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Wilson RC, Riezk A, Arkell P, Ming D, Armiger R, Latham V, Gilchrist MJ, Märtson AG, Hope WW, Holmes AH, Rawson TM. Towards pharmacokinetic boosting of phenoxymethylpenicillin (penicillin-V) using probenecid for the treatment of bacterial infections. Sci Rep 2024; 14:16762. [PMID: 39034340 PMCID: PMC11271292 DOI: 10.1038/s41598-024-67354-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 07/10/2024] [Indexed: 07/23/2024] Open
Abstract
In the face of increasing antimicrobial tolerance and resistance there is a global obligation to optimise oral antimicrobial dosing strategies including narrow spectrum penicillins, such as penicillin-V. We conducted a randomised, crossover study in healthy volunteers to characterise the influence of probenecid on penicillin-V pharmacokinetics and estimate the pharmacodynamics against Streptococcus pneumoniae. Twenty participants took six doses of penicillin-V (250 mg, 500 mg or 750 mg four times daily) with and without probenecid. Total and free concentrations of penicillin-V and probenecid were measured at two timepoints. A pharmacokinetic model was developed, and the probability of target attainment (PTA) calculated. The mean difference (95% CI) between penicillin-V alone and in combination with probenecid for serum total and free penicillin-V concentrations was significantly different at both timepoints (total: 45 min 4.32 (3.20-5.32) mg/L p < 0.001, 180 min 2.2 (1.58-3.25) mg/L p < 0.001; free: 45 min 1.15 (0.88-1.42) mg/L p < 0.001, 180 min 0.5 (0.35-0.76) mg/L p < 0.001). There was no difference between the timepoints in probenecid concentrations. PTA analysis shows probenecid allows a fourfold increase in MIC cover. Addition of probenecid was safe and well tolerated. The data support further research into improved dosing structures for complex outpatient therapy and might also be used to address penicillin supply shortages.
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Affiliation(s)
- Richard C Wilson
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK.
- Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, Acton, London, W12 0NN, UK.
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK.
- David Price Evans Infectious Diseases and Global Health Group, The University of Liverpool, Liverpool, L7 8TX, UK.
| | - Alaa Riezk
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
- Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, Acton, London, W12 0NN, UK
| | - Paul Arkell
- Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, Acton, London, W12 0NN, UK
| | - Damien Ming
- Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, Acton, London, W12 0NN, UK
| | - Ryan Armiger
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
- Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, Acton, London, W12 0NN, UK
| | - Victoria Latham
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - Mark J Gilchrist
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
- Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, Acton, London, W12 0NN, UK
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - Anne-Grete Märtson
- Leiden Academic Centre for Drug Research, Leiden University, 2333 AL, Leiden, The Netherlands
| | - William W Hope
- Antimicrobial Pharmacodynamics and Therapeutics Group, The University of Liverpool, Liverpool, L7 8TX, UK
| | - Alison H Holmes
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
- Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, Acton, London, W12 0NN, UK
- David Price Evans Infectious Diseases and Global Health Group, The University of Liverpool, Liverpool, L7 8TX, UK
| | - Timothy M Rawson
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
- Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, Acton, London, W12 0NN, UK
- David Price Evans Infectious Diseases and Global Health Group, The University of Liverpool, Liverpool, L7 8TX, UK
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2
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Wiesner A, Zagrodzki P, Paśko P. Do dietary interventions exert clinically important effects on the bioavailability of β-lactam antibiotics? A systematic review with meta-analyses. J Antimicrob Chemother 2024; 79:722-757. [PMID: 38334389 DOI: 10.1093/jac/dkae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/17/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Managing drug-food interactions may help to achieve the optimal action and safety profile of β-lactam antibiotics. METHODS We conducted a systematic review with meta-analyses in adherence to PRISMA guidelines for 32 β-lactams. We included 166 studies assessing the impact of food, beverages, antacids or mineral supplements on the pharmacokinetic (PK) parameters or PK/pharmacodynamic (PK/PD) indices. RESULTS Eighteen of 25 β-lactams for which data on food impact were available had clinically important interactions. We observed the highest negative influence of food (AUC or Cmax decreased by >40%) for ampicillin, cefaclor (immediate-release formulations), cefroxadine, cefradine, cloxacillin, oxacillin, penicillin V (liquid formulations and tablets) and sultamicillin, whereas the highest positive influence (AUC or Cmax increased by >45%) for cefditoren pivoxil, cefuroxime and tebipenem pivoxil (extended-release tablets). Significantly lower bioavailability in the presence of antacids or mineral supplements occurred for 4 of 13 analysed β-lactams, with the highest negative impact for cefdinir (with iron salts) and moderate for cefpodoxime proxetil (with antacids). Data on beverage impact were limited to 11 antibiotics. With milk, the extent of absorption was decreased by >40% for cefalexin, cefradine, penicillin G and penicillin V, whereas it was moderately increased for cefuroxime. No significant interaction occurred with cranberry juice for two tested drugs (amoxicillin and cefaclor). CONCLUSIONS Factors such as physicochemical features of antibiotics, drug formulation, type of intervention, and patient's health state may influence interactions. Due to the poor actuality and diverse methodology of included studies and unproportionate data availability for individual drugs, we judged the quality of evidence as low.
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Affiliation(s)
- Agnieszka Wiesner
- Doctoral School of Medical and Health Sciences, Jagiellonian University Medical College, Krakow, Poland
- Department of Food Chemistry and Nutrition, Faculty of Pharmacy, Jagiellonian University Medical College, Krakow, Poland
| | - Paweł Zagrodzki
- Department of Food Chemistry and Nutrition, Faculty of Pharmacy, Jagiellonian University Medical College, Krakow, Poland
| | - Paweł Paśko
- Department of Food Chemistry and Nutrition, Faculty of Pharmacy, Jagiellonian University Medical College, Krakow, Poland
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Bowhay TR, Tsang T, Wei JCZ, Edwik W, Fridman A, Hubber J, Jo JY, Mckay N, O'Brien C, Osmond-Wallam J, Smythe J, Crump JA, Arnold B. Oral antimicrobial therapy for cellulitis versus outpatient parenteral antimicrobial therapy: a single-centre audit of cellulitis outcomes. Intern Med J 2024; 54:320-327. [PMID: 37461382 DOI: 10.1111/imj.16173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 06/05/2023] [Indexed: 02/15/2024]
Abstract
BACKGROUND Cellulitis is a common acute skin and soft tissue infection that causes substantial morbidity and healthcare costs. AIMS To audit the impact on cellulitis management, regimen tolerability and outcomes of switching from outpatient parenteral antimicrobial therapy (OPAT) using intravenous (i.v.) cefazolin once daily plus probenecid to oral beta-lactam therapy (OBLT) using oral flucloxacillin plus probenecid. METHODS We undertook a retrospective audit on cellulitis management, regimen tolerability and outcomes at the Dunedin Public Hospital Emergency Department (ED) before and after a change of the local outpatient cellulitis treatment pathway from OPAT using i.v. cefazolin once daily plus probenecid to OBLT using oral flucloxacillin plus probenecid. RESULTS OPAT was used in 97/123 (78.9%) patients with cellulitis before compared to 1/70 (1.4%) after the pathway change (odds ratio (OR), 0.04, P < 0.01). OBLT was used in 26/123 (21.1%) patients with cellulitis before and 69/70 (98.6%) after (OR, 218.8, P < 0.01). Antimicrobial change due to intolerance occurred in 4/123 (3.2%) patients with cellulitis before and 4/70 (5.7%) after (OR, 1.8, P, not significant (NS)) the pathway change. Inpatient admission within 28 days occurred in 15/123 (12.2%) cellulitis patients before and 9/70 (12.9%) after (OR, 1.1, P, NS) the pathway change. CONCLUSIONS Implementation of a change in outpatient cellulitis treatment pathway resulted in a significant change in prescribing practice. Our findings suggest that OBLT was both tolerable and had similar outcomes to OPAT.
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Affiliation(s)
- Thomas R Bowhay
- Dunedin Public Hospital, Te Whatu Ora (Health New Zealand) Southern, Dunedin, New Zealand
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Tiffany Tsang
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Jeremy C Z Wei
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Wafa Edwik
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Avi Fridman
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Julia Hubber
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Jae Y Jo
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Nicole Mckay
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Catherine O'Brien
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Joe Osmond-Wallam
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - James Smythe
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - John A Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Brendan Arnold
- Dunedin Public Hospital, Te Whatu Ora (Health New Zealand) Southern, Dunedin, New Zealand
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4
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Bizot F, Tensorer T, Garcia L, Goyenvalle A. Impact of the Inhibition of Organic Anion Transporter on Tricyclo-DNA-Mediated Exon Skipping in the mdx Mouse Model. Nucleic Acid Ther 2023; 33:374-380. [PMID: 37967388 DOI: 10.1089/nat.2023.0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Antisense-mediated exon skipping is one of the most promising therapeutic strategies for Duchenne muscular dystrophy (DMD) and some antisense oligonucleotide (ASO) drugs have already been approved by the U.S. FDA for DMD. The potential of this therapy is still limited by several challenges including the poor distribution of ASOs to target tissues. Indeed, most of them accumulate in the kidney and tend to be rapidly eliminated after systemic delivery. We hypothesized here that preventing renal clearance of ASO using organic anion transporter (OAT) inhibitor could increase the bioavailability of ASOs and thus their distribution to target tissues and ultimately their efficacy in muscles. Mdx mice were, therefore, treated with ASO with or without the OAT inhibitor named probenecid. Our findings indicate that OAT inhibition, or at least using probenecid, does not improve the therapeutic potential of ASO-mediated exon-skipping approaches for the treatment of DMD.
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Affiliation(s)
- Flavien Bizot
- Université de Versailles Saint Quentin en Yveline, Inserm, END-ICAP, Université Paris-Saclay, Versailles, France
| | | | - Luis Garcia
- Université de Versailles Saint Quentin en Yveline, Inserm, END-ICAP, Université Paris-Saclay, Versailles, France
| | - Aurélie Goyenvalle
- Université de Versailles Saint Quentin en Yveline, Inserm, END-ICAP, Université Paris-Saclay, Versailles, France
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de Kretser D, Mora J, Bloomfield M, Campbell A, Cheng MP, Guy S, Hensgens M, Kalimuddin S, Lee TC, Legg A, Mahar RK, Marks M, Marsh J, McGlothlin A, Morpeth SC, Sud A, Ten Oever J, Yahav D, Tong SY, Davis JS, Walls G, Goodman AL, Bonten M. Early oral antibiotic switch in Staphylococcus aureus bacteraemia: The Staphylococcus aureus Network Adaptive Platform (SNAP) Trial Early Oral Switch Protocol. Clin Infect Dis 2023:ciad666. [PMID: 37921609 DOI: 10.1093/cid/ciad666] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/07/2023] [Accepted: 10/20/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Staphylococcus aureus bloodstream infection (bacteraemia) is traditionally treated with at least two weeks of IV antibiotics in adults, 3-7 days in children, and often longer for those with complicated disease. The current practice of treating S. aureus bacteraemia (SAB) with prolonged IV antibiotics (rather than oral antibiotics) is based on historical observational research and expert opinion. Prolonged IV antibiotic therapy has significant disadvantages for patients and healthcare systems, and there is growing interest in whether a switch to oral antibiotics following an initial period of IV therapy is a safe alternative for clinically stable patients. PROTOCOL The early oral switch (EOS) domain of the S. aureus Network Adaptive Platform (SNAP) trial will assess early switch to oral antibiotics compared with continued IV treatment in clinically stable patients with SAB. The primary endpoint is 90-day all-cause mortality. Hospitalised SAB patients are assessed at platform day 7 +/- 2 (uncomplicated SAB) and day 14 +/-2 (complicated SAB) to determine their eligibility for randomisation to EOS (intervention) or continued IV treatment (current standard of care). DISCUSSION Recruitment is occurring to the EOS domain of the SNAP trial. As of August 2023, 21% of all SNAP participants had been randomised to the EOS domain, a total of 264 participants across 77 centres, with an aim to recruit at least 1000 participants. We describe challenges and facilitators to enrolment in this domain to aid those planning similar trials.
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Affiliation(s)
- Dana de Kretser
- Medical Research Council Clinical Trials Unit, University College London, London, United Kingdom
| | - Jocelyn Mora
- Department of Infectious Diseases University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Max Bloomfield
- Department of Infection Services, Wellington Regional Hospital, New Zealand
| | - Anita Campbell
- Telethon Kids Institute, Wesfarmers Centre of Infectious Diseases and Vaccines, The University of Western Australia, Perth, Australia
| | - Matthew P Cheng
- Divisions of Infectious Diseases and Medical Microbiology, McGill University Health Centre, Montreal, Canada
| | - Stephen Guy
- Department of Infectious Diseases, Eastern Health, Box Hill, 3128, Australia
- Monash University (including Australian and New Zealand Intensive Care Research Centre), Clayton, 3800, Australia, Australia
| | - Marjolein Hensgens
- UMC Utrecht, Utrecht University, Utrecht, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Shirin Kalimuddin
- Department of Infectious Diseases, Singapore General Hospital, 169608, Singapore, Singapore
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, 169857, Singapore, Singapore
| | - Todd C Lee
- Clinical Practice Assessment Unit and Division of Infectious Diseases, McGill University, Montreal, Canada
| | - Amy Legg
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Herston Infectious Diseases Institute, Herston, Brisbane, Australia
| | - Robert K Mahar
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Australia
| | - Michael Marks
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases, University College London Hospital, London
- Division of Infection and Immunity, University College London, London
| | - Julie Marsh
- Telethon Kids Institute &/Department of Infectious Diseases &/Wesfarmers Centre for Vaccines and Infectious Diseases, Perth Children's Hospital, Perth, Australia
| | | | | | - Archana Sud
- Department of Infectious Diseases, University of Sydney, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Jaap Ten Oever
- Department of Internal Medicine and Radboud Centre for Infectious Diseases, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Dafna Yahav
- Infectious Diseases Unit, Sheba Medical Center, Ramat-Gan, Israel
| | - Steven Yc Tong
- Department of Infectious Diseases University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Joshua S Davis
- School of Medicine and Public Health and Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | | | - Anna L Goodman
- Medical Research Council Clinical Trials Unit, University College London, London, United Kingdom
- Department of Infectious Diseases, Guy's and St Thomas' Foundation NHS Trust, London, UK
| | - Marc Bonten
- UMC Utrecht, Utrecht University, Utrecht, the Netherlands
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Luo J, Ren H, Ye J, Wang X, Li P, Bai J, Lu Y, Du S. Differences in in vivo absorption of flavone glycosides, flavone aglycones and terpene lactones under different dosage forms and physiological conditions. JOURNAL OF ETHNOPHARMACOLOGY 2023; 306:116159. [PMID: 36649852 DOI: 10.1016/j.jep.2023.116159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 06/17/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Ginkgo biloba L. extract (GBE) oral preparations have been used for many years in the prevention and treatment of cardiovascular and cerebrovascular diseases, and the main active ingredients are flavonoids and terpene lactones. Among them, the oral absorption of the prototype components of flavonoid glycosides into the blood needs to be further clarified, and the differences in the oral absorption of different components in GBE by different dosage forms and physiological conditions are not clear yet. AIM OF THE STUDY To clarify the oral absorption of the prototype flavonoid glycosides in vivo, and to further explore the differences in the oral absorption of various active compounds under different oral dosage forms and dietary conditions. MATERIALS AND METHODS Firstly, the target compounds were selected based on the characteristic chromatogram of GBE and literature. Then, the content differences of three different oral GBE preparations were studied, and their pharmacokinetics (PK) were compared. Finally, the PK differences of the preparations with better oral absorption under different dietary conditions were studied. RESULTS Five flavonoid glycosides, three aglycones and four terpene lactones were selected as the research objects. The content determination results of GBE tablets, guttate pills and tinctures showed that the content of several components especially flavonoid glycosides in the tincture was higher than that of the other two preparations. After oral administration of these three preparations, the PK study showed different results from previous studies. The PK behavior of flavonoid glycosides was also determined at the same time as flavonoid glycosides and terpene lactones. and the bioavailability of flavonoid glycosides in the tincture was higher than that of the other two preparations. PK results of fasting and non-fasting showed that taking GBE tincture on an empty stomach increased the absorption of various compounds, especially flavonoid glycosides. However, due to the existence of food residues in the gastrointestinal tract, the oral bioavailability of flavonoid glycosides was significantly improved. CONCLUSIONS This study discussed the differences in the content and oral absorption of active compounds in different oral preparations of GBE, clarified the in vivo absorption of flavonoid glycosides prototype, as well as the influence of diet on the PK of active compounds, which has certain guiding significance for the clinical application of GBE oral preparations.
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Affiliation(s)
- Juyuan Luo
- Department of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102488, China.
| | - Hairu Ren
- Department of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102488, China.
| | - Jinhong Ye
- Department of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102488, China.
| | - Xinran Wang
- Department of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102488, China.
| | - Pengyue Li
- Department of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102488, China.
| | - Jie Bai
- Department of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102488, China.
| | - Yang Lu
- Department of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102488, China.
| | - Shouying Du
- Department of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102488, China.
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Combination with a FtsZ inhibitor potentiates the in vivo efficacy of oxacillin against methicillin-resistant Staphylococcus aureus. Med Chem Res 2022; 31:1705-1715. [PMID: 37065467 PMCID: PMC10104549 DOI: 10.1007/s00044-022-02960-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Oxacillin is a first-line antibiotic for the treatment of methicillin-sensitive Staphylococcus aureus (MSSA) infections but is ineffective against methicillin-resistant S. aureus (MRSA) due to resistance. Here we present results showing that co-administering oxacillin with the FtsZ-targeting prodrug TXA709 renders oxacillin efficacious against MRSA. The combination of oxacillin and the active product of TXA709 (TXA707) is associated with synergistic bactericidal activity against clinical isolates of MRSA that are resistant to current standard-of-care antibiotics. We show that MRSA cells treated with oxacillin in combination with TXA707 exhibit morphological characteristics and PBP2 mislocalization behavior similar to that exhibited by MSSA cells treated with oxacillin alone. Co-administration with TXA709 renders oxacillin efficacious in mouse models of both systemic and tissue infection with MRSA, with this efficacy being observed at human-equivalent doses of oxacillin well below that recommended for daily adult use. Pharmacokinetic evaluations in mice reveal that co-administration with TXA709 also increases total exposure to oxacillin. Viewed as a whole, our results highlight the clinical potential of repurposing oxacillin to treat MRSA infections through combination with a FtsZ inhibitor.
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8
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Demonstrating the health economic benefit of alternative management strategies: how Emergency Department initiated outpatient care of cellulitis can save healthcare dollars. CAN J EMERG MED 2022; 24:467-468. [PMID: 35917028 DOI: 10.1007/s43678-022-00346-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 06/13/2022] [Indexed: 11/02/2022]
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9
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Wilson RC, Arkell P, Riezk A, Gilchrist M, Wheeler G, Hope W, Holmes AH, Rawson TM. Addition of probenecid to oral β-lactam antibiotics: a systematic review and meta-analysis. J Antimicrob Chemother 2022; 77:2364-2372. [PMID: 35726853 DOI: 10.1093/jac/dkac200] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/29/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To explore the literature comparing the pharmacokinetic and clinical outcomes from adding probenecid to oral β-lactams. METHODS Medline and EMBASE were searched from inception to December 2021 for all English language studies comparing the addition of probenecid (intervention) with an oral β-lactam [flucloxacillin, penicillin V, amoxicillin (± clavulanate), cefalexin, cefuroxime axetil] alone (comparator). ROBINS-I and ROB-2 tools were used. Data on antibiotic therapy, infection diagnosis, primary and secondary outcomes relating to pharmacokinetics and clinical outcomes, plus adverse events were extracted and reported descriptively. For a subset of studies comparing treatment failure between probenecid and control groups, meta-analysis was performed. RESULTS Overall, 18/295 (6%) screened abstracts were included. Populations, methodology and outcome data were heterogeneous. Common populations included healthy volunteers (9/18; 50%) and those with gonococcal infection (6/18; 33%). Most studies were crossover trials (11/18; 61%) or parallel-arm randomized trials (4/18; 22%). Where pharmacokinetic analyses were performed, addition of probenecid to oral β-lactams increased total AUC (7/7; 100%), Cmax (5/8; 63%) and serum t½ (6/8; 75%). Probenecid improved PTA (2/2; 100%). Meta-analysis of 3105 (2258 intervention, 847 control) patients treated for gonococcal disease demonstrated a relative risk of treatment failure in the random-effects model of 0.33 (95% CI 0.20-0.55; I2 = 7%), favouring probenecid. CONCLUSIONS Probenecid-boosted β-lactam therapy is associated with improved outcomes in gonococcal disease. Pharmacokinetic data suggest that probenecid-boosted oral β-lactam therapy may have a broader application, but appropriately powered mechanistic and efficacy studies are required.
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Affiliation(s)
- Richard C Wilson
- National Institute for Health and Care Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, UK.,Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, Acton, London W12 0NN, UK.,Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Paul Arkell
- Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, Acton, London W12 0NN, UK.,Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Alaa Riezk
- Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, Acton, London W12 0NN, UK
| | - Mark Gilchrist
- National Institute for Health and Care Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, UK.,Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, Acton, London W12 0NN, UK.,Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Graham Wheeler
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, Wood Lane, London W12 7RH, UK
| | - William Hope
- Centre for Excellence in Infectious Diseases Research (CEIDR), University of Liverpool, Liverpool L7 8TX, UK
| | - Alison H Holmes
- National Institute for Health and Care Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, UK.,Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, Acton, London W12 0NN, UK.,Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Timothy M Rawson
- National Institute for Health and Care Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, UK.,Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, Acton, London W12 0NN, UK.,Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
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10
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Optimizing antimicrobial use: challenges, advances and opportunities. Nat Rev Microbiol 2021; 19:747-758. [PMID: 34158654 DOI: 10.1038/s41579-021-00578-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2021] [Indexed: 02/06/2023]
Abstract
An optimal antimicrobial dose provides enough drug to achieve a clinical response while minimizing toxicity and development of drug resistance. There can be considerable variability in pharmacokinetics, for example, owing to comorbidities or other medications, which affects antimicrobial pharmacodynamics and, thus, treatment success. Although current approaches to antimicrobial dose optimization address fixed variability, better methods to monitor and rapidly adjust antimicrobial dosing are required to understand and react to residual variability that occurs within and between individuals. We review current challenges to the wider implementation of antimicrobial dose optimization and highlight novel solutions, including biosensor-based, real-time therapeutic drug monitoring and computer-controlled, closed-loop control systems. Precision antimicrobial dosing promises to improve patient outcome and is important for antimicrobial stewardship and the prevention of antimicrobial resistance.
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Drennan PG, Green JK, Gardiner SJ, Metcalf SCL, Kirkpatrick CMJ, Everts RJ, Zhang M, Chambers ST. Population pharmacokinetics of free flucloxacillin in patients treated with oral flucloxacillin plus probenecid. Br J Clin Pharmacol 2021; 87:4681-4690. [PMID: 33963595 DOI: 10.1111/bcp.14887] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 04/22/2021] [Accepted: 05/02/2021] [Indexed: 12/27/2022] Open
Abstract
Oral flucloxacillin may be coadministered with probenecid to reduce flucloxacillin clearance and increase attainment of pharmacokinetic-pharmacodynamic (PK/PD) targets. The aims of this study were to develop a population PK model of free flucloxacillin when administered orally with probenecid, and to identify optimal dosing regimens for this combination. METHODS We performed a prospective observational study of adults (45 participants) treated with oral flucloxacillin 1000 mg and probenecid 500 mg 8-hourly for proven or probable staphylococcal infections. Steady-state mid-dose-interval flucloxacillin measurements (45 concentrations) were combined with existing data from a crossover study of healthy participants receiving flucloxacillin with and without probenecid (11 participants, 363 concentrations). We developed a population pharmacokinetic model of free flucloxacillin concentrations within Monolix, and used Monte Carlo simulation to explore optimal dosing regimens to attain PK/PD targets proposed in the literature (free drug time above minimum inhibitory concentration). RESULTS Flucloxacillin disposition was best described by a 1-compartment model with a lag time and first-order absorption. Free flucloxacillin clearance depended on probenecid, allometrically-scaled fat free mass (FFM) and estimated glomerular filtration rate (eGFR). Predicted PK/PD target attainment was suboptimal with standard dosing regimens with flucloxacillin alone, but substantially improved in the presence of probenecid. CONCLUSION The simulation results reported can be used to identify dose regimens that optimise flucloxacillin exposure according to eGFR and FFM. Patients with higher FFM and eGFR may require the addition of probenecid and 6-hourly dosing to achieve PK/PD targets. The regimen was well-tolerated, suggesting a potential for further evaluation in controlled clinical trials to establish efficacy.
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Affiliation(s)
- Philip G Drennan
- Department of Microbiology and Infectious Diseases, Royal Prince Alfred Hospital, Sydney, Australia.,Department of Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jared K Green
- Department of Infectious Diseases, Christchurch Hospital, Christchurch, New Zealand
| | - Sharon J Gardiner
- Department of Infectious Diseases, Christchurch Hospital, Christchurch, New Zealand.,Department of Clinical Pharmacology, Christchurch Hospital, Christchurch, New Zealand.,Department of Pharmacy, Christchurch Hospital, Christchurch, New Zealand
| | - Sarah C L Metcalf
- Department of Infectious Diseases, Christchurch Hospital, Christchurch, New Zealand
| | - Carl M J Kirkpatrick
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | | | - Mei Zhang
- Department of Medicine, University of Otago, Christchurch, New Zealand.,Toxicology, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Stephen T Chambers
- Department of Infectious Diseases, Christchurch Hospital, Christchurch, New Zealand.,Department of Pathology, University of Otago, Christchurch, New Zealand
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