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Zhang L, Wang H, Bai Y, Wang L, Bai Y, Hu J. Evaluation of the mutant selection window of danofloxacin against Actinobacillus pleuropneumoniae in an in vitro dynamic model. Front Vet Sci 2023; 10:1107608. [PMID: 36793382 PMCID: PMC9923107 DOI: 10.3389/fvets.2023.1107608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 01/11/2023] [Indexed: 01/31/2023] Open
Abstract
Introduction The rapid emergence and widespread spread of multidrug-resistant bacteria is a serious threat to the health of humans and animals. The pharmacokinetic/pharmacodynamic (PK/PD) integration model based on mutant selection window (MSW) theory is an important method to optimize the dosage regimen to prevent the emergence and spread of drug-resistant bacteria. Actinobacillus pleuropneumoniae (AP) is a pathogen that can cause pleuropneumonia in pigs. Methods We employed an in vitro dynamic infection model (DIM) to study the prevention of drug-resistant mutations of danofloxacin against AP. A peristaltic pump was applied to establish an in vitro DIM to simulate the PK of danofloxacin in plasma, and to study the MSW of danofloxacin against AP. A peristaltic-pump in vitro infection model was established to simulate dynamic changes in the danofloxacin concentration in pig plasma. PK and PD data were obtained. Then, the relationship between PK/PD parameters and antibacterial activity was analyzed by the sigmoid Emax model. Results and discussion The area under the curve during 24 h/ the minimum concentration that inhibits colony formation by 99% (AUC24h/MIC99) had the best-fitting relationship with antibacterial activity. The AUC24h/MIC99 values for a bacteriostatic effect, bactericidal effect, and eradication effect were 2.68, 33.67, and 71.58 h, respectively. We hope these results can provide valuable guidance when using danofloxacin to treat AP infection.
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Affiliation(s)
- Longfei Zhang
- College of Animal Science and Veterinary Medicine of Henan Institute of Science and Technology, Xinxiang, China
| | - Hongjuan Wang
- College of Animal Science and Veterinary Medicine of Henan Institute of Science and Technology, Xinxiang, China
| | - Yilin Bai
- School of Agricultural Sciences, Zhengzhou University, Zhengzhou, China
| | - Lei Wang
- College of Animal Science and Veterinary Medicine of Henan Institute of Science and Technology, Xinxiang, China,*Correspondence: Lei Wang ✉
| | - Yueyu Bai
- College of Animal Science and Veterinary Medicine of Henan Institute of Science and Technology, Xinxiang, China,School of Agricultural Sciences, Zhengzhou University, Zhengzhou, China,Yueyu Bai ✉
| | - Jianhe Hu
- College of Animal Science and Veterinary Medicine of Henan Institute of Science and Technology, Xinxiang, China,Jianhe Hu ✉
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Ye L, Cheng L, Kong L, Zhao X, Xie G, He J, Liu H, Deng Y, Wu X, Wang T, Yang X. Pharmacokinetic and pharmacodynamic analysis of cefoperazone/sulbactam for the treatment of pediatric sepsis by Monte Carlo simulation. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2022; 14:1148-1154. [PMID: 35225994 DOI: 10.1039/d1ay01385h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Pediatric sepsis syndrome is one of the most common reasons for pediatric intensive care unit hospitalization (PICU). Cefoperazone/sulbactam is a time-dependent beta-lactamase inhibitor combination which has been widely used in the treatment of sepsis. But the pharmacokinetic (PK) and pharmacodynamic (PD) data of cefoperazone/sulbactam are unknown in children with sepsis. The present work aimed to determine whether the usual dosing regimens of cefoperazone/sulbactam (1 hour infusion, 50 mg kg-1, every 12 hours) were suitable for these patients in PICU. A total of fourteen patients were enrolled and the PK parameters were estimated by non-compartmental analysis using WinNonlin software. The t1/2 and AUC0-12 of cefoperazone and sulbactam were 3.60 and 1.77 h, and 900.97 and 67.68 h μg mL-1, respectively. The Vd and CL of cefoperazone and sulbactam were 1.65 L and 5.16 L, and 17.41 mL min-1 and 122.62 mL min-1, respectively. The probability of target attainments (PTAs) of cefoperazone at different minimum inhibitory concentrations (MICs) based on the percentage time that concentrations exceed the minimum inhibitory concentration (% T > MIC) value were performed by Monte Carlo simulation and PTA was >90% at MICs ≤16 μg mL-1. The PK/PD profile of dosing regimens tested will assist in selecting the appropriate cefoperazone/sulbactam regimens for these patients. At a target of 80% T > MIC, the usual dosing regimens can provide good coverage for pathogens with MICs of ≤32 μg mL-1. The ratio between cefoperazone and sulbactam at 1 : 1 may be more suitable in pediatric sepsis. Individual dose and therapeutic drug monitoring in clinical practice will help achieve the best therapeutic effect while minimizing toxicity.
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Affiliation(s)
- Linhu Ye
- Department of Pharmacy, Shenzhen Hospital, Southern Medical University, No. 1333, New Road, Baoan District, Shenzhen, 518100, P.R. China.
- Department of Pharmacy, The First People's Hospital of Bijie, Bijie 551700, P.R. China
| | - Lei Cheng
- Department of Pharmacy, The First People's Hospital of Bijie, Bijie 551700, P.R. China
| | - Lingti Kong
- Department of Pharmacy, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, China
| | - Xinqian Zhao
- Department of Pharmacy, The First People's Hospital of Bijie, Bijie 551700, P.R. China
| | - Guoyan Xie
- Department of Pharmacy, The First People's Hospital of Bijie, Bijie 551700, P.R. China
| | - Jing He
- Department of Pharmacy, The First People's Hospital of Bijie, Bijie 551700, P.R. China
| | - Hong Liu
- Department of Pharmacy, The First People's Hospital of Bijie, Bijie 551700, P.R. China
| | - Yan Deng
- Department of Pharmacy, The First People's Hospital of Bijie, Bijie 551700, P.R. China
| | - Xinyu Wu
- Department of Pharmacy, The First People's Hospital of Bijie, Bijie 551700, P.R. China
| | - Tingting Wang
- Department of Pharmacy, The First People's Hospital of Bijie, Bijie 551700, P.R. China
| | - Xixiao Yang
- Department of Pharmacy, Shenzhen Hospital, Southern Medical University, No. 1333, New Road, Baoan District, Shenzhen, 518100, P.R. China.
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Considerations for the optimal management of antibiotic therapy in elderly patients. J Glob Antimicrob Resist 2020; 22:325-333. [PMID: 32165285 DOI: 10.1016/j.jgar.2020.02.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 02/14/2020] [Accepted: 02/26/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To maximise efficacy and minimise toxicity, special considerations are required for antibiotic prescription in elderly patients. This review aims to provide practical suggestions for the optimal management of antibiotic therapy in elderly patients. METHODS This was a narrative review. A literature search of published articles in the last 15 years on antibiotics and elderly patients was performed using the Cochrane Library and PubMed electronic databases. The three priority areas were identified: (i) pharmacokinetics/pharmacodynamics (PK/PD) for optimising dosage regimens and route of administration; (ii) antibiotic dosages in some special subpopulations; and (iii) treatment considerations relating to different antibiotic classes and their adverse events. RESULTS Clinicians should understand the altered PK/PD of drugs in this population owing to co-morbid conditions and normal physiological changes associated with ageing. The body of evidence justifies the need for individualised dose selection, especially in patients with impaired renal and liver function. Clinicians should be aware of the major drug-drug interactions commonly observed in the elderly as well as potential side effects. CONCLUSION Antibiotic therapy in the elderly requires a comprehensive approach, including strategies to improve appropriate antibiotic prescribing, limit their use for uncomplicated infections and ensure the attainment of an optimal PK/PD target. To this purpose, further studies involving the elderly are needed to better understand the PK of antibiotics. Moreover, it is necessary to assess the role therapeutic drug monitoring in guiding antibiotic therapy in elderly patients in order to evaluate its impact on clinical outcome.
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Zhang L, Kang Z, Yao L, Gu X, Huang Z, Cai Q, Shen X, Ding H. Pharmacokinetic/Pharmacodynamic Integration to Evaluate the Changes in Susceptibility of Actinobacillus pleuropneumoniae After Repeated Administration of Danofloxacin. Front Microbiol 2018; 9:2445. [PMID: 30369920 PMCID: PMC6194310 DOI: 10.3389/fmicb.2018.02445] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 09/24/2018] [Indexed: 11/14/2022] Open
Abstract
To evaluate the relationship between pharmacokinetic/pharmacodynamic (PK/PD) parameters and changes in susceptibility and resistance frequency of Actinobacillus pleuropneumoniae CVCC 259, a piglet tissue cage (TC) infection model was established. After A. pleuropneumoniae populations maintained at 108 CFU/mL in TCs, piglets were treated with various doses of danofloxacin once daily for 5 consecutive days by intramuscular injection. Both the concentrations of danofloxacin and the population of vial cells were determined. Changes in susceptibility and resistance frequency were monitored. Polymerase chain reaction (PCR) amplification of quinolone resistance-determining regions (QRDRs) and DNA sequencing were performed to identify point mutations in gyrA, gyrB, parC, and parE genes. Furthermore, the susceptibility of mutants to danofloxacin and enrofloxacin was determined in the presence or absence of reserpine to assess whether the mutants were caused by efflux pumps. The MICs and resistant frequency of A. pleuropneumoniae both increased when danofloxacin concentrations fluctuated between MIC99 (0.05 μg/mL) and MPC (mutant prevention concentration, 0.4 μg/mL). As for PK/PD parameters, the resistant mutants were selected and enriched when AUC24h/MIC99 ranged from 34.68 to 148.65 h or AUC24h/MPC ranged from 4.33 to 18.58 h. Substitutions of Ser-83→Tyr or Ser-83→Phe in gyrA and Lys-53→Glu in parC were observed. The susceptibility of mutants obtained via danofloxacin treatment at 1.25 and 2.5 mg/kg were less affected by reserpine. These results demonstrate that maintaining the value of AUC24h/MPC above 18.58 h may produce a desirable antibacterial effect and protect against A. pleuropneumoniae resistance to danofloxacin.
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Affiliation(s)
- Longfei Zhang
- Guangdong Key Laboratory for Veterinary Drug Development and Safety Evaluation, South China Agricultural University, Guangzhou, China
| | - Zheng Kang
- Guangdong Key Laboratory for Veterinary Drug Development and Safety Evaluation, South China Agricultural University, Guangzhou, China
| | - Lihua Yao
- Guangdong Key Laboratory for Veterinary Drug Development and Safety Evaluation, South China Agricultural University, Guangzhou, China
| | - Xiaoyan Gu
- Guangdong Key Laboratory for Veterinary Drug Development and Safety Evaluation, South China Agricultural University, Guangzhou, China
| | - Zilong Huang
- Guangdong Key Laboratory for Veterinary Drug Development and Safety Evaluation, South China Agricultural University, Guangzhou, China
| | - Qinren Cai
- Technical Center for Inspection and Quarantine, Zhuhai Entry-Exit Inspection and Quarantine Bureau, Zhuhai, China
| | - Xiangguang Shen
- Guangdong Key Laboratory for Veterinary Drug Development and Safety Evaluation, South China Agricultural University, Guangzhou, China
| | - Huanzhong Ding
- Guangdong Key Laboratory for Veterinary Drug Development and Safety Evaluation, South China Agricultural University, Guangzhou, China
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Cojutti PG, Ramos-Martin V, Schiavon I, Rossi P, Baraldo M, Hope W, Pea F. Population Pharmacokinetics and Pharmacodynamics of Levofloxacin in Acutely Hospitalized Older Patients with Various Degrees of Renal Function. Antimicrob Agents Chemother 2017; 61:e02134-16. [PMID: 28031199 PMCID: PMC5328580 DOI: 10.1128/aac.02134-16] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 12/17/2016] [Indexed: 01/31/2023] Open
Abstract
A retrospective study was conducted in a large sample of acutely hospitalized older patients who underwent therapeutic drug monitoring during levofloxacin treatment. The aim was to assess the population pharmacokinetics (popPK) and pharmacodynamics of levofloxacin among older patients. PopPK and Monte Carlo simulation were performed to define the permissible doses in older patients according to various degrees of renal function. Classification and regression tree (CART) analysis was used to detect the cutoff 24-hour area under the concentration-time curve (AUC24)/MIC ratio that best correlated with the clinical outcome. The probability of target attainment (PTA) of this value was calculated against different pathogens. A total of 168 patients were included, and 330 trough and 239 peak concentrations were used for the popPK analysis. Creatinine clearance (CrCL) was the only covariate that improved the model fit (levofloxacin CL = 0.399 + 0.051 × CrCLCKD-EPI [creatinine clearance estimated by means of the chronic kidney disease epidemiology]). Drug doses ranged between 500 mg every 48 h and 500 mg every 12 h in relation to different renal functions. The identified cutoff AUC24/MIC ratio (≥95.7) was the only covariate that correlated with a favorable clinical outcome in multivariate regression analysis (odds ratio [OR], 20.85; 95% confidence interval [CI], 1.56 to 186.73). PTAs were optimal (>80%) against Escherichia coli and Haemophilus influenzae, borderline against Staphylococcus aureus, and suboptimal against Pseudomonas aeruginosa The levofloxacin doses defined in our study may be effective for the treatment of infections due to bacterial pathogens, with an MIC of ≤0.5 mg/liter in older patients with various degrees of renal function, while minimizing the toxicity risk. Conversely, the addition of another active antimicrobial should be considered whenever treating infections caused by less susceptible pathogens.
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Affiliation(s)
- Pier Giorgio Cojutti
- Institute of Clinical Pharmacology, Santa Maria della Misericordia University Hospital of Udine, Udine, Italy
- Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy
| | - Virginia Ramos-Martin
- Antimicrobial Pharmacodynamics and Therapeutics, Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Isabella Schiavon
- First Division of Internal Medicine Santa Maria della Misericordia University Hospital of Udine, Udine, Italy
| | - Paolo Rossi
- First Division of Internal Medicine Santa Maria della Misericordia University Hospital of Udine, Udine, Italy
| | - Massimo Baraldo
- Institute of Clinical Pharmacology, Santa Maria della Misericordia University Hospital of Udine, Udine, Italy
- Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy
| | - William Hope
- Antimicrobial Pharmacodynamics and Therapeutics, Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Federico Pea
- Institute of Clinical Pharmacology, Santa Maria della Misericordia University Hospital of Udine, Udine, Italy
- Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy
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Xiong M, Wu X, Ye X, Zhang L, Zeng S, Huang Z, Wu Y, Sun J, Ding H. Relationship between Cefquinome PK/PD Parameters and Emergence of Resistance of Staphylococcus aureus in Rabbit Tissue-Cage Infection Model. Front Microbiol 2016; 7:874. [PMID: 27375594 PMCID: PMC4896111 DOI: 10.3389/fmicb.2016.00874] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 05/24/2016] [Indexed: 11/13/2022] Open
Abstract
In order to explore the relationship between different antibiotic dosing regimens and selective enrichment of resistant strains, tissue-cage infection model was established in rabbits to study relationship between cefquinome pharmacokinetic/pharmacodynamic parameters and the change of susceptibility of Staphylococcus aureus (S. aureus). In this model, above 108 CFU/mL of S. aureus culture were exposed to cefquinome concentrations below the MIC99 (the minimal concentration that inhibits colony formation by 99% in vitro, 0.3 μg/mL), between the MIC99 and the MPC (the mutant prevent concentration in vitro, 1.6 μg/mL), and above the MPC after intramuscular injection with cefquinome at doses of 4, 8, 16, and 32 mg/kg of body weight (bw) once daily for 5 days or 4, 8, 16, and 24 mg/kg of bw twice daily for 2.5 days. Samples of tissue-cage fluid were collected from the tissue-cage at 2, 4, 6, 8, 10, 12, 24 h after each dosing (one dosing daily) or at 2, 4, 6, 8, 10, and 12 h (two dosing daily). Cefquinome concentration, susceptibility of S. aureus to cefquinome, and bacterial numbers at the infected site were monitored. The MICs of S. aureus and the fraction of resistant bacteria both increased when cefquinome concentrations fluctuated between the MIC99 and MPC. Resistant bacteria were selected in vivo when %T > MPC was < 58% of administration interval or %T > MIC99 was ≥70% of administration interval. These findings demonstrate that low-level, cefquinome-resistant S. aureus were selected predominantly when drug concentrations fell inside a concentration window in in vivo model, which was evidenced by pulsed-field gel electrophoresis. The selection of resistant bacteria arose from both susceptible bacteria being killed and resistant bacteria re-growth. Keeping drug concentrations above the MPC for ≥58% of administration interval provides a strategy to achieve effective antibacterial activity and minimize the emergence of resistance to cefquinome.
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Affiliation(s)
- Mingpeng Xiong
- National Risk Assessment Laboratory for Antimicrobial Resistance of Microorganisms of Animal Original Bacteria, College of Veterinary Medicine, South China Agricultural University Guangzhou, China
| | - Xun Wu
- National Risk Assessment Laboratory for Antimicrobial Resistance of Microorganisms of Animal Original Bacteria, College of Veterinary Medicine, South China Agricultural University Guangzhou, China
| | - Xiaomei Ye
- National Risk Assessment Laboratory for Antimicrobial Resistance of Microorganisms of Animal Original Bacteria, College of Veterinary Medicine, South China Agricultural University Guangzhou, China
| | - Longfei Zhang
- National Risk Assessment Laboratory for Antimicrobial Resistance of Microorganisms of Animal Original Bacteria, College of Veterinary Medicine, South China Agricultural University Guangzhou, China
| | - Shuyi Zeng
- National Risk Assessment Laboratory for Antimicrobial Resistance of Microorganisms of Animal Original Bacteria, College of Veterinary Medicine, South China Agricultural University Guangzhou, China
| | - Zilong Huang
- National Risk Assessment Laboratory for Antimicrobial Resistance of Microorganisms of Animal Original Bacteria, College of Veterinary Medicine, South China Agricultural University Guangzhou, China
| | - Yuzhi Wu
- National Risk Assessment Laboratory for Antimicrobial Resistance of Microorganisms of Animal Original Bacteria, College of Veterinary Medicine, South China Agricultural University Guangzhou, China
| | - Jian Sun
- National Risk Assessment Laboratory for Antimicrobial Resistance of Microorganisms of Animal Original Bacteria, College of Veterinary Medicine, South China Agricultural University Guangzhou, China
| | - Huanzhong Ding
- National Risk Assessment Laboratory for Antimicrobial Resistance of Microorganisms of Animal Original Bacteria, College of Veterinary Medicine, South China Agricultural University Guangzhou, China
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Cazaubon Y, Bourguignon L, Goutelle S, Martin O, Maire P, Ducher M. Are ciprofloxacin dosage regimens adequate for antimicrobial efficacy and prevention of resistance?Pseudomonas aeruginosabloodstream infection in elderly patients as a simulation case study. Fundam Clin Pharmacol 2015; 29:615-24. [DOI: 10.1111/fcp.12156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 09/17/2015] [Accepted: 09/21/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Yoann Cazaubon
- University Hospitals of Lyon; Pierre Garraud Hospital; Pharmacy. 136 rue du Commandant Charcot Lyon FR 69005 France
- Laboratory of pharmacology-toxicology; University Hospitals of Reims; Maison Blanche Hospital; 45 rue Cognacq Jay Reims Cedex FR 51092 France
- UMR CNRS 5558; Lyon 1 University; LBBE; 43 bd du 11 novembre 1918 Villeurbanne Cedex FR 69622 France
| | - Laurent Bourguignon
- University Hospitals of Lyon; Pierre Garraud Hospital; Pharmacy. 136 rue du Commandant Charcot Lyon FR 69005 France
- UMR CNRS 5558; Lyon 1 University; LBBE; 43 bd du 11 novembre 1918 Villeurbanne Cedex FR 69622 France
| | - Sylvain Goutelle
- University Hospitals of Lyon; Pierre Garraud Hospital; Pharmacy. 136 rue du Commandant Charcot Lyon FR 69005 France
- UMR CNRS 5558; Lyon 1 University; LBBE; 43 bd du 11 novembre 1918 Villeurbanne Cedex FR 69622 France
| | - Olivier Martin
- University Hospitals of Lyon; Pierre Garraud Hospital; Pharmacy. 136 rue du Commandant Charcot Lyon FR 69005 France
| | - Pascal Maire
- University Hospitals of Lyon; Pierre Garraud Hospital; Pharmacy. 136 rue du Commandant Charcot Lyon FR 69005 France
- UMR CNRS 5558; Lyon 1 University; LBBE; 43 bd du 11 novembre 1918 Villeurbanne Cedex FR 69622 France
| | - Michel Ducher
- University Hospitals of Lyon; Pierre Garraud Hospital; Pharmacy. 136 rue du Commandant Charcot Lyon FR 69005 France
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Saeed MA, Vlasakakis G, Della Pasqua O. Rational use of medicines in older adults: Can we do better during clinical development? Clin Pharmacol Ther 2015; 97:440-3. [DOI: 10.1002/cpt.87] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 01/15/2015] [Accepted: 02/03/2015] [Indexed: 11/08/2022]
Affiliation(s)
- MA Saeed
- Kellogg College; University of Oxford; UK
- Global Regulatory Affairs; GlaxoSmithKline Uxbridge UK
| | - G Vlasakakis
- Clinical Pharmacology Modelling & Simulation; GlaxoSmithKline Uxbridge UK
| | - O Della Pasqua
- Clinical Pharmacology Modelling & Simulation; GlaxoSmithKline Uxbridge UK
- Clinical Pharmacology & Therapeutics; University College London; UK
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Role of therapeutic drug monitoring in pulmonary infections: use and potential for expanded use of dried blood spot samples. Bioanalysis 2015; 7:481-95. [DOI: 10.4155/bio.14.318] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Respiratory tract infections are among the most common infections in men. We reviewed literature to document their pharmacological treatments, and the extent to which therapeutic drug monitoring (TDM) is needed during treatment. We subsequently examined potential use of dried blood spots as sample procedure for TDM. TDM was found to be an important component of clinical care for many (but not all) pulmonary infections. For gentamicin, linezolid, voriconazole and posaconazole dried blood spot methods and their use in TDM were already evident in literature. For glycopeptides, β-lactam antibiotics and fluoroquinolones it was determined that development of a dried blood spot (DBS) method could be useful. This review identifies specific antibiotics for which development of DBS methods could support the optimization of treatment of pulmonary infections.
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Asín-Prieto E, Rodríguez-Gascón A, Isla A. Applications of the pharmacokinetic/pharmacodynamic (PK/PD) analysis of antimicrobial agents. J Infect Chemother 2015; 21:319-29. [PMID: 25737147 DOI: 10.1016/j.jiac.2015.02.001] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 01/20/2015] [Accepted: 02/02/2015] [Indexed: 12/15/2022]
Abstract
The alarming increase of resistance against multiple currently available antibiotics is leading to a rapid lose of treatment options against infectious diseases. Since the antibiotic resistance is partially due to a misuse or abuse of the antibiotics, this situation can be reverted when improving their use. One strategy is the optimization of the antimicrobial dosing regimens. In fact, inappropriate drug choice and suboptimal dosing are two major factors that should be considered because they lead to the emergence of drug resistance and consequently, poorer clinical outcomes. Pharmacokinetic/pharmacodynamic (PK/PD) analysis in combination with Monte Carlo simulation allows to optimize dosing regimens of the antibiotic agents in order to conserve their therapeutic value. Therefore, the aim of this review is to explain the basis of the PK/PD analysis and associated techniques, and provide a brief revision of the applications of PK/PD analysis from a therapeutic point-of-view. The establishment and reevaluation of clinical breakpoints is the sticking point in antibiotic therapy as the clinical use of the antibiotics depends on them. Two methodologies are described to establish the PK/PD breakpoints, which are a big part of the clinical breakpoint setting machine. Furthermore, the main subpopulations of patients with altered characteristics that can condition the PK/PD behavior (such as critically ill, elderly, pediatric or obese patients) and therefore, the outcome of the antibiotic therapy, are reviewed. Finally, some recommendations are provided from a PK/PD point of view to enhance the efficacy of prophylaxis protocols used in surgery.
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Affiliation(s)
- Eduardo Asín-Prieto
- Pharmacokinetics, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain; Centro de Investigación Lascaray ikergunea, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Alicia Rodríguez-Gascón
- Pharmacokinetics, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain; Centro de Investigación Lascaray ikergunea, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Arantxazu Isla
- Pharmacokinetics, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain; Centro de Investigación Lascaray ikergunea, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain.
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Testing the mutant selection window hypothesis with Escherichia coli exposed to levofloxacin in a rabbit tissue cage infection model. Eur J Clin Microbiol Infect Dis 2013; 33:385-9. [DOI: 10.1007/s10096-013-1968-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 08/23/2013] [Indexed: 10/26/2022]
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