institute for Community Health Research, College of Medicine and Pharmacy, Hue University, Hue, Vietnam
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
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Resendiz AS, Bernad MJ, Sanchez Lemus JC, Rodríguez IJ, Carlin Valderrabano SC, Estrada DV. Disposition and pharmacokinetics of azithromycin in serum and a lung tissue of two modified-release formulations compared with an immediate-release product on the market. Pak J Pharm Sci 2020; 33:1079-1085. [PMID: 33191232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The aim of this study was to determine the disposition and pharmacokinetics in serum and a lung tissue homogenate in guinea pig (Cavia porcellus) of two experimental formulations of azithromycin, those were included in a modified release polymer matrix (MRF) after oral administration. The results obtained are compared with a commercial form of immediate release. 3 groups of animals were randomly formed in groups of 7 for control and 14 for each group of modified-release formulations (MRFs) were treated with a single dose of 8mg/kg of active principle. In lung tissue, comparisons of concentration of azithromycin, showed statistically significant differences between commercial product, MRF1 and MRF2. All pharmacokinetic parameters for MRF1 and MRF2 were significantly different with the exception of Cmax with respect to commercial product. The treatment of the animals with MRFs may have several benefits over treatment with azithromycin alone since could increase dosing interval for the two MRFs evaluated and reduce the frequency of application, patient stress levels and toxicological risks by accumulation of the active principle.
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Affiliation(s)
- Alonso Sierra Resendiz
- Department of Physiology and Pharmacology, Veterinary Medicine School, National Autonomous University of Mexico, Mexico
| | - María Josefa Bernad
- Pharmaceutical Technology, Chemistry Faculty, National Autonomous University of Mexico, Mexico
| | - Julio Cesar Sanchez Lemus
- Department of Chemical and Biological Inspection of the Veterinary Medicine School, National Autonomous University of Mexico
| | - Ivan Juarez Rodríguez
- Department of Preventive Medicine and Public Health, Veterinary Medicine School, National Autonomous University of Mexico
| | | | - Dinorah Vargas Estrada
- Department of Physiology and Pharmacology, Veterinary Medicine School, National Autonomous University of Mexico, Mexico
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Skaggs C, Kirkpatrick L, Wichert WRA, Skaggs N, Manicke NE. A statistical approach to optimizing paper spray mass spectrometry parameters. Rapid Commun Mass Spectrom 2020; 34:e8601. [PMID: 32043669 DOI: 10.1002/rcm.8601] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/28/2019] [Accepted: 08/30/2019] [Indexed: 06/10/2023]
Abstract
RATIONALE Paper spray mass spectrometry (PS-MS) was used to analyze and quantify ampicillin, a hydrophilic compound and frequently utilized antibiotic. Hydrophilic molecules are difficult to analyze via PS-MS due to their strong binding affinity to paper substrates and low ionization efficiency, among other reasons. METHODS Solvent and paper parameters were optimized to increase the extraction of ampicillin from the paper substrate. After optimizing these key parameters, a Resolution IV 1/16 fractional factorial design with two center points was employed to screen eight different design parameters simultaneously. RESULTS Pore size, sample volume, and solvent volume were the most significant factors affecting average peak area under the curve (AUC) and the signal-to-blank (S/B) ratio for the 1 μg/mL ampicillin calibrant. After optimizing the key parameters, a linear calibration curve with a range of 0.2 μg/mL to 100 μg/mL was generated (R2 = 0.98) and the limit of detection (LOD) and lower limit of quantification (LLOQ) were calculated to be 0.07 μg/mL and 0.25 μg/mL, respectively. CONCLUSIONS The statistical optimization procedure undertaken here increased the mass spectral signal intensity by more than a factor of 40. This statistical method of screening followed by optimization experiments proved faster and more efficient, and produced more drastic improvements than typical one-factor-at-a-time experiments.
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Affiliation(s)
- Christine Skaggs
- Department of Chemistry and Chemical Biology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, 46202, USA
| | - Lindsey Kirkpatrick
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - William R A Wichert
- Department of Chemistry and Chemical Biology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, 46202, USA
| | - Nicole Skaggs
- Technical Problem Solver, General Motors Proving Grounds, Milford, MI, 48380, USA
| | - Nicholas E Manicke
- Department of Chemistry and Chemical Biology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, 46202, USA
- Forensics and Investigative Sciences, Indiana University-Purdue University Indianapolis, Indianapolis, IN, 46202, USA
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22
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Roujansky A, Martin M, Gomart C, Hulin A, Mounier R. Multidrug-Resistant Staphylococcus epidermidis Ventriculostomy-Related Infection Successfully Treated by Intravenous Ceftaroline after Failure of Daptomycin Treatment. World Neurosurg 2020; 136:221-225. [PMID: 31931253 DOI: 10.1016/j.wneu.2020.01.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/02/2020] [Accepted: 01/03/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Ventriculostomy-related infection with multidrug-negative strains are challenging to treat. We report the use of new antibiotics in such a case. CASE DESCRIPTION We report the case of a neurosurgical intensive care unit patient who developed ventriculostomy-related infection with a multidrug-resistant Staphylococcus epidermidis. Vancomycin, recommended in such cases, was not used due to high minimal inhibitory concentrations and concerns for lack of pharmacokinetic/pharmacodynamic target attainment. Daptomycin and ceftaroline remained the only treatment options. Daptomycin was shown microbiologically ineffective after 10 treatment days, with undetectable cerebrospinal fluid (CSF) concentration. Ceftaroline, a novel beta-lactam agent to which the strain showed susceptibility, was thus used. Serum and CSF samples were assessed for antibiotic concentrations. Our results show that CSF bacterial clearance was obtained after 6 days of such treatment. Serum and CSF samplings showed low penetration ratios (2.6%-4.8%), probably due to mild inflammatory CSF profile, with CSF concentration at minimal inhibitory concentration level. CONCLUSIONS We observed than even in the case of mild meningeal inflammation, ceftaroline penetration in CSF, although moderate, enabled efficient bacterial clearance and clinical efficacy, in adjunction to correct ventriculoperitoneal shunt management.
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Affiliation(s)
- Ariane Roujansky
- Department of Anesthesia and Surgical Intensive Care, Henri Mondor University Hospital of Paris, Paris XII School of Medicine, Créteil, France.
| | - Mathieu Martin
- Department of Anesthesia and Surgical Intensive Care, Henri Mondor University Hospital of Paris, Paris XII School of Medicine, Créteil, France
| | - Camille Gomart
- Department of Microbiology, Henri Mondor University Hospital, Assitance Publique-Hôpitaux de Paris (APHP), University Paris-Est Créteil (UPEC), Créteil, France
| | - Anne Hulin
- Department of Pharmacology, Henri Mondor University Hospital, Assitance Publique-Hôpitaux de Paris (APHP), University Paris-Est Créteil (UPEC), Créteil, France
| | - Roman Mounier
- Department of Microbiology, Henri Mondor University Hospital, Assitance Publique-Hôpitaux de Paris (APHP), University Paris-Est Créteil (UPEC), Créteil, France; Groupe de Recherche Clinique IMPACT, Institut Mondor de la Recherche Biomédicale, Université Paris-Est Créteil, Créteil, France
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23
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Li X, Fan K, Yang R, Du X, Qu B, Miao X, Lu L. A long lifetime ratiometrically luminescent tetracycline nanoprobe based on Ir(III) complex-doped and Eu 3+-functionalized silicon nanoparticles. J Hazard Mater 2020; 386:121929. [PMID: 31895999 DOI: 10.1016/j.jhazmat.2019.121929] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/17/2019] [Accepted: 12/17/2019] [Indexed: 06/10/2023]
Abstract
Different from fluorescent dyes-doped or carbon materials-based ratiometric tetracycline nanoprobes, herein, a new Ir(III) complex-doped and europium(III) ion (Eu3+)-functionalized silicon nanoparticles (Ir(III)@SiNPs-Eu3+) with long luminescent lifetimes was firstly fabricated for selective detection of tetracycline (TC) in complex systems through time-resolved emission spectra (TRES) measurement. In the presence of TC, the red phosphorescence of Eu3+ is greatly enhanced by adsorption energy transfer emission (AETE) of TC, while the strong green luminescence of Ir(III)@SiNPs is quenched by the inner filtration effect (IFE) of TC. Based on these striking emission changes, Ir(III)@SiNPs-Eu3+ can sensitively detect TC in the linear range of 0.01-20 μM with a detection limit of 4.9 × 10-3 μM. Benefitting from the long lifetime of Ir(III)@SiNPs-Eu3+, the nanoprobe demonstrates excellent TC detection performance through TRES in high background system of 5 % human serum. Furthermore, the formed Ir(III)@SiNPs-Eu3+/TC complex can be used to sensitively recognize Hg2+ via a ratiometric luminescence mode. Notably, the cytotoxicity of Ir(III)@SiNPs-Eu3+ is very low and thus the sensitive monitoring the detection of Ir(III)@SiNPs-Eu3+ to TC and Hg2+ also works well in porcine renal cells, demonstrating high application potential in real samples.
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Affiliation(s)
- Xiaotong Li
- College of Chemistry and Pharmaceutical Sciences, Qingdao Agricultural University, Qingdao 266109, China
| | - Kaimei Fan
- College of Chemistry and Pharmaceutical Sciences, Qingdao Agricultural University, Qingdao 266109, China
| | - Ruimei Yang
- College of Veterinary Medicine, Qingdao Agricultural University, Qingdao 266109, China
| | - Xiuxiu Du
- College of Chemistry and Pharmaceutical Sciences, Qingdao Agricultural University, Qingdao 266109, China
| | - Baohan Qu
- College of Chemistry and Pharmaceutical Sciences, Qingdao Agricultural University, Qingdao 266109, China
| | - Xiangmin Miao
- School of Life Science, Jiangsu Normal University, Xuzhou 221116, China.
| | - Lihua Lu
- College of Chemistry and Pharmaceutical Sciences, Qingdao Agricultural University, Qingdao 266109, China.
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Yu Z, Han X, Li F, Tan X, Shi W, Fu C, Yan H, Zhang G. Lengthening the aptamer to hybridize with a stem-loop DNA assistant probe for the electrochemical detection of kanamycin with improved sensitivity. Anal Bioanal Chem 2020; 412:2391-2397. [PMID: 32076786 DOI: 10.1007/s00216-020-02481-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/28/2020] [Accepted: 01/31/2020] [Indexed: 11/25/2022]
Abstract
By adding 6 thymines to lengthen the parent aptamer combined with the change of "on" and "off" induced by the target for an assistant stem-loop DNA probe (ASP-SLP-MB), a new folding-type electrochemical kanamycin (Kana) aptamer-engineering dual-probe-based sensor (sensor d) was developed. By purposefully reducing the background current and increasing the electron transfer efficiency of methylene blue (MB), the sensor obtained significantly enhanced detection sensitivity compared with non-aptamer-engineering one-probe-based sensor (sensor a). Such efficacy was validated by a big decrease from 530.6 to 210.2 nA for the background current signal and from 360 to 0.3 nM for the detection limit. In addition to the improved sensitivity, the sensor also exhibited good selectivity, anti-fouling detection performance, and potential quantitative analysis ability, showing a feasible potential practical analytical application in real-life complicated samples, for example, milk and serum. The released results prove that the aptamer-engineering method is effective in improving the analytical performance of folding-type sensors and provides a methodological guidance for the design and fabrication of other high-performance folding-type aptasensors. Graphical abstract.
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Affiliation(s)
- Zhigang Yu
- Post-Doctoral Research Center of Chongqing Key Laboratory of Inorganic Special Functional Materials, College of Chemistry and Chemical Engineering, Yangtze Normal University, Fuling, Chongqing, 408100, China.
- School of Materials Science and Engineering, College of Chemical and Environmental Engineering, Harbin University of Science and Technology, Harbin, 150040, Heilongjiang, China.
| | - Xianda Han
- Post-Doctoral Research Center of Chongqing Key Laboratory of Inorganic Special Functional Materials, College of Chemistry and Chemical Engineering, Yangtze Normal University, Fuling, Chongqing, 408100, China
- School of Materials Science and Engineering, College of Chemical and Environmental Engineering, Harbin University of Science and Technology, Harbin, 150040, Heilongjiang, China
| | - Fengqin Li
- Post-Doctoral Research Center of Chongqing Key Laboratory of Inorganic Special Functional Materials, College of Chemistry and Chemical Engineering, Yangtze Normal University, Fuling, Chongqing, 408100, China
| | - Xiaoping Tan
- Post-Doctoral Research Center of Chongqing Key Laboratory of Inorganic Special Functional Materials, College of Chemistry and Chemical Engineering, Yangtze Normal University, Fuling, Chongqing, 408100, China
| | - Wenbing Shi
- Post-Doctoral Research Center of Chongqing Key Laboratory of Inorganic Special Functional Materials, College of Chemistry and Chemical Engineering, Yangtze Normal University, Fuling, Chongqing, 408100, China
| | - Cuicui Fu
- Post-Doctoral Research Center of Chongqing Key Laboratory of Inorganic Special Functional Materials, College of Chemistry and Chemical Engineering, Yangtze Normal University, Fuling, Chongqing, 408100, China
| | - Hong Yan
- School of Materials Science and Engineering, College of Chemical and Environmental Engineering, Harbin University of Science and Technology, Harbin, 150040, Heilongjiang, China
| | - Guiling Zhang
- School of Materials Science and Engineering, College of Chemical and Environmental Engineering, Harbin University of Science and Technology, Harbin, 150040, Heilongjiang, China.
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25
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Paal M, Heilmann M, Koch S, Bertsch T, Steinmann J, Höhl R, Liebchen U, Schuster C, Kleine FM, Vogeser M. Comparative LC-MS/MS and HPLC-UV Analyses of Meropenem and Piperacillin in Critically Ill Patients. Clin Lab 2020; 65. [PMID: 31532096 DOI: 10.7754/clin.lab.2019.190210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Therapeutic drug monitoring (TDM) of beta-lactam antibiotics has become a valuable tool to guide dosing in critically ill patients. The main goal of the study was to compare two routinely used techniques for beta-lactam TDM in intensive care unit (ICU) patient samples, namely isotope dilution liquid chromatography tandem mass spectrometry (ID-LC-MS/MS) and high-performance liquid chromatography combined with ultra-violet detection (HPLC-UV). METHODS A set of 80 sera/plasma samples from ICU patients receiving therapeutic meropenem or piperacillin dosage was investigated. Sample duplicates and quality assessment samples were assayed in parallel with an in-house LC-MS/MS and a commercially available IVD HPLC-UV kit. A pharmacokinetic and pharmacodynamic (PK/PD) target with ≥ 22.5 mg/L for piperacillin and ≥ 8.0 mg/L for meropenem was used for medical assessment of trough sample (n = 40) antibiotic concentrations. RESULTS There was no difference between serum and Li-heparin plasmas. Concentration deviations were found for 4% of meropenem and 17% of piperacillin samples. Eliminating the influence of the systemic bias of approximately 10% for piperacillin, measurement discrepancies ≥ 25% between LC-MS/MS and HPLC-UV analyses were only observed for ≈ 4 - 6% of all samples. In the same way, identical PK/PD target attainment rates of 50 - 60% could be obtained. CONCLUSIONS After correction of the analytical bias for piperacillin measurements, both methods showed comparable results, also with respect to clinical decision limits. HPLC-UV analysis is an adequate TDM methodology for testing of beta-lactam antibiotics in centers where no special knowledge in LC-MS/MS based TDM is present. However, potential matrix effects, interferences, and calibration issues for both methods must be taken into account.
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Matsuo Y, Matsumoto S, Wajima T, Matsubara K. Pharmacokinetic modeling and simulation for dose rationale of doripenem in neonates and infants. Drug Metab Pharmacokinet 2020; 35:145-150. [PMID: 31969257 DOI: 10.1016/j.dmpk.2019.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/25/2019] [Accepted: 10/15/2019] [Indexed: 11/18/2022]
Abstract
The aims of this study were to construct a population pharmacokinetic model of doripenem in neonates and infants and to assess the dosing regimen for patients <3 months of age using Monte-Carlo pharmacokinetic/pharmacodynamic (PKPD) simulations. In the population pharmacokinetic analysis using 187 plasma concentrations from 47 neonates and infants, a two-compartment model well described plasma doripenem concentrations with the most significant covariates of chronological age and gestational age identified for the pharmacokinetics of doripenem. Monte-Carlo simulations suggested that the selected dosages for neonates and infants based on chronological age and gestational age (5 or 10 mg/kg) would provide ≥90% target attainment of 40%fT>MIC against MIC of 2 μg/mL in all age groups. These results would be useful for understanding the PKPD characteristics of doripenem, which could provide essential information on optimal therapeutic treatment for neonates and infants.
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Affiliation(s)
- Yumiko Matsuo
- Clinical Pharmacology & Pharmacokinetics, Project Management Department, Shionogi & Co., Ltd, Japan.
| | - Sayaka Matsumoto
- Clinical Pharmacology & Pharmacokinetics, Project Management Department, Shionogi & Co., Ltd, Japan
| | - Toshihiro Wajima
- Clinical Pharmacology & Pharmacokinetics, Project Management Department, Shionogi & Co., Ltd, Japan
| | - Kazuo Matsubara
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Japan
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27
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Abdulla A, Ewoldt TMJ, Hunfeld NGM, Muller AE, Rietdijk WJR, Polinder S, van Gelder T, Endeman H, Koch BCP. The effect of therapeutic drug monitoring of beta-lactam and fluoroquinolones on clinical outcome in critically ill patients: the DOLPHIN trial protocol of a multi-centre randomised controlled trial. BMC Infect Dis 2020; 20:57. [PMID: 31952493 PMCID: PMC6969462 DOI: 10.1186/s12879-020-4781-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 01/08/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Critically ill patients undergo extensive physiological alterations that will have impact on antibiotic pharmacokinetics. Up to 60% of intensive care unit (ICU) patients meet the pharmacodynamic targets of beta-lactam antibiotics, with only 30% in fluoroquinolones. Not reaching these targets might increase the chance of therapeutic failure, resulting in increased mortality and morbidity, and antibiotic resistance. The DOLPHIN trial was designed to demonstrate the added value of therapeutic drug monitoring (TDM) of beta-lactam and fluoroquinolones in critically ill patients in the ICU. METHODS A multi-centre, randomised controlled trial (RCT) was designed to assess the efficacy and cost-effectiveness of model-based TDM of beta-lactam and fluoroquinolones. Four hundred fifty patients will be included within 24 months after start of inclusion. Eligible patients will be randomly allocated to either study group: the intervention group (active TDM) or the control group (non-TDM). In the intervention group dose adjustment of the study antibiotics (cefotaxime, ceftazidime, ceftriaxone, cefuroxime, amoxicillin, amoxicillin with clavulanic acid, flucloxacillin, piperacillin with tazobactam, meropenem, and ciprofloxacin) on day 1, 3, and 5 is performed based upon TDM with a Bayesian model. The primary outcome will be ICU length of stay. Other outcomes amongst all survival, disease severity, safety, quality of life after ICU discharge, and cost effectiveness will be included. DISCUSSION No trial has investigated the effect of early TDM of beta-lactam and fluoroquinolones on clinical outcome in critically ill patients. The findings from the DOLPHIN trial will possibly lead to new insights in clinical management of critically ill patients receiving antibiotics. In short, to TDM or not to TDM? TRIAL REGISTRATION EudraCT number: 2017-004677-14. Sponsor protocol name: DOLPHIN. Registered 6 March 2018 . Protocol Version 6, Protocol date: 27 November 2019.
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Affiliation(s)
- A Abdulla
- Department of Hospital Pharmacy, Erasmus University Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, the Netherlands.
| | - T M J Ewoldt
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - N G M Hunfeld
- Department of Hospital Pharmacy, Erasmus University Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, the Netherlands
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A E Muller
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Medical Microbiology, Haaglanden Medical Center, The Hague, The Netherlands
| | - W J R Rietdijk
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - S Polinder
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - T van Gelder
- Department of Hospital Pharmacy, Erasmus University Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, the Netherlands
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - H Endeman
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - B C P Koch
- Department of Hospital Pharmacy, Erasmus University Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, the Netherlands
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Beechinor RJ, Cohen-Wolkowiez M, Jasion T, Hornik CP, Lang JE, Hernandez R, Gonzalez D. A Dried Blood Spot Analysis for Solithromycin in Adolescents, Children, and Infants: A Short Communication. Ther Drug Monit 2019; 41:761-765. [PMID: 31318840 PMCID: PMC6856424 DOI: 10.1097/ftd.0000000000000670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Solithromycin is a fourth-generation macrolide antibiotic with potential efficacy in pediatric community-acquired bacterial pneumonia. Pharmacokinetic (PK) studies of solithromycin in pediatric subjects are limited, therefore application of minimally invasive drug sampling techniques, such as dried blood spots (DBS), may enhance the enrollment of children in PK studies. The objectives of this study were to compare solithromycin concentrations in DBS with those in liquid plasma samples (LPS) and to quantify the effects of modeling DBS concentrations on the results of a population PK model. METHODS Comparability analysis was performed on matched DBS and LPS solithromycin concentrations collected from two different phase 1 clinical trials of solithromycin treatment in children (clinicaltrials.gov #NCT01966055 and #NCT02268279). Comparability of solithromycin concentrations was evaluated based on DBS:LPS ratio, median percentage prediction error, and median absolute percentage prediction error. The effect of correcting DBS concentrations for both hematocrit and protein binding was investigated. In addition, a previously published population PK model (NONMEM) was leveraged to compare parameter estimates resulting from either DBS or LPS concentrations. RESULTS A total of 672 paired DBS-LPS concentrations were available from 95 subjects (age: 0-17 years of age). The median (range) LPS and DBS solithromycin concentrations were 0.3 (0.01-12) mcg/mL and 0.32 (0.01-14) mcg/mL, respectively. Median percentage prediction error and median absolute percentage prediction error of raw DBS to LPS solithromycin concentrations were 5.26% and 22.95%, respectively. In addition, the majority of population PK parameter estimates resulting from modeling DBS concentrations were within 15% of those obtained from modeling LPS concentrations. CONCLUSIONS Solithromycin concentrations in DBS were similar to those measured in LPS and did not require correction for hematocrit or protein binding.
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Affiliation(s)
- Ryan J Beechinor
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michael Cohen-Wolkowiez
- Department of Pediatrics, Duke University Medical Center, Durham
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Theresa Jasion
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Christoph P Hornik
- Department of Pediatrics, Duke University Medical Center, Durham
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Jason E Lang
- Department of Pediatrics, Duke University Medical Center, Durham
| | | | - Daniel Gonzalez
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Dugovich BS, Crane LL, Alcantar BB, Beechler BR, Dolan BP, Jolles AE. Multiple innate antibacterial immune defense elements are correlated in diverse ungulate species. PLoS One 2019; 14:e0225579. [PMID: 31774834 PMCID: PMC6881064 DOI: 10.1371/journal.pone.0225579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 11/07/2019] [Indexed: 12/29/2022] Open
Abstract
In this study, we aimed to evaluate to what extent different assays of innate immunity reveal similar patterns of variation across ungulate species. We compared several measures of innate antibacterial immune function across seven different ungulate species using blood samples obtained from captive animals maintained in a zoological park. We measured mRNA expression of two receptors involved in innate pathogen detection, toll-like receptors 2 and 5 (TLR2 and 5), the bactericidal capacity of plasma, as well as the number of neutrophils and lymphocytes. Species examined included aoudad (Ammotragus lervia), American bison (Bison bison bison), yak (Bos grunniens), Roosevelt elk (Cervus canadensis roosevelti), fallow deer (Dama dama), sika deer (Cervus nippon), and Damara zebra (Equus quagga burchellii). Innate immunity varied among ungulate species. However, we detected strong, positive correlations between the different measures of innate immunity-specifically, TLR2 and TLR5 were correlated, and the neutrophil to lymphocyte ratio was positively associated with TLR2, TLR5, and bacterial killing ability. Our results suggest that ecoimmunological study results may be quite robust to the choice of assays, at least for antibacterial innate immunity; and that, despite the complexity of the immune system, important sources of variation in immunity in natural populations may be discoverable with comparatively simple tools.
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Affiliation(s)
- Brian S. Dugovich
- Department of Integrative Biology, Oregon State University, Corvallis, OR, United States of America
| | - Lucie L. Crane
- Department of Biomedical Sciences, Oregon State University, Corvallis, OR, United States of America
| | - Benji B. Alcantar
- Department of Biomedical Sciences, Oregon State University, Corvallis, OR, United States of America
- Wildlife Safari, Winston, OR, United States of America
| | - Brianna R. Beechler
- Department of Biomedical Sciences, Oregon State University, Corvallis, OR, United States of America
| | - Brian P. Dolan
- Department of Biomedical Sciences, Oregon State University, Corvallis, OR, United States of America
| | - Anna E. Jolles
- Department of Biomedical Sciences, Oregon State University, Corvallis, OR, United States of America
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Chen TW, Rajaji U, Chen SM, Muthumariyappan A, Mogren MMA, Jothi Ramalingam R, Hochlaf M. Facile synthesis of copper(II) oxide nanospheres covered on functionalized multiwalled carbon nanotubes modified electrode as rapid electrochemical sensing platform for super-sensitive detection of antibiotic. Ultrason Sonochem 2019; 58:104596. [PMID: 31450358 DOI: 10.1016/j.ultsonch.2019.05.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/07/2019] [Accepted: 05/09/2019] [Indexed: 05/17/2023]
Abstract
Herein, we report a super-active electrocatalyst of copper(II) oxide nanoparticles (CuO NPs) decorated functionalized multiwalled carbon nanotubes (CuO NPs@f-MWCNTs) by the ultrasonic method. The as-synthesized CuO NPs@f-MWCNTs was characterized through the FESEM, XPS, XRD and electrochemical impedance spectroscopy (EIS). The combination of highly active CuO NPs and highly conductive f-MWCNTs film with rapid detection enables this nanohybrid to display excellent electrochemical performance towards anesthesia drug. Furthermore, the hybrid electrocatalyst modified SPCE was developed for the determination of flunitrazepam (FTM) for the first time. FTM is important anesthesia drug with high adverse effect in human body. Benefiting from the synergistic reaction of CuO NPs and f-MWCNTs, this nanohybrid exhibited high sensitivity and specificity towards FTM electro-reduction. The CuO NPs@f-MWCNTs film modified SPCE exhibits outstanding electrochemical activity including excellent reproducibility, wide linear range from 0.05 to 346.6 µM with nanomolar limit of detection for FTM detection. Further, the as-modified CuO NPs@f-MWCNTs/SPCE has been applied to determination of FTM in biological and drug samples with satisfactory recovery results, thereby showing a notable potential for extensive (bio) sensor applications.
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Affiliation(s)
- Tse-Wei Chen
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, No. 1, Section 3, Chung-Hsiao East Road, Taipei 106, Taiwan; Research and Development Center for Smart Textile Technology, National Taipei University of Technology, No. 1, Section 3, Chung-Hsiao East Road, Taipei 106, Taiwan
| | - Umamaheswari Rajaji
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, No. 1, Section 3, Chung-Hsiao East Road, Taipei 106, Taiwan
| | - Shen-Ming Chen
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, No. 1, Section 3, Chung-Hsiao East Road, Taipei 106, Taiwan.
| | - Akilarasan Muthumariyappan
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, No. 1, Section 3, Chung-Hsiao East Road, Taipei 106, Taiwan
| | - Muneerah Mogren Al Mogren
- Chemistry Department, Faculty of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia
| | - R Jothi Ramalingam
- Surfactant Research Chair, Chemistry Department, College of Science, King Saud University, P.O. Box-2455, Riyadh 11451, Saudi Arabia
| | - Majdi Hochlaf
- Laboratoire Modelisation et Simulation Multi Echelle, MSME UMR 8208 CNRS, Universit́ e Paris-Est, ́5 Blvd. Descartes, 77454 Marne-la-Vallee, France
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Dauphin-Ducharme P, Yang K, Arroyo-Currás N, Ploense KL, Zhang Y, Gerson J, Kurnik M, Kippin TE, Stojanovic MN, Plaxco KW. Electrochemical Aptamer-Based Sensors for Improved Therapeutic Drug Monitoring and High-Precision, Feedback-Controlled Drug Delivery. ACS Sens 2019; 4:2832-2837. [PMID: 31556293 PMCID: PMC6886665 DOI: 10.1021/acssensors.9b01616] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The electrochemical aptamer-based (E-AB) sensing platform appears to be a convenient (rapid, single-step, and calibration-free) and modular approach to measure concentrations of specific molecules (irrespective of their chemical reactivity) directly in blood and even in situ in the living body. Given these attributes, the platform may thus provide significant opportunities to render therapeutic drug monitoring (the clinical practice in which dosing is adjusted in response to plasma drug measurements) as frequent and convenient as the measurement of blood sugar has become for diabetics. The ability to measure arbitrary molecules in the body in real time could even enable closed-loop feedback control over plasma drug levels in a manner analogous to the recently commercialized controlled blood sugar systems. As initial exploration of this, we describe here the selection of an aptamer against vancomycin, a narrow therapeutic window antibiotic for which therapeutic monitoring is a critical part of the standard of care, and its adaptation into an electrochemical aptamer-based (E-AB) sensor. Using this sensor, we then demonstrate: (i) rapid (seconds) and convenient (single-step and calibration-free) measurement of plasma vancomycin in finger-prick-scale samples of whole blood, (ii) high-precision measurement of subject-specific vancomycin pharmacokinetics (in a rat animal model), and (iii) high-precision, closed-loop feedback control over plasma levels of the drug (in a rat animal model). The ability to not only track (with continuous-glucose-monitor-like measurement frequency and convenience) but also actively control plasma drug levels provides an unprecedented route toward improving therapeutic drug monitoring and, more generally, the personalized, high-precision delivery of pharmacological interventions.
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Affiliation(s)
- Philippe Dauphin-Ducharme
- Department of Chemistry and Biochemistry, University of California, Santa Barbara, Santa Barbara, California 93106, United States
- Center for Bioengineering, University of California, Santa Barbara, Santa Barbara, California 93106, United States
| | - Kyungae Yang
- Center for Innovative Diagnostic and Therapeutic Approaches, Department of Medicine, Columbia University, New York, New York 10032, United States
| | - Netzahualcóyotl Arroyo-Currás
- Department of Pharmacology and Molecular Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, United States
| | - Kyle L. Ploense
- Department of Chemistry and Biochemistry, University of California, Santa Barbara, Santa Barbara, California 93106, United States
- Center for Bioengineering, University of California, Santa Barbara, Santa Barbara, California 93106, United States
| | - Yameng Zhang
- Center for Innovative Diagnostic and Therapeutic Approaches, Department of Medicine, Columbia University, New York, New York 10032, United States
| | - Julian Gerson
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, Santa Barbara, California 93106, United States
- Department of Molecular, Cellular and Developmental Biology, University of California, Santa Barbara, Santa Barbara, California 93106, United States
- Neuroscience Research Institute, University of California, Santa Barbara, Santa Barbara, California 93106, United States
| | - Martin Kurnik
- Department of Chemistry and Biochemistry, University of California, Santa Barbara, Santa Barbara, California 93106, United States
- Center for Bioengineering, University of California, Santa Barbara, Santa Barbara, California 93106, United States
| | - Tod E. Kippin
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, Santa Barbara, California 93106, United States
- Department of Molecular, Cellular and Developmental Biology, University of California, Santa Barbara, Santa Barbara, California 93106, United States
- Neuroscience Research Institute, University of California, Santa Barbara, Santa Barbara, California 93106, United States
| | - Milan N. Stojanovic
- Center for Innovative Diagnostic and Therapeutic Approaches, Department of Medicine, Columbia University, New York, New York 10032, United States
- Department of Biomedical Engineering and Systems Biology, Columbia University, New York, New York 10032, United States
| | - Kevin W. Plaxco
- Department of Chemistry and Biochemistry, University of California, Santa Barbara, Santa Barbara, California 93106, United States
- Center for Bioengineering, University of California, Santa Barbara, Santa Barbara, California 93106, United States
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Kiss T, Timár Z, Szabó A, Lukács A, Velky V, Oszlánczi G, Horváth E, Takács I, Zupkó I, Csupor D. Effect of green tea on the gastrointestinal absorption of amoxicillin in rats. BMC Pharmacol Toxicol 2019; 20:54. [PMID: 31470904 PMCID: PMC6717353 DOI: 10.1186/s40360-019-0332-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 08/23/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The investigation of food-drug and plant-drug interactions has become increasingly important. In case of antibiotics, it is essential to achieve and maintain a plasma concentration sufficient for the antimicrobial action. Although, on theoretical basis, the interaction of polyphenols and antibiotics may be hypothesized, experimental data are lacking to assess its clinical relevance. The aim of our study was to assess the interaction between one of the most widely used antibiotics, amoxicillin, and green tea, the most frequently consumed drink with high polyphenol content. METHODS The effects of green tea on the plasma level of amoxicillin was studied in an in vivo experiment in rats. The plasma level of amoxicillin was monitored by LC-MS/MS for 240 min after oral administration. The polyphenol content of green tea was determined by the Folin-Ciocalteu method. RESULTS The peak plasma concentration of amoxicillin significantly decreased upon its co-administration with green tea, although the AUC0-240 of the antibiotic did not decrease significantly in the group treated with amoxicillin suspended in green tea. CONCLUSIONS Our results suggest a potentially relevant interaction between green tea and amoxicillin, worth being further studied in humans.
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Affiliation(s)
- Tivadar Kiss
- Department of Pharmacognosy, Faculty of Pharmacy, University of Szeged, Eötvös utca 6, Szeged, H-6720 Hungary
- Interdisciplinary Centre for Natural Products, University of Szeged, Eötvös utca 6, Szeged, H-6720 Hungary
| | - Zoltán Timár
- SOLVO Biotechnology, Közép Fasor 52, Szeged, H-6726 Hungary
| | - Andrea Szabó
- Interdisciplinary Centre for Natural Products, University of Szeged, Eötvös utca 6, Szeged, H-6720 Hungary
- Department of Public Health, Faculty of Medicine, University of Szeged, Dóm tér 10, Szeged, H-6720 Hungary
| | - Anita Lukács
- Interdisciplinary Centre for Natural Products, University of Szeged, Eötvös utca 6, Szeged, H-6720 Hungary
- Department of Public Health, Faculty of Medicine, University of Szeged, Dóm tér 10, Szeged, H-6720 Hungary
| | - Viktória Velky
- SOLVO Biotechnology, Közép Fasor 52, Szeged, H-6726 Hungary
| | - Gábor Oszlánczi
- Interdisciplinary Centre for Natural Products, University of Szeged, Eötvös utca 6, Szeged, H-6720 Hungary
- Department of Public Health, Faculty of Medicine, University of Szeged, Dóm tér 10, Szeged, H-6720 Hungary
| | - Edina Horváth
- Department of Public Health, Faculty of Medicine, University of Szeged, Dóm tér 10, Szeged, H-6720 Hungary
| | - István Takács
- Department of Pharmacognosy, Faculty of Pharmacy, University of Szeged, Eötvös utca 6, Szeged, H-6720 Hungary
| | - István Zupkó
- Interdisciplinary Centre for Natural Products, University of Szeged, Eötvös utca 6, Szeged, H-6720 Hungary
- Department of Pharmacodynamics and Biopharmacy, University of Szeged, Eötvös utca 6, Szeged, H-6720 Hungary
| | - Dezső Csupor
- Department of Pharmacognosy, Faculty of Pharmacy, University of Szeged, Eötvös utca 6, Szeged, H-6720 Hungary
- Interdisciplinary Centre for Natural Products, University of Szeged, Eötvös utca 6, Szeged, H-6720 Hungary
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Li Y, Du Q, Zhang X, Huang Y. Ratiometric detection of tetracycline based on gold nanocluster enhanced Eu 3+ fluorescence. Talanta 2019; 206:120202. [PMID: 31514885 DOI: 10.1016/j.talanta.2019.120202] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 07/25/2019] [Accepted: 07/30/2019] [Indexed: 11/19/2022]
Abstract
Tetracycline (TC), a widely-used antibiotic to treat bacterial infections, combines with Eu3+ to form a stable EuTC complex that has a low fluorescence (FL) yield because of Eu3+ coordination with water molecules. We report a simple, label-free ratiometric fluorescent platform for sensitively and selectively sensing of TC, using L-histidine caped gold nanoclusters (His-AuNCs) as a FL indicator and an enhancer of Eu3+ FL. The His-AuNCs were prepared via chemical reduction of Au(III) by L-histidine, which was a reducer and a protecting agent. The His-AuNCs exhibited good photostability, outstanding stability toward high ionic strengths, storage stability, and favorable optical properties. In the absence of TC, the AuNCs-Eu3+ system displays strong FL emission at 475 nm (F475) from the His-AuNCs and weak FL at 620 nm from Eu3+ (F620) with excitation at 375 nm. TC quenches the His-AuNC FL and greatly enhances the Eu3+ emission. This is attributed to an enhancement of the EuTC complex fluorescence by the His-AuNCs. Thus, a ratiometric F620/F475 FL signal can be used for TC detection by simply mixing AuNCs and Eu3+. Under the optimized conditions, the linear range from 10 nM to 60 μM and a detection limit of 4 nM (S/N = 3) for TC were obtained. The application of the assay platform for the detection of TC in environmental and biological samples was demonstrated. The sensing platform has advantages of easy preparation, rapid response, high sensitivity, and good selectivity.
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Affiliation(s)
- Yuanyuan Li
- Key Laboratory of Eco-environments in Three Gorges Reservoir Region, Ministry of Education, College of Chemistry and Chemical Engineering, Southwest University, Chongqing, 400715, China
| | - Qianqian Du
- Key Laboratory of Eco-environments in Three Gorges Reservoir Region, Ministry of Education, College of Chemistry and Chemical Engineering, Southwest University, Chongqing, 400715, China
| | - Xiaodan Zhang
- Key Laboratory of Eco-environments in Three Gorges Reservoir Region, Ministry of Education, College of Chemistry and Chemical Engineering, Southwest University, Chongqing, 400715, China
| | - Yuming Huang
- Key Laboratory of Eco-environments in Three Gorges Reservoir Region, Ministry of Education, College of Chemistry and Chemical Engineering, Southwest University, Chongqing, 400715, China.
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Li J, Das S, Zhou D, Al-Huniti N. Population Pharmacokinetic Modeling and Probability of Target Attainment Analyses in Asian Patients With Community-Acquired Pneumonia Treated With Ceftaroline Fosamil. Clin Pharmacol Drug Dev 2019; 8:682-694. [PMID: 31044546 DOI: 10.1002/cpdd.673] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 02/26/2019] [Indexed: 01/05/2023]
Abstract
Efficacy of ceftaroline fosamil, the prodrug of the active metabolite ceftaroline, was demonstrated in a phase 3 study of hospitalized Asian patients with Pneumonia Outcomes Research Team (PORT) risk class III-IV community-acquired pneumonia (NCT01371838). The objectives of the current analysis were to expand an existing ceftaroline and ceftaroline fosamil population pharmacokinetic (PK) model with data from this phase 3 study and a phase 1 study (NCT01458743) assessing ceftaroline PK in healthy Chinese volunteers and to evaluate the probability of PK/pharmacodynamic (PK/PD) target attainment (PTA) in Asian patients with community-acquired pneumonia (CAP) treated with ceftaroline fosamil. The ceftaroline plasma concentration-time course was simulated for 5000 Asian patients with CAP for different renal function subgroups using the final model. PTA was calculated for Streptococcus pneumoniae, Staphylococcus aureus, and non-extended-spectrum β-lactamase-producing Enterobacteriaceae. PTA was also evaluated for ceftaroline MIC90 values of isolates collected from Asia-Pacific surveillance studies (2012-2014) and for EUCAST and FDA/CLSI ceftaroline susceptibility break points. The final model reasonably described the ceftaroline PK. Race was not found to be a significant covariate impacting ceftaroline PK, suggesting similar ceftaroline PK in Asian and Western populations when corrected for body weight. High PTAs (90%-100%) were predicted for Asian patients with CAP treated with ceftaroline fosamil, covering MIC90 values of target CAP pathogens from the region. Similarly, >90% PTAs were predicted at EUCAST and FDA/CLSI clinical break points for these pathogens. These results support the use of the ceftaroline fosamil dosing regimens approved in Europe and the United States in Asian patients with PORT III-IV CAP.
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Suzuki S, Naito S, Numasawa Y, Asada M, Shoji N, Zeniya M, Takahashi D, Sato H, Iimori S, Nomura N, Sohara E, Okado T, Ishiwata Y, Nagata M, Rai T, Yokota T, Uchida S. Encephalopathy Induced by High Plasma and Cerebrospinal Fluid Ceftriaxone Concentrations in a Hemodialysis Patient. Intern Med 2019; 58:1775-1779. [PMID: 30799339 PMCID: PMC6630125 DOI: 10.2169/internalmedicine.1785-18] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Encephalopathy is a rare side effect of cephalosporin treatment. We herein present a case of encephalopathy induced by ceftriaxone, a third-generation cephalosporin, in a patient with renal failure. An 86-year-old woman on maintenance hemodialysis received ceftriaxone for Helicobacter cinaedi bacteremia. Her mental status deteriorated during antibiotic treatment, and an electroencephalogram revealed triphasic waves predominantly in the frontal area. Her consciousness improved after the discontinuation of the antibiotic due to the suspicion of ceftriaxone-induced encephalopathy. This is the first reported case of encephalopathy associated with high plasma and cerebrospinal fluid ceftriaxone concentrations, and provides significant evidence for a causal relationship between the administration of ceftriaxone and the onset of encephalopathy.
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Affiliation(s)
- Soichiro Suzuki
- Department of Nephrology, Tokyo Medical and Dental University, Japan
| | - Shotaro Naito
- Department of Nephrology, Tokyo Medical and Dental University, Japan
| | - Yoshiyuki Numasawa
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Japan
| | - Mizuho Asada
- Department of Pharmacy, Medical Hospital, Tokyo Medical and Dental University, Japan
| | - Norikazu Shoji
- Department of Nephrology, Tokyo Medical and Dental University, Japan
| | - Moko Zeniya
- Department of Nephrology, Tokyo Medical and Dental University, Japan
| | - Daiei Takahashi
- Department of Nephrology, Tokyo Medical and Dental University, Japan
| | - Hidehiko Sato
- Department of Nephrology, Tokyo Medical and Dental University, Japan
| | - Soichiro Iimori
- Department of Nephrology, Tokyo Medical and Dental University, Japan
| | - Naohiro Nomura
- Department of Nephrology, Tokyo Medical and Dental University, Japan
| | - Eisei Sohara
- Department of Nephrology, Tokyo Medical and Dental University, Japan
| | - Tomokazu Okado
- Department of Nephrology, Tokyo Medical and Dental University, Japan
| | - Yasuyoshi Ishiwata
- Department of Pharmacy, Medical Hospital, Tokyo Medical and Dental University, Japan
| | - Masashi Nagata
- Department of Pharmacy, Medical Hospital, Tokyo Medical and Dental University, Japan
| | - Tatemitsu Rai
- Department of Nephrology, Tokyo Medical and Dental University, Japan
| | - Takanori Yokota
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Japan
| | - Shinichi Uchida
- Department of Nephrology, Tokyo Medical and Dental University, Japan
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Spaggiari D, Desfontaine V, Cruchon S, Guinchard S, Vocat A, Blattes E, Pitteloud J, Ciullini L, Bardinet C, Ivanyuk A, Makarov V, Ryabova O, Buclin T, Cole ST, Decosterd LA. Development and validation of a multiplex UHPLC-MS/MS method for the determination of the investigational antibiotic against multi-resistant tuberculosis macozinone (PBTZ169) and five active metabolites in human plasma. PLoS One 2019; 14:e0217139. [PMID: 31150423 PMCID: PMC6544242 DOI: 10.1371/journal.pone.0217139] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 05/07/2019] [Indexed: 12/31/2022] Open
Abstract
The emergence of Mycobacterium tuberculosis strains resistant to current first-line antibiotic regimens constitutes a major global health threat. New treatments against multidrug-resistant tuberculosis (MDR-TB) are thus eagerly needed in particular in countries with a high MDR-TB prevalence. In this context, macozinone (PBTZ169), a promising drug candidate with an unique mode of action and highly potent in vitro tuberculocidal properties against MDR Mycobacterium strains, has now reached the clinical phase and has been notably tested in healthy male volunteers in Switzerland. To that endeavor, a multiplex UHPLC-MS/MS method has been developed for the sensitive and accurate human plasma levels determination of PBTZ169 along with five metabolites retaining in vitro anti-TB activity. Plasma protein precipitation with methanol was carried out as a simplified sample clean-up procedure followed by direct injection of the undiluted supernatant for the bioanalysis of the six analytes within 5 min, using 1.8 μm reversed-phase chromatography coupled to triple quadrupole mass spectrometry employing electrospray ionization in the positive mode. Stable isotopically-labelled PBTZ169 was used as internal standard (ISTD), while metabolites could be reliably quantified using two unlabeled chemical analogues selected as ISTD from a large in-house analogous compounds library. The overall methodology was fully validated according to current recommendations (FDA, EMEA) for bioanalytical methods, which include selectivity, carryover, qualitative and quantitative matrix effect, extraction recovery, process efficiency, trueness, precision, accuracy profiles, method and instrument detection limits, integrity to dilution, anticoagulant comparison and short- and long-term stabilities. Stability studies on the reduced metabolite H2-PBTZ169 have shown no significant impact on the actual PBTZ169 concentrations determined with the proposed assay. This simplified, rapid, sensitive and robust methodology has been applied to the bioanalysis of human plasma samples collected within the frame of a phase I clinical study in healthy volunteers receiving PBTZ169.
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Affiliation(s)
- Dany Spaggiari
- Laboratory & Service of Clinical Pharmacology, Department of Laboratories, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Vincent Desfontaine
- Laboratory & Service of Clinical Pharmacology, Department of Laboratories, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Sandra Cruchon
- Laboratory & Service of Clinical Pharmacology, Department of Laboratories, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Sylvie Guinchard
- Laboratory & Service of Clinical Pharmacology, Department of Laboratories, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Anthony Vocat
- Global Health Institute, School of Life Sciences, EPFL, Lausanne, Switzerland
| | - Emilyne Blattes
- Innovative Medicines for Tuberculosis (IM4TB), Lausanne, Switzerland
| | - Jeff Pitteloud
- Laboratory & Service of Clinical Pharmacology, Department of Laboratories, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Lorenzo Ciullini
- Laboratory & Service of Clinical Pharmacology, Department of Laboratories, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Carine Bardinet
- Laboratory & Service of Clinical Pharmacology, Department of Laboratories, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Anton Ivanyuk
- Laboratory & Service of Clinical Pharmacology, Department of Laboratories, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Vadim Makarov
- Innovative Medicines for Tuberculosis (IM4TB), Lausanne, Switzerland
- Federal Research Center “Fundamentals of Biotechnology RAS”, Moscow, Russia
| | - Olga Ryabova
- Federal Research Center “Fundamentals of Biotechnology RAS”, Moscow, Russia
| | - Thierry Buclin
- Laboratory & Service of Clinical Pharmacology, Department of Laboratories, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Stewart T. Cole
- Global Health Institute, School of Life Sciences, EPFL, Lausanne, Switzerland
- Innovative Medicines for Tuberculosis (IM4TB), Lausanne, Switzerland
| | - Laurent A. Decosterd
- Laboratory & Service of Clinical Pharmacology, Department of Laboratories, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
- * E-mail:
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Abstract
Objectives: To assess the appropriateness of vancomycin dosing and monitoring at Lebanese hospitals. Methods: This was a multicenter retrospective study conducted at 3 Lebanese hospitals between January and March 2018. Patients 18 years of age and older treated with vancomycin for a systemic infection or prophylaxis were eligible for study enrollment. Consistency with the Infectious Diseases Society of America guidelines was evaluated to determine whether the dose of vancomycin was appropriate, as well as for the time of trough measurement, and the target concentration obtained. Results: From a total of 120 patients who met the inclusion criteria, only 11 (12%) were given the appropriate maintenance dose of vancomycin with respect to actual body weight. The trough levels were monitored for 67 (55.8%) patients, with 20 (29.9%) of these patients achieving appropriate therapeutic trough levels of 15-20 mg/l. The trough concentration time measurement before the fourth dose was only carried out in 28 (41.8%) of the 67 patients. Conclusion: This study reveals a gap between the appropriate utilization of vancomycin with respect to the international guidelines in the studied Lebanese hospitals. It highlights the need for dosing and monitoring protocols suitable for vancomycin utilization in these hospitals.
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Affiliation(s)
- Diana N Malaeb
- Department of Clinical Practice, Lebanese International University, Mouseitbah, Lebanon. E-mail.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Suraritdechachai S, Charoenpakdee C, Young I, Maher S, Vilaivan T, Praneenararat T. Rapid Detection of the Antibiotic Sulfamethazine in Pig Body Fluids by Paper Spray Mass Spectrometry. J Agric Food Chem 2019; 67:3055-3061. [PMID: 30799617 DOI: 10.1021/acs.jafc.9b00500] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We report herein a practical method for nonlethal detection of the antibiotic sulfamethazine in pig body fluids via the combination of simple extraction and paper spray mass spectrometry (PS-MS). This method requires minimal sample preparation while still providing high sensitivities and accuracies in complex matrices including pig whole blood (LOD = 7.9 μg/L; recovery = 95.4-103.7%), pig serum (LOD = 11.5 μg/L; recovery = 103.2-106.2%), and synthetic urine (LOD = 11.2 μg/L; recovery = 99.1-103.2%). Given a known correlation between the level of sulfamethazine in body fluids and edible tissues, this method shows great promise as a practical and nonlethal solution for rapid testing of the drug, which can substantially aid managerial decision in the livestock industry.
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Affiliation(s)
- Surased Suraritdechachai
- Department of Chemistry, Faculty of Science , Chulalongkorn University , Phayathai Road , Pathumwan, Bangkok , 10330 , Thailand
- The Chemical Approaches for Food Applications Research Group, Faculty of Science , Chulalongkorn University , Phayathai Road , Pathumwan, Bangkok , 10330 , Thailand
| | - Chayan Charoenpakdee
- Department of Chemistry, Faculty of Science , Chulalongkorn University , Phayathai Road , Pathumwan, Bangkok , 10330 , Thailand
- Organic Synthesis Research Unit, Department of Chemistry, Faculty of Science , Chulalongkorn University , Phayathai Road , Pathumwan, Bangkok , 10330 , Thailand
| | - Iain Young
- Institute of Integrative Biology , University of Liverpool , Crown Street , Liverpool , L69 7ZB , United Kingdom
| | - Simon Maher
- Department of Electrical Engineering & Electronics , University of Liverpool , Brownlow Hill , Liverpool , L69 3GJ , United Kingdom
| | - Tirayut Vilaivan
- Department of Chemistry, Faculty of Science , Chulalongkorn University , Phayathai Road , Pathumwan, Bangkok , 10330 , Thailand
- Organic Synthesis Research Unit, Department of Chemistry, Faculty of Science , Chulalongkorn University , Phayathai Road , Pathumwan, Bangkok , 10330 , Thailand
| | - Thanit Praneenararat
- Department of Chemistry, Faculty of Science , Chulalongkorn University , Phayathai Road , Pathumwan, Bangkok , 10330 , Thailand
- The Chemical Approaches for Food Applications Research Group, Faculty of Science , Chulalongkorn University , Phayathai Road , Pathumwan, Bangkok , 10330 , Thailand
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Kauss T, Langlois MH, Guyonnet-Dupérat A, Phoeung T, Xie XY, Cartwright A, White N, Gomes M, Gaudin K. Development of Rectodispersible Tablets and Granulate Capsules for the Treatment of Serious Neonatal Sepsis in Developing Countries. J Pharm Sci 2019; 108:2805-2813. [PMID: 30878515 DOI: 10.1016/j.xphs.2019.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/05/2019] [Accepted: 03/06/2019] [Indexed: 02/05/2023]
Abstract
Current pediatric antibiotic therapies often use oral and parenteral routes of administration. Neither are suitable for treating very sick neonates who cannot take oral medication and may be several hours away from hospital in developing countries. Here, we report on the development of rectal forms of ceftriaxone, a third-generation cephalosporin. Rectodispersible tablets and capsules were developed and successfully passed 6-month accelerated stability tests. Rabbit bioavailability showed plasma concentrations above the minimal inhibitory concentrations for 3 formulations of rectodispersible tablets and 2 formulations of hard capsules. Clinical batches are currently being prepared for human evaluation with the prospect of offering therapeutic alternatives for treating critically ill neonates. This proof of concept for efficient rectal delivery of antibiotics could help the development of other rectal antibiotic treatments and increase options for noninvasive drug development for pediatric patients.
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Affiliation(s)
- Tina Kauss
- Faculty of Pharmacy, University Bordeaux, EA 4575 Analytical and Pharmaceutical Developments Applied to Neglected Diseases and Counterfeits, Bordeaux, France.
| | - Marie-Hélène Langlois
- Faculty of Pharmacy, University Bordeaux, EA 4575 Analytical and Pharmaceutical Developments Applied to Neglected Diseases and Counterfeits, Bordeaux, France
| | - Alice Guyonnet-Dupérat
- Faculty of Pharmacy, University Bordeaux, EA 4575 Analytical and Pharmaceutical Developments Applied to Neglected Diseases and Counterfeits, Bordeaux, France
| | - Thida Phoeung
- Faculty of Pharmacy, University Bordeaux, EA 4575 Analytical and Pharmaceutical Developments Applied to Neglected Diseases and Counterfeits, Bordeaux, France
| | - Xiao Yu Xie
- Faculty of Pharmacy, University Bordeaux, EA 4575 Analytical and Pharmaceutical Developments Applied to Neglected Diseases and Counterfeits, Bordeaux, France
| | | | - Nicholas White
- Nuffield Department of Medicine, Centre for Tropical Medicine, University of Oxford, Oxford, UK; Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Melba Gomes
- World Health Organization, Geneva, Switzerland
| | - Karen Gaudin
- Faculty of Pharmacy, University Bordeaux, EA 4575 Analytical and Pharmaceutical Developments Applied to Neglected Diseases and Counterfeits, Bordeaux, France
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Khadam MW, Ashraf MM, Naz U, Bukhari NI, Tahir IM, Asghar D. Disposition kinetics, renal clearance and urinary excretion of cefixime in adolescent Pakistani boys - DRUG ANALYSIS REPORT. J PAK MED ASSOC 2019; 69:367-372. [PMID: 30890829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To investigate the role of environmental variation, genetic differences and age on disposition kinetics, renal clearance and urinary excretion of oral cefixime 400mg in healthy boys. METHODS The cross-sectional study was conducted at the University of Agriculture, Faisalabad, Pakistan, from August 2014 to July 2015, and comprised healthy boys aged 12-17 years after oral administration of cefixime capsule 400mg. Serum and urine samples were collected before and after drug administration and were stored at - 20oC until evaluation of cefixime concentration in each sample by high performance liquid chromatography. Drug concentration versus time data was used for pharmacokinetic calculations using one compartment model. Data obtained for urinary excretion and renal clearance of cefixime was analysed using regression-correlation analysis. RESULTS There were eight boys in the study. Mean values for elimination half-life, volume of distribution and total body clearance were 2.4}0.2 hours, 0.9}0.0L/kg and 0.3}0.0L/h/kg, respectively. The ratio of renal clearance of cefixime (0.7 ml/min/kg) to that of endogenous creatinine (0.8ml/min/kg) was 0.9. Cumulative mean percentage of cefixime excreted from young adolescent boys was 11.6 } 0.5%. CONCLUSION Other than filtration, back-diffusion was also involved in renal handling of cefixime. There was enough indication that major portion of cefixime was excreted from a young body through bile.
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Sorli L, Luque S, Li J, Rodríguez E, Campillo N, Fernandez X, Soldado J, Domingo I, Montero M, Grau S, Horcajada JP. Colistin Use in Patients with Chronic Kidney Disease: Are We Underdosing Patients? Molecules 2019; 24:molecules24030530. [PMID: 30717123 PMCID: PMC6384574 DOI: 10.3390/molecules24030530] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 01/29/2019] [Accepted: 01/31/2019] [Indexed: 01/08/2023] Open
Abstract
Colistin is administered as its inactive prodrug colistimethate (CMS). Selection of an individualized CMS dose for each patient is difficult due to its narrow therapeutic window, especially in patients with chronic kidney disease (CKD). Our aim was to analyze CMS use in patients with CKD. Secondary objectives were to assess the safety and efficacy of CMS in this special population. In this prospective observational cohort study of CMS-treated CKD patients, CKD was defined as the presence of a glomerular filtration rate (GFR) < 60 mL/min/m2 for more than 3 months. The administered doses of CMS were compared with those recently published in the literature. Worsened CKD at the end of treatment (EOT) was evaluated with the RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease) criteria. Colistin plasma concentrations (Css) were measured using high-performance liquid chromatography. Fifty-nine patients were included. Thirty-six (61.2%) were male. The median age was 76 (45–95) years and baseline GFR was 36.6 ± 13.6. The daily mean CMS dosage used was compared with recently recommended doses (3.36 vs. 6.07; p < 0.001). Mean Css was 0.9 (0.2–2.9) mg/L, and Css was <2 mg/L in 50 patients (83.3%). Clinical cure was achieved in 43 (72.9%) patients. Worsened renal function at EOT was present in 20 (33.9%) patients and was reversible in 10 (52.6%). The CMS dosages used in this cohort were almost half those currently recommended. The mean achieved Css were under the recommended target of 2 mg/dL. Despite this, clinical cure rate was high. In this patient cohort, the incidence of nephrotoxicity was similar to those found in other recent studies performed in the general population and was reversible in 52.6%. These results suggest that CMS is safe and effective in patients with CKD and may encourage physicians to adjust dosage regimens to recent recommendations in order to optimize CMS treatments.
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Affiliation(s)
- Luisa Sorli
- Infectious Diseases Department, Hospital del Mar, Infectious Pathology and Antimicrobial Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, 08003 Barcelona, Spain.
- Spanish Network for Research in Infectious Diseases (REIPI RD 16/0016/0015), Instituto de Salud Carlos III, 28001 Madrid, Spain.
| | - Sonia Luque
- Spanish Network for Research in Infectious Diseases (REIPI RD 16/0016/0015), Instituto de Salud Carlos III, 28001 Madrid, Spain.
- Pharmacy Department, Hospital del Mar, Infectious Pathology and Antimicrobial Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, 08003 Barcelona, Spain.
| | - Jian Li
- Monash Biomedicine Discovery Institute, Department of Microbiology, Monash University, Clayton, 3800 Victoria, Australia.
| | - Eva Rodríguez
- Nephrology Department, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB). CEXS-Universitat Pompeu Fabra, 08003, 08003 Barcelona, Spain.
| | - Nuria Campillo
- Spanish Network for Research in Infectious Diseases (REIPI RD 16/0016/0015), Instituto de Salud Carlos III, 28001 Madrid, Spain.
- Pharmacy Department, Hospital del Mar, Infectious Pathology and Antimicrobial Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, 08003 Barcelona, Spain.
| | - Xenia Fernandez
- Spanish Network for Research in Infectious Diseases (REIPI RD 16/0016/0015), Instituto de Salud Carlos III, 28001 Madrid, Spain.
- Pharmacy Department, Hospital del Mar, Infectious Pathology and Antimicrobial Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, 08003 Barcelona, Spain.
| | - Jade Soldado
- Infectious Diseases Department, Hospital del Mar, Infectious Pathology and Antimicrobial Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, 08003 Barcelona, Spain.
- Spanish Network for Research in Infectious Diseases (REIPI RD 16/0016/0015), Instituto de Salud Carlos III, 28001 Madrid, Spain.
| | - Ignacio Domingo
- Infectious Diseases Department, Hospital del Mar, Infectious Pathology and Antimicrobial Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, 08003 Barcelona, Spain.
- Spanish Network for Research in Infectious Diseases (REIPI RD 16/0016/0015), Instituto de Salud Carlos III, 28001 Madrid, Spain.
| | - Milagro Montero
- Infectious Diseases Department, Hospital del Mar, Infectious Pathology and Antimicrobial Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, 08003 Barcelona, Spain.
- Spanish Network for Research in Infectious Diseases (REIPI RD 16/0016/0015), Instituto de Salud Carlos III, 28001 Madrid, Spain.
| | - Santiago Grau
- Spanish Network for Research in Infectious Diseases (REIPI RD 16/0016/0015), Instituto de Salud Carlos III, 28001 Madrid, Spain.
- Pharmacy Department, Hospital del Mar, Infectious Pathology and Antimicrobial Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, 08003 Barcelona, Spain.
| | - Juan P Horcajada
- Infectious Diseases Department, Hospital del Mar, Infectious Pathology and Antimicrobial Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, 08003 Barcelona, Spain.
- Spanish Network for Research in Infectious Diseases (REIPI RD 16/0016/0015), Instituto de Salud Carlos III, 28001 Madrid, Spain.
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Yoshida T, Yoshida S, Okada H, Suzuki A, Niwa T, Suzuki K, Ohmori T, Kobayashi R, Baba H, Suzuki K, Murakami N, Itoh Y, Ogura S. Risk factors for decreased teicoplanin trough concentrations during initial dosing in critically ill patients. Pharmazie 2019; 74:120-124. [PMID: 30782263 DOI: 10.1619/ph.2019.8731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Aim of the study: Here, we investigated the risk factors for decreased teicoplanin plasma trough concentrations relative to the initial dosing in critically ill patients. Patients and methods: Data obtained from 80 eligible critically ill patients who received intravenous teicoplanin were retrospectively analyzed. Risk factors for decreases in teicoplanin trough concentrations 72 h after administration of teicoplanin of more than 30% relative to predicted concentrations based on initial dosing setting were identified by logistic regression analysis. Results: Although prediction trough concentration and total dose of two days no significant differences were seen between the variation group and the non-variation group, actual trough concentration was significantly different between two groups (19.9±5.6 μg/ml vs 10.3±2.2 μg/ml, p < 0.001). In multivariate analysis, serum albumin ≤ 2.2 mg/dl (odds ratio [OR] = 3.003, 95% CI 1.072-8.408; p = 0.036) and SOFA score ≥ 9 (OR = 3.498, 95% CI 1.171-10.450; p = 0.025) were significant risk factors for decreased teicoplanin plasma trough concentrations. Conclusion: In critically ill patients, high SOFA score and low serum albumin were risk factors for decreased teicoplanin plasma trough concentration during initial dosing.
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Lacroix C, Kheloufi F, Montastruc F, Bennis Y, Pizzoglio V, Micallef J. Serious central nervous system side effects of cephalosporins: A national analysis of serious reports registered in the French Pharmacovigilance Database. J Neurol Sci 2019; 398:196-201. [PMID: 30683462 DOI: 10.1016/j.jns.2019.01.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/19/2018] [Accepted: 01/14/2019] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Among antibiotics, Central Nervous System (CNS) adverse drug reactions (ADRs) are often under-suspected and overlooked. Cephalosporins are an important cause of drug-induced CNS ADRs but the characteristics of such ADR have not been fully explored. We aimed to characterize the profile of cephalosporins serious CNS ADRs. METHOD We performed an analysis of serious reports recorded in the French Pharmacovigilance database from 1987 to 2017. RESULTS A total of 511 serious ADRs reports was analyzed. Patients had a mean age of 67.1 years and were mainly men (52.5%), with a mean creatinine clearance of 32.9 ml/min. The most involved molecules were cefepime (33.1%), ceftriaxone (29.7%), ceftazidime (19.6%), cefotaxime (9%) and cefazoline (2.9%), mostly administered intravenously (87.3%). A CNS history was observed in 25% of the reports (n = 128). Patients exhibited encephalopathy (30.3%), confusional state (19.4%), convulsion (15.1%), myoclonia (9.4%), status epilepticus (9.2%), coma (6.3%) and hallucination (4.3%). The mean time of onset was 7.7 days and the mean duration was 6 days. Cephalosporin plasma levels were recorded for 153 patients (29.9%) and 107 were above the standards including 62 (57.9%) related to renal impairment. Electroencephalograms were performed in 38.2% (n = 195) of the patients and 81% (n = 158) were abnormal. CONCLUSION This study characterizes an off-target CNS ADRs of several cephalosporins. Ceftriaxone represented a large part of our reports after cefepime and it would be relevant to warn healthcare professionals. Investigations (EEG, though plasma levels and renal function) can be precious tools for clinicians to make a prompt diagnosis and improve patients' outcomes.
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Affiliation(s)
- C Lacroix
- Centre Régional de Pharmacovigilance, Service de Pharmacologie Clinique et Pharmacovigilance, APHM, INSERM, Inst Neurosci Syst, Aix Marseille Univ, Marseille, France
| | - F Kheloufi
- Centre Régional de Pharmacovigilance, Service de Pharmacologie Clinique et Pharmacovigilance, APHM, INSERM, Inst Neurosci Syst, Aix Marseille Univ, Marseille, France
| | - F Montastruc
- Centre Midi-Pyrénées de Pharmacovigilance, Pharmacoépidémiologie et d'Informations sur le Médicament, Centre Hospitalier Universitaire, Faculté de Médecine, Service de Pharmacologie Médicale et Clinique, Toulouse, France; Unité clinique de Pharmacologie psychiatrique, Faculté de Médecine, Centre Hospitalier Universitaire, Toulouse, France
| | - Y Bennis
- Centre Régional de Pharmacovigilance, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | - V Pizzoglio
- Centre Régional de Pharmacovigilance, Hospices Civils de Lyon, Lyon, France
| | - J Micallef
- Centre Régional de Pharmacovigilance, Service de Pharmacologie Clinique et Pharmacovigilance, APHM, INSERM, Inst Neurosci Syst, Aix Marseille Univ, Marseille, France.
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Chambers J, Page-Sharp M, Salman S, Dyer J, Davis TME, Batty KT, Manning L. Ertapenem for osteoarticular infections in obese patients: a pharmacokinetic study of plasma and bone concentrations. Eur J Clin Pharmacol 2018; 75:511-517. [PMID: 30511329 DOI: 10.1007/s00228-018-2597-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 11/04/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Ertapenem is used off-label to treat osteoarticular infections but there are few pharmacokinetic (PK) data to guide optimal dosing strategies in patients who may be obese with multiple co-morbidities including diabetes and peripheral vascular disease. METHODS Participants undergoing lower limb amputation or elective joint arthroplasty received a dose of intravenous ertapenem prior to surgery. Eight plasma samples were collected over 24 h, together with at least one bone sample per patient. Ertapenem concentrations in plasma and bone were measured using liquid-chromatography/mass-spectroscopy and analysed using non-linear mixed effects PK modelling. RESULTS Plasma and bone concentrations were obtained from 10 participants. The final population PK model showed that a fat free body mass was the most appropriate body size adjustment. Ertapenem diffused rapidly into bone but concentrations throughout the 24 h dosing period were on average 40-fold higher in plasma, corresponding to a bone to plasma ratio of 0.025, and highly variable between individuals. Simulations demonstrated a high probability of target attainment (PTA) for free plasma concentrations when the minimum inhibitory concentrations (MIC) were ≤ 0.25 mg/L. By contrast, at MICs of 0.5 mg/L and ≥ 1 mg/L, the fractions of patients attaining this target was ~ 80% and 40%, respectively. In bone, the PTA was ≤ 45% when the MIC was ≥ 0.25 mg/L. CONCLUSION Local bone and free plasma concentrations appear adequate for osteoarticular infections where Enterobacteriaceae are the main causative pathogens, but for Staphylococcus aureus and other bacteria, conventional dosing may lead to inadequate PTA.
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Affiliation(s)
- Jonathan Chambers
- Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Madhu Page-Sharp
- School of Pharmacy and Biomedical Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Sam Salman
- Faculty of Health and Medical Sciences, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - John Dyer
- Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Timothy M E Davis
- Faculty of Health and Medical Sciences, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - Kevin T Batty
- School of Pharmacy and Biomedical Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Laurens Manning
- Faculty of Health and Medical Sciences, Harry Perkins Research Institute, Fiona Stanley Hospital, University of Western Australia, PO Box 404, Bull Creek 6149, Murdoch, Western Australia, Australia.
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Komirenko AS, Riddle V, Gibbons JA, Van Wart S, Seroogy JD. A Phase 1 Study To Assess the Pharmacokinetics of Intravenous Plazomicin in Adult Subjects with Varying Degrees of Renal Function. Antimicrob Agents Chemother 2018; 62:e01128-18. [PMID: 30275092 PMCID: PMC6256775 DOI: 10.1128/aac.01128-18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/29/2018] [Indexed: 12/31/2022] Open
Abstract
Plazomicin is an FDA-approved aminoglycoside for the treatment of complicated urinary tract infections. In this open-label study, 24 adults with normal renal function or mild, moderate, or severe renal impairment (n = 6 per group) received a single 7.5-mg/kg of body weight dose of plazomicin as a 30-min intravenous infusion. Total clearance declined with renal impairment, resulting in 1.98-fold and 4.42-fold higher plazomicin exposures, as measured by the area under the concentration-time curve from 0 h to infinity, in subjects with moderate and severe impairment, respectively, than in subjects with normal renal function. (This study has been registered at ClinicalTrials.gov under identifier NCT01462136.).
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Affiliation(s)
| | | | | | - Scott Van Wart
- Institute for Clinical Pharmacodynamics, Schenectady, New York, USA
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Asada M, Nagata M, Mizuno T, Uchida T, Kurashima N, Takahashi H, Makita K, Arai H, Echizen H, Yasuhara M. Effects of cardiopulmonary bypass on the disposition of cefazolin in patients undergoing cardiothoracic surgery. Pharmacol Res Perspect 2018; 6:e00440. [PMID: 30410768 PMCID: PMC6218359 DOI: 10.1002/prp2.440] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 09/27/2018] [Accepted: 10/02/2018] [Indexed: 11/21/2022] Open
Abstract
The aim of the study was to evaluate the disposition of plasma unbound cefazolin in patients undergoing cardiothoracic surgery with cardiopulmonary bypass (CPB). Adult patients undergoing cardiothoracic surgery with CPB were enrolled in the study. Cefazolin sodium was given intravenously before skin incision (1 g) and at the beginning of CPB (2 g). Thereafter, an additional dose (1 g) was given every 4 hours. Seven to ten blood samples were collected before and during surgery. Plasma total and unbound (ultrafiltrated) cefazolin concentrations were analyzed using an HPLC-UV method. Plasma protein binding was analyzed with the Langmuir model. Twenty-seven patients (aged 70 ± 12 years, body weight 62 ± 12 kg, mean ± SD) with GFR >30 mL min-1 completed the study. There was a significant (P < 0.001) increase in median plasma unbound fraction of cefazolin from 21% before skin incision to 45% during CPB (P < 0.001), which was accompanied by a significant (P < 0.001) reduction in median plasma albumin concentration from 36 to 27 g L-1. Plasma concentrations of unbound cefazolin exceeded the assumed target thresholds of 2 μg mL-1 in all samples and of 8 μg mL-1 in all but one of 199 samples. The increased plasma unbound fraction of cefazolin would be attributable to dilutional reduction of serum albumin at the beginning of CPB and to saturable plasma protein binding of cefazolin. These data reveal CPB may alter the plasma protein binding and possibly distribution of cefazolin. Further studies are warranted to reappraise the protocol of antimicrobial prophylaxis with cefazolin in patients undergoing surgery with CPB.
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Affiliation(s)
- Mizuho Asada
- Department of PharmacyMedical HospitalTokyo Medical and Dental University (TMDU)TokyoJapan
| | - Masashi Nagata
- Department of PharmacyMedical HospitalTokyo Medical and Dental University (TMDU)TokyoJapan
- Department of Pharmacokinetics and PharmacodynamicsGraduate School of Medical and Dental SciencesTokyo Medical and Dental University (TMDU)TokyoJapan
| | - Tomohiro Mizuno
- Department of Cardiovascular SurgeryGraduate School of Medical and Dental ScienceTokyo Medical and Dental University (TMDU)TokyoJapan
| | - Tokujiro Uchida
- Department of AnesthesiologyGraduate School of Medical and Dental SciencesTokyo Medical and Dental University (TMDU)TokyoJapan
| | - Naoki Kurashima
- Medical Engineering CenterMedical Hospital of Tokyo Medical and Dental University (TMDU)TokyoJapan
| | - Hiromitsu Takahashi
- Department of PharmacyMedical HospitalTokyo Medical and Dental University (TMDU)TokyoJapan
| | - Koshi Makita
- Department of AnesthesiologyGraduate School of Medical and Dental SciencesTokyo Medical and Dental University (TMDU)TokyoJapan
| | - Hirokuni Arai
- Department of Cardiovascular SurgeryGraduate School of Medical and Dental ScienceTokyo Medical and Dental University (TMDU)TokyoJapan
| | - Hirotoshi Echizen
- Department of PharmacotherapyMeiji Pharmaceutical UniversityTokyoJapan
| | - Masato Yasuhara
- Department of Pharmacokinetics and PharmacodynamicsGraduate School of Medical and Dental SciencesTokyo Medical and Dental University (TMDU)TokyoJapan
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Moczarnik J, Berger DJ, Noxon JO, LeVine DN, Lin Z, Coetzee JF, Mochel JP. Relative Oral Bioavailability of Two Amoxicillin-Clavulanic Acid Formulations in Healthy Dogs: A Pilot Study. J Am Anim Hosp Assoc 2018; 55:14-22. [PMID: 30427713 DOI: 10.5326/jaaha-ms-6872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The use of human generic amoxicillin-clavulanic acid formulations in veterinary medicine is currently lacking supportive evidence. This pilot study was conducted to determine preliminary pharmacokinetic parameters and relative oral bioavailability of a human generic and veterinary proprietary 4:1 amoxicillin-clavulanic acid formulation in healthy dogs to evaluate whether drug exposure was similar and to determine if further comparative investigation is warranted. Each dog received a single oral dose of each formulation containing 500:125 mg of amoxicillin-clavulanic acid at two separate instances with a 2 wk washout period between product administration. Following drug administration, blood was collected at fixed times over 24 hr to measure plasma amoxicillin and clavulanic acid concentrations using liquid chromatography-mass spectrometry. There were no statistically significant differences between pharmacokinetic parameters of either formulation. Clavulanic acid showed greater between-dog variation in drug exposure between formulations compared with amoxicillin and was also observed to be more variable within the veterinary proprietary formulation. The average relative oral bioavailability was 98.2% (23.6% coefficient of variation) for amoxicillin and 152.6% (64.3% coefficient of variation) for clavulanic acid between formulations. This pilot investigation supports the need for further bioequivalence studies regarding these formulations before commenting on product interchangeability.
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Affiliation(s)
- Jennifer Moczarnik
- From the Lloyd Veterinary Medical Center (J.M.), Department of Veterinary Clinical Sciences (D.J.B., J.O.N., D.N.L.), and Department of Biomedical Sciences (J.P.M.), College of Veterinary Medicine, Iowa State University, Ames, Iowa; and Department of Anatomy and Physiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas (Z.L., J.F.C.)
| | - Darren J Berger
- From the Lloyd Veterinary Medical Center (J.M.), Department of Veterinary Clinical Sciences (D.J.B., J.O.N., D.N.L.), and Department of Biomedical Sciences (J.P.M.), College of Veterinary Medicine, Iowa State University, Ames, Iowa; and Department of Anatomy and Physiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas (Z.L., J.F.C.)
| | - James O Noxon
- From the Lloyd Veterinary Medical Center (J.M.), Department of Veterinary Clinical Sciences (D.J.B., J.O.N., D.N.L.), and Department of Biomedical Sciences (J.P.M.), College of Veterinary Medicine, Iowa State University, Ames, Iowa; and Department of Anatomy and Physiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas (Z.L., J.F.C.)
| | - Dana N LeVine
- From the Lloyd Veterinary Medical Center (J.M.), Department of Veterinary Clinical Sciences (D.J.B., J.O.N., D.N.L.), and Department of Biomedical Sciences (J.P.M.), College of Veterinary Medicine, Iowa State University, Ames, Iowa; and Department of Anatomy and Physiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas (Z.L., J.F.C.)
| | - Zhoumeng Lin
- From the Lloyd Veterinary Medical Center (J.M.), Department of Veterinary Clinical Sciences (D.J.B., J.O.N., D.N.L.), and Department of Biomedical Sciences (J.P.M.), College of Veterinary Medicine, Iowa State University, Ames, Iowa; and Department of Anatomy and Physiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas (Z.L., J.F.C.)
| | - Johann F Coetzee
- From the Lloyd Veterinary Medical Center (J.M.), Department of Veterinary Clinical Sciences (D.J.B., J.O.N., D.N.L.), and Department of Biomedical Sciences (J.P.M.), College of Veterinary Medicine, Iowa State University, Ames, Iowa; and Department of Anatomy and Physiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas (Z.L., J.F.C.)
| | - Jonathan P Mochel
- From the Lloyd Veterinary Medical Center (J.M.), Department of Veterinary Clinical Sciences (D.J.B., J.O.N., D.N.L.), and Department of Biomedical Sciences (J.P.M.), College of Veterinary Medicine, Iowa State University, Ames, Iowa; and Department of Anatomy and Physiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas (Z.L., J.F.C.)
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Gwee A, Cranswick N, Donath SM, Hunt R, Curtis N. Protocol for a randomised controlled trial of continuous infusions of vancomycin to improve the attainment of target vancomycin levels in young infants: The VANC trial. BMJ Open 2018; 8:e022603. [PMID: 30391914 PMCID: PMC6231575 DOI: 10.1136/bmjopen-2018-022603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 09/14/2018] [Accepted: 09/17/2018] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Vancomycin is frequently used in the treatment of late-onset sepsis in young infants and is routinely administered as intermittent infusions (IIV); however, existing IIV dosing guidelines achieve target vancomycin levels in less than half of infants. Continuous infusions of vancomycin (CIV) are an attractive alternative as adult studies report a higher attainment of target vancomycin levels, simpler drug monitoring and fewer drug side effects. METHODS This is a multicentre, randomised controlled trial in which 200 young infants (aged 0-90 days) requiring vancomycin will be randomised to CIV or IIV for a duration determined by the treating clinician. Vancomycin levels will be measured immediately after the first dose in both arms. Trough and peak levels will be determined in the IIV arm and steady-state levels 18-30 hours after commencement of infusion will be measured in the CIV arm. Full blood count, urea and electrolytes, and C reactive protein level will be monitored throughout treatment. For all Gram-positive bacteria isolated from blood culture, a vancomycin Etest will be done to determine the minimum inhibitory concentration of the bacterium. ANALYSIS Primary outcome: the proportion of infants with levels within target range at their first steady-state concentration. SECONDARY OUTCOMES (1) the proportion of drug-related adverse effects; (2) the time to achieve target levels in the blood; (3) the pharmacodynamics of vancomycin (using non-linear mixed effect modelling). ETHICS AND DISSEMINATION The study has been approved by The Royal Children's Hospital Melbourne Human Research Ethics Committee (HREC) (No. 34030) and the South Eastern Sydney Local Health District HREC (SSA 16/G/335). Results will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT02210169.
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Affiliation(s)
- Amanda Gwee
- Departments of General Medicine and Neonatal Medicine, The Royal Children’s Hospital, Melbourne, Victoria, Australia
- Infectious Diseases & Microbiology, Neonatal Research, Clinical Epidemiology & Biostatistics Unit, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Noel Cranswick
- Departments of General Medicine and Neonatal Medicine, The Royal Children’s Hospital, Melbourne, Victoria, Australia
- Infectious Diseases & Microbiology, Neonatal Research, Clinical Epidemiology & Biostatistics Unit, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Susan M Donath
- Infectious Diseases & Microbiology, Neonatal Research, Clinical Epidemiology & Biostatistics Unit, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Rodney Hunt
- Departments of General Medicine and Neonatal Medicine, The Royal Children’s Hospital, Melbourne, Victoria, Australia
- Infectious Diseases & Microbiology, Neonatal Research, Clinical Epidemiology & Biostatistics Unit, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Nigel Curtis
- Departments of General Medicine and Neonatal Medicine, The Royal Children’s Hospital, Melbourne, Victoria, Australia
- Infectious Diseases & Microbiology, Neonatal Research, Clinical Epidemiology & Biostatistics Unit, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
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Mader MMD, Czorlich P, König C, Fuhrmann V, Kluge S, Westphal M, Grensemann J. Intrathecal penetration of meropenem and vancomycin administered by continuous infusion in patients suffering from ventriculitis-a retrospective analysis. Acta Neurochir (Wien) 2018; 160:2099-2105. [PMID: 30242495 DOI: 10.1007/s00701-018-3680-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 09/12/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Vancomycin and meropenem are frequently used as empiric treatment for ventriculitis. Penetration into the cerebrospinal fluid (CSF) depends on various factors with a high inter-individual variability. Because attaining and maintaining adequate concentrations of meropenem and vancomycin in the CSF is crucial for their bactericidal effect, we introduced a routine therapeutic drug monitoring (TDM) from CSF and serum for both antibiotics. We studied the antibiotic penetration into the CSF. METHODS Patient data including serum and CSF concentrations for meropenem and vancomycin were collected in a retrospective fashion. Antibiotic CSF penetration ratio was calculated for each patient. Antibiotics were administered by continuous infusion aiming for serum target concentrations of 20-30 mg/L for vancomycin and 16-32 mg/L for meropenem. RESULTS Twenty-two patients with 36 CSF/serum pairs for meropenem and 43 pairs for vancomycin were studied. No patient suffered from renal or liver insufficiency. Mean vancomycin serum concentration was 22 ± 8 mg/L and the mean CSF concentration 4.5 ± 2.6 mg/L. CSF penetration was 20 ± 11% (coefficient of determination (R2) 0.02). For meropenem, the mean serum concentration was 30.7 ± 14.9 mg/L, mean CSF concentration 5.5 ± 5.2 mg/L, and a penetration of 18 ± 12%, R2 = 0.42. CONCLUSION Penetration of meropenem and vancomycin into the CSF is low while showing a high interindividual variability. Various patients in our study cohort were at risk for insufficient target attainment in CSF. Continuous administration of antibiotics under routine TDM appears to be a feasible and reasonable approach for optimization of intrathecal drug levels in patients suffering from ventriculitis. TDM might guide individual dosing adaptation and efforts to predict the CSF penetration of meropenem and vancomycin in cases of ventriculitis.
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Affiliation(s)
- Marius Marc-Daniel Mader
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Patrick Czorlich
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Christina König
- Hospital Pharmacy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Valentin Fuhrmann
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Jörn Grensemann
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
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