Simultaneous high-performance liquid chromatography analysis of azithromycin and two of its metabolites in human tears and plasma

A simple, high-throughput and validated LC-MS/MS method for determination of azithromycin in human plasma and its application to a clinical pharmacokinetic study

A sensitive, specific and rapid liquid chromatographic-tandem mass spectrometric (LC-MS/MS) method was developed and validated to quantify azithromycin concentrations in human plasma. Azithromycin (AZI) is the most common outpatient prescribed antibiotic in the US and clinical studies have demonstrated the efficacy and safety of AZI in many bacterial infections. To support a clinical study, we developed a high throughput LC-MS/MS method to process up to 250 samples per day to quantify AZI in human plasma. Samples were prepared by solid phase extraction. Separation was achieved with an ACE C₁₈ column (2.1 x 100 mm, 1.7 μm) equipped with a C₁₈ guard column. The mobile phase consisted of 0.1% formic acid and methanol/acetonitrile (1:1, v/v) at a flow rate of 0.25 mL/min. The ionization was optimized with positive electrospray source using multiple reaction monitoring transition, m/z 749.50>591.45 for AZI and m/z 754.50>596.45 for AZI-d5. Extraction recoveries were approximately 90% for AZI. The assay was linear from 0.5 to 2000 ng/mL and required only 100 μL of plasma with total analysis time of 4.5 minutes. The method was successfully applied to pharmacokinetic studies of a weight-based dosing protocol for AZI.

Azithromycin: mechanisms of action and their relevance for clinical applications

Azithromycin is a macrolide antibiotic which inhibits bacterial protein synthesis, quorum-sensing and reduces the formation of biofilm. Accumulating effectively in cells, particularly phagocytes, it is delivered in high concentrations to sites of infection, as reflected in rapid plasma clearance and extensive tissue distribution. Azithromycin is indicated for respiratory, urogenital, dermal and other bacterial infections, and exerts immunomodulatory effects in chronic inflammatory disorders, including diffuse panbronchiolitis, post-transplant bronchiolitis and rosacea. Modulation of host responses facilitates its long-term therapeutic benefit in cystic fibrosis, non-cystic fibrosis bronchiectasis, exacerbations of chronic obstructive pulmonary disease (COPD) and non-eosinophilic asthma. Initial, stimulatory effects of azithromycin on immune and epithelial cells, involving interactions with phospholipids and Erk1/2, are followed by later modulation of transcription factors AP-1, NFκB, inflammatory cytokine and mucin release. Delayed inhibitory effects on cell function and high lysosomal accumulation accompany disruption of protein and intracellular lipid transport, regulation of surface receptor expression, of macrophage phenotype and autophagy. These later changes underlie many immunomodulatory effects of azithromycin, contributing to resolution of acute infections and reduction of exacerbations in chronic airway diseases. A sub-group of post-transplant bronchiolitis patients appears to be sensitive to azithromycin, as may be patients with severe sepsis. Other promising indications include chronic prostatitis and periodontitis, but weak activity in malaria is unlikely to prove crucial. Long-term administration of azithromycin must be balanced against the potential for increased bacterial resistance. Azithromycin has a very good record of safety, but recent reports indicate rare cases of cardiac torsades des pointes in patients at risk.

Azithromycin

Azithromycin is an azalide, a subclass of macrolide antibiotics. It is derived from erythromycin, with a methyl-substituted nitrogen atom incorporated into the lactone ring, thus making the lactone ring 15-membered. It prevents bacteria from growing by interfering with their protein synthesis. It binds to the 50S subunit of the bacterial ribosome and thus inhibits translation of mRNA. Azithromycin is used to treat or prevent certain bacterial infections, most often those causing middle ear infections, strep throat, pneumonia, typhoid, bronchitis, and sinusitis. In recent years, it has been used primarily to prevent bacterial infections in infants and those with weaker immune systems. It is also effective against certain sexually transmitted infections, such as nongonococcal urethritis, chlamydia, and cervicitis. Recent studies have indicated it also to be effective against late-onset asthma, but these findings are controversial and not widely accepted. The present study gives a comprehensive profile of azithromycin, including detailed physico-chemical properties, nomenclature, formulae, methods of preparation, and methods of analysis (including compendial, electrochemical, spectroscopic, and chromatographic methods of analysis). Developed validated stability-indicating (HPLC and biodiffusion assay methods under accelerated acidic, alkaline, and oxidative conditions, in addition to effect of different types of light, temperature, and pH. Detailed clinical applications also presented (mechanism of action, ADME profile, clinical uses and doses, side effects, and drug interactions). Each of the above stages includes appropriate figures and tables. More than 80 references were given as a proof of the above-mentioned studies.

Utility of noninvasive biomatrices in pharmacokinetic studies

Blood and plasma are the biomatrices traditionally used for drug monitoring and their pharmacokinetic profiling. Blood is the circulating fluid in contact with all organs and tissues of body and thus is the most representative fluid for measuring systemic drug levels. However, venipuncture suffers from the caveat of being an invasive technique which often makes people reluctant to participate in clinical studies. Thus, there is a need for noninvasive bio-fluids that are ethically appropriate, cost-efficient and toxicologically relevant. These alternate bio-fluids may prove clinically useful as alternatives to plasma/serum in therapeutic drug monitoring, pharmacokinetic and toxicokinetic studies, doping control in sports medicine and to monitor local adverse effects. These may be of particular interest in the case of special population groups such as neonates, children, the elderly, terminally ill patients and pregnant or lactating women, and offer the advantage of circumvention of the demand for specialized personnel for sample collection. This review describes such noninvasive bio-fluids (saliva, sweat, tears and milk) that have been considered for pharmacokinetic drug analysis, emphasizing their sample preparation, its associated difficulties and their correlation with plasma.

Quantitative determination of azithromycin in plasma, blood and isolated neutrophils by liquid chromatography using pre-column derivatization with 9-fluorenylmethyloxycarbonyl-chloride and fluorescence detection

In this study, a high-performance liquid chromatographic method with pre-column derivatization and fluorescence detection was optimised and validated for the quantification of azithromycin (AZM) in plasma. Clarithromycin (CLM) was used as an internal standard. Pre-column derivatization was done with 9-fluorenylmethyloxycarbonyl-chloride. Recovery from blood and polymorphonuclear neutrophils (PMNNs) isolated by a gravity separation procedure was also assessed. Analytical separation was carried out using a C18 column as stationary phase and acetonitril-phosphatebuffer as mobile phase. Peak quantification was carried out by excitation at 26 7 nm and detection at 317 nm. A lower limit of quantitation of 0.042+/-0.017 mg/l in plasma, 0.119+/-0.065 mg/l in blood and 0.072+/-0.036 in water was achieved. Linearity was assessed from 0 to 1.5mg/l in plasma and blood and from 0-9 mg/l in water. The analytical method proved to be applicable in a pharmacokinetic study of AZM in a Cystic Fibrosis patient.

Lachrymal Determinations: Methods and Updates on Biopharmaceutical and Clinical Applications

This article displays different procedures used to collect lachrymal fluid and describes some of its applications. Sampling tears represents the main difficulty to produce precise and reproducible results. The direct sampling procedure consists in collecting tears with capillary tubes and has the drawback of demanding previous stimulation that induces major dilution. The indirect method does not require preliminary stimulation but has been held responsible for altering epithelium and promoting leakage from plasma. Schirmer strips and sponges are classically required. Applications are numerous in biopharmaceutical and clinical fields. The determination of endogenous components has great potentiality as a diagnostic tool, but the use of tear as a substitute of plasma does not present clinical relevance. Levels of drugs like immunosuppressive or antibiotic agents are determined in tears to verify that pharmacological concentrations are reached and frequency of administration is deduced from kinetic fitting.

Ultrasensitive assay of azithromycin in medicine and bio-Fluids based on its enhanced luminol–H2O2 chemiluminescence reaction using flow injection technique

A simple flow injection chemiluminescence method with synergistic enhancement has been investigated for the rapid and sensitive determination of azithromycin. The synergistic action was significant in the chemiluminescence system of luminol-hydrogen peroxide with azithromycin as an enhancer. The enhanced chemiluminescence intensity was linear with the concentration of azithromycin over the range from 0.1 pg x mL(-1) to 1.0 ng x mL(-1) (r(2=)0.9988) with a detection limit (3sigma) of 0.04 pg x mL(-1). At a flow rate of 2.0 mL x min(-1), a complete analytical process could be performed within 0.5 min, including sampling and washing, with a relative standard deviation of less than 3.0%. The proposed method was applied successfully in the assay of azithromycin in pharmaceutical preparations, human urine and serum without any pre-treatment procedure.

Analysis of unknown compounds in azithromycin bulk samples with liquid chromatography coupled to ion trap mass spectrometry

A selective reversed-phase liquid chromatography/mass spectrometry (LC/MS(n)) method is described for the identification of azithromycin impurities and related substances in commercial azithromycin samples. Mass spectral data are acquired on an LCQ ion trap mass spectrometer equipped with an atmospheric pressure chemical ionization interface operated in positive ion mode. The LCQ provides on-line LC/MS(n) capability, making it ideally suited for identification purposes. In comparison with UV detection, this hyphenated technique provides as its main advantage efficient identification of novel substances without time-consuming isolation and purification procedures. Using this technique, six novel related substances detected in commercial azithromycin samples have been studied.

Spectrofluorimetric analysis of certain macrolide antibiotics in bulk and pharmaceutical formulations

The macrolides (erythromycin, erythromycin esters, azithromycin dihydrate, clarithromycin and roxithromycin) can be analyzed by a simple spectrofluorimetric method based on the oxidation by cerium(VI) in the presence of sulphuric acid and monitoring the fluorescence of cerium(III) formed at lambda(ex) 255 nm and lambda(em) 348 nm. All variables affecting the reaction conditions as cerium(VI), sulphuric acid concentrations, heating time, temperature and dilution solvents were carefully studied. Linear calibration graphs were obtained in the range of 42.6-1200 ng ml(-1) with a percentage relative standard deviation in the range of 0.014-0.058%. Quantitation and detection limits were calculated. The method was applied successfully for the assay of the studied drugs in pure and pharmaceutical dosage forms as tablets, capsules and suspension. Recovery experiments revealed recovery of 98.3-100.8%. The effect of potential interference due to common ingredients as glucose, sucrose, lactose, citric acid, and propylene glycol was investigated. Applying standard addition method shows a recovery of 97.7-100.9% macrolide antibiotics from their corresponding dosage forms.

Chromatography of guanidino compounds

Guanidino compounds involved in the urea and guanidine cycles have been found in serum of nephritic patients, and some guanidino compounds have been suspected to be uremic toxins. The simultaneous analysis of naturally occurring metabolites is important for diagnosis of diseases. In this review, liquid chromatographic analysis of natural metabolites of guanidino compounds are described. the information about arginine as a precursor of nitric oxide are included. The reports of pharmaceutical compounds having a guanidino group, peptides containing arginine and aminoglycosides are summarized in Table 1.

Analysis of small-scale biological compartments by capillary electrophoresis

Two characteristics of capillary electrophoresis make the technique attractive for the separation of the components of microscale compartments within living organisms: small sample volume requirements and direct compatibility with biofluids. Indeed, capillary electrophoresis has been used for analysis down to a sub-cellular level. There are also potentially many applications of capillary electrophoresis to biological compartments on a super-cellular scale, which are nevertheless so small that they make analysis by conventional separations techniques difficult or impractical. The analytical challenges in small-scale bioanalysis are first to develop a suitable method for collection of sample and its introduction into the separation capillary, and secondly, to achieve the required separation. Examples reviewed here will primarily focus on the analysis of tear fluid or airway surface liquid, cases in which the amount of sample that can be collected range from around 10 microl to around 100 nl.