1
|
Saleem T, Zamir A, Rasool MF, Imran I, Saeed H, Alqahtani F. Exploring the pharmacokinetics of second-generation cephalosporin, cefaclor: a systematic review in healthy and diseased populations. Xenobiotica 2024; 54:171-181. [PMID: 38517680 DOI: 10.1080/00498254.2024.2333009] [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] [Received: 01/01/2024] [Accepted: 03/17/2024] [Indexed: 03/24/2024]
Abstract
Cefaclor is a bactericidal antibiotic recommended for treating diverse types of infections. This review aims to comprehensively assess the pharmacokinetic (PK) data on cefaclor in humans.Google Scholar, PubMed, Cochrane Library, and EBSCO databases were systematically performed to identify all the relevant studies containing at least one reported PK parameter of cefaclor.Cefaclor shows the linear PK profile as the area under the plasma concentration-time curve from 0 to t (AUC0-t) and maximum plasma concentration (Cmax) increase in a dose-dependent manner. The AUC0-t of cefaclor in the rice diet was found to be higher than that of bread food, i.e. 19.9 ± 2.6 ug/ml.hr vs 15.4 ± 4 ug/ml.hr. The AUC in paediatrics during the fed state was significantly higher compared to that in adults. Patients with renal impairments showed a Cmax 2.2 times higher than that of normal subjects. A significant increase in Cmax was depicted among individuals following a vegetarian diet in comparison with the non-vegetarian diet. Moreover, cefaclor exhibits time-dependent killing above the minimum inhibitory concentration (MIC < 2 ug), favouring its use in treating infections caused by specific pathogens.This systematic review summarises all the reported PK parameters of cefaclor in healthy and diseased subjects in the literature. This data can help practitioners in adjusting cefaclor doses among different diseases and populations to avoid drug interactions and adverse effects.
Collapse
Affiliation(s)
- Tahir Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Ammara Zamir
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Muhammad Fawad Rasool
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Imran Imran
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Hamid Saeed
- University College of Pharmacy, Allama Iqbal Campus, University of the Punjab, Lahore, Pakistan
| | - Faleh Alqahtani
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
2
|
Kanan M, Atif S, Mohammed F, Balahmar Y, Adawi Y, AlSaleem R, Farhan A, Alghoribi M, Mohammed S, Alshanbari R, Fahad M, Kallab R, Mohammed R, Alassaf D, Hazza A. A Systematic Review on the Clinical Pharmacokinetics of Cephalexin in Healthy and Diseased Populations. Antibiotics (Basel) 2023; 12:1402. [PMID: 37760698 PMCID: PMC10526061 DOI: 10.3390/antibiotics12091402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/08/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
Cephalexin is a first-generation β-lactam antibiotic used in adults and pediatrics to treat various streptococcal and staphylococcal infections. This review aims to summarize and evaluate all the pharmacokinetic (PK) data on cephalexin by screening out all pertinent studies in human beings following the per oral (PO) route. By employing different online search engines such as Google Scholar, PubMed, Cochrane Central, and Science Direct, 23 studies were retrieved, among which nine were in healthy subjects, five in diseased ones, and the remaining were drug-drug, drug-food, and bioequivalence-related. These studies were included only based on the presence of plasma concentration-time profiles or PK parameters, i.e., maximum plasma concentration (Cmax), half-life (t1/2) area under the curve from time 0-infinity (AUC0-∞), and clearance (CL/F). A dose-proportional increase in AUC0-∞ and Cmax can be portrayed in different studies conducted in the healthy population. In comparison to cefaclor, Cmax was recorded to be 0.5 folds higher for cephalexin in the case of renal impairment. An increase in AUC0-∞ was seen in cephalexin on administration with probenecid, i.e., 117 µg.h/mL vs. 68.1 µg.h/mL. Moreover, drug-drug interactions with omeprazole, ranitidine, zinc sulfate, and drug-food interactions for cephalexin and other cephalosporins have also been depicted in different studies with significant changes in all PK parameters. This current review has reported all accessible studies containing PK variables in healthy and diseased populations (renal, dental, and osteoarticular infections, continuous ambulatory peritoneal dialysis) that may be favorable for health practitioners in optimizing doses among the latter.
Collapse
Affiliation(s)
- Mohammed Kanan
- Department of Clinical Pharmacy, King Fahad Medical City, Riyadh 12211, Saudi Arabia
| | - Shahd Atif
- Al Iman General Hospital, Riyadh 12211, Saudi Arabia;
| | - Faisal Mohammed
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24211, Saudi Arabia;
| | - Yara Balahmar
- Department of Clinical Pharmacy, College of Pharmacy, Ibn Sina College, Jeddah, Saudi Arabia;
| | - Yasir Adawi
- Department of Clinical Pharmacy, Jazan University, Jazan 85534, Saudi Arabia;
| | - Revan AlSaleem
- College of Pharmacy, King Khalid University, Abha 61421, Saudi Arabia; (R.A.); (S.M.); (R.M.)
| | - Ahmed Farhan
- Department of Pharmacy, Prince Sultan Military Medical City, Riyadh 12211, Saudi Arabia;
| | - Manayer Alghoribi
- Al-Nahda General Hospital, Private Healthcare, Taif 26575, Saudi Arabia;
| | - Saud Mohammed
- College of Pharmacy, King Khalid University, Abha 61421, Saudi Arabia; (R.A.); (S.M.); (R.M.)
| | - Raghad Alshanbari
- Department of Pharmacy, Erfan and Bagedo General Hospital, Jeddah 22230, Saudi Arabia;
| | - Malak Fahad
- Department of Clinical Pharmacy, Northern Borders University, Rafha 91911, Saudi Arabia;
| | - Rana Kallab
- Department of Pharmacy, Aldawaa Pharmacy, Arar 73551, Saudi Arabia;
| | - Reem Mohammed
- College of Pharmacy, King Khalid University, Abha 61421, Saudi Arabia; (R.A.); (S.M.); (R.M.)
| | - Dimah Alassaf
- College of Medicine, Princess Noura University, Riyadh 12211, Saudi Arabia;
| | - Ashwag Hazza
- Department of Pharmacy, Altaawin Medical Clinics, Alkharj 16443, Saudi Arabia;
| |
Collapse
|
3
|
Jeong SH, Jang JH, Cho HY, Lee YB. Population Pharmacokinetic Analysis of Cefaclor in Healthy Korean Subjects. Pharmaceutics 2021; 13:pharmaceutics13050754. [PMID: 34069627 PMCID: PMC8160640 DOI: 10.3390/pharmaceutics13050754] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/12/2021] [Accepted: 05/18/2021] [Indexed: 01/21/2023] Open
Abstract
The aims of this study were: (1) to perform population pharmacokinetic analysis of cefaclor in healthy Korean subjects, and (2) to investigate possible effects of various covariates on pharmacokinetic parameters of cefaclor. Although cefaclor belongs to the cephalosporin family antibiotic that has been used in various indications, there have been very few population studies on factors affecting its pharmacokinetics. Therefore, this study is very important in that effective therapy could be possible through a population pharmacokinetic study that explores effective covariates related to cefaclor pharmacokinetic diversity between individuals. Pharmacokinetic results of 48 subjects with physical and biochemical parameters were used for the population pharmacokinetic analysis of cefaclor. A one-compartment with lag-time and first-order absorption/elimination was constructed as a base model and extended to include covariates that could influence between-subject variability. Creatinine clearance and body weight significantly influenced systemic clearance and distribution volume of cefaclor. Cefaclor’s final population pharmacokinetic model was validated and some of the population’s pharmacokinetic diversity could be explained. Herein, we first describe the establishment of a population pharmacokinetic model of cefaclor for healthy Koreans that might be useful for customizing cefaclor or exploring additional covariates in patients.
Collapse
Affiliation(s)
- Seung-Hyun Jeong
- College of Pharmacy, Chonnam National University, 77 Yongbong-ro, Buk-gu, Gwangju 61186, Korea; (S.-H.J.); (J.-H.J.)
| | - Ji-Hun Jang
- College of Pharmacy, Chonnam National University, 77 Yongbong-ro, Buk-gu, Gwangju 61186, Korea; (S.-H.J.); (J.-H.J.)
| | - Hea-Young Cho
- College of Pharmacy, CHA University, 335 Pangyo-ro, Bundang-gu, Seongnam-si 13488, Gyeonggi-do, Korea
- Correspondence: (H.-Y.C.); (Y.-B.L.); Tel.: +82-31-881-7167 (H.-Y.C.); +82-62-530-2931 (Y.-B.L.)
| | - Yong-Bok Lee
- College of Pharmacy, Chonnam National University, 77 Yongbong-ro, Buk-gu, Gwangju 61186, Korea; (S.-H.J.); (J.-H.J.)
- Correspondence: (H.-Y.C.); (Y.-B.L.); Tel.: +82-31-881-7167 (H.-Y.C.); +82-62-530-2931 (Y.-B.L.)
| |
Collapse
|
4
|
Kusama Y, Muraki Y, Mochizuki T, Kurai H, Gu Y, Ohmagari N. Relationship between drug formulary and frequently used cephalosporins, macrolides and quinolones in Japanese hospitals. J Infect Chemother 2019; 26:211-215. [PMID: 31543436 DOI: 10.1016/j.jiac.2019.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 06/10/2019] [Accepted: 08/20/2019] [Indexed: 11/16/2022]
Abstract
In Japan, hospitals' pharmaceutical affairs committees freely select the drugs to be purchased depending on the regulations of each hospital. This system poses a risk of the absence of essential drugs or an excess of similar drugs, and may promote inappropriate use of third-generation cephalosporins (3GCs) and quinolones. Against this backdrop, we researched availability of antibacterial agents in Japanese hospitals. We conducted a questionnaire-based study in eastern Shizuoka Prefecture, Japan. Questionnaires were sent to 33 hospitals that had established an interactive regional partnership on infection control. We analyzed the number of available oral cephalosporins, macrolides, and quinolones in each hospital, and the correlation between the number of total available antibacterial agents and the hospital scale and cephalexin availability. Thirty-one hospitals participated in this study. First-generation cephalosporin (1 GC) was available in only 22.5% of them. In all participating hospitals, 3GCs were available, with more than one 3 GC available in 74.2%. Quinolones were available in all hospitals, and more than one quinolone in 67.7%. The numbers of hospital beds and total available antibacterial agents were positively correlated and hospitals that owned cephalexin available also significantly more often owned other available antibacterial agents. 1 GC were available in only a few hospitals, while multiple 3GCs and quinolones were available in most. This situation may lead to excess use of 3GCs or quinolones in Japan. A low number of available drugs was associated with cephalexin unavailability. Outpatient antimicrobial stewardship may focus not only on the quality of medicine, but also on the prescribing environment.
Collapse
Affiliation(s)
- Yoshiki Kusama
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, Japan; Collaborative Chairs Emerging and Reemerging Infectious Diseases, National Center for Global Health and Medicine, Graduate School of Medicine, Tohoku University, 1-1, Seriryo-tyo, Aoba-ku, Sendai, Miyagi, Japan.
| | - Yuichi Muraki
- Department of Clinical Pharmacoepidemiology, Kyoto Pharmaceutical University, 5, Nakauchi-machi, Misasagi, Yamashina-ku, Kyoto-shi, Kyoto, Japan
| | - Takahiro Mochizuki
- Department of Pharmacy, Shizuoka Cancer Center Hospital, Shizuoka, 1007, Shimonagakubo, Nagaizumi-cho, Sundo-gun, Shizuoka, Japan
| | - Hanako Kurai
- Division of Infectious Diseases, Shizuoka Cancer Center Hospital, 1007, Shimonagakubo, Nagaizumi-cho, Sundo-gun, Shizuoka, Japan
| | - Yoshiaki Gu
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, Japan
| | - Norio Ohmagari
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, Japan; Collaborative Chairs Emerging and Reemerging Infectious Diseases, National Center for Global Health and Medicine, Graduate School of Medicine, Tohoku University, 1-1, Seriryo-tyo, Aoba-ku, Sendai, Miyagi, Japan
| |
Collapse
|
5
|
|
6
|
Liu R, Tang AMY, Tan YL, Limenta LMG, Lee EJD. Effects of Sodium Bicarbonate and Ammonium Chloride Pre-treatments on PEPT2 (SLC15A2) Mediated Renal Clearance of Cephalexin in Healthy Subjects. Drug Metab Pharmacokinet 2011; 26:87-93. [DOI: 10.2133/dmpk.dmpk-10-rg-039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
7
|
Interethnic differences of PEPT2 (SLC15A2) polymorphism distribution and associations with cephalexin pharmacokinetics in healthy Asian subjects. Eur J Clin Pharmacol 2008; 65:65-70. [PMID: 18766334 DOI: 10.1007/s00228-008-0488-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2008] [Accepted: 03/13/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The aims of this study were to characterize the population frequency of PEPT2 (SLC15A2) polymorphic variants in three Asian ethnic populations, namely Chinese, Malay and Asian Indian, and to investigate the associations of ethnicity (Chinese vs. Asian Indian), PEPT2 haplotype and cephalexin pharmacokinetics in healthy Asian subjects. METHODS PEPT2 polymorphisms were screened from a cohort of 96 Chinese, 96 Malay and 96 Asian Indian subjects. Cephalexin (1000 mg, orally) pharmacokinetics was characterized in an additional 15 Chinese and 15 Asian Indian healthy subjects. These 30 subjects were subsequently genotyped for their PEPT2 polymorphisms. RESULTS In total, ten common single nucleotide polymorphisms (SNPs) were detected in the three populations, forming two PEPT2 haplotypes. There were significant ethnic differences in PEPT2 haplotype distribution: the frequencies of the *1 and *2 alleles were 0.307 and 0.693 in the Chinese population, 0.495 and 0.505 in the Malay population and 0.729 and 0.271 in Asian Indian population, respectively. The C (max) of cephalexin was significantly lower in the Chinese (29.80 +/- 4.09 microg ml(-1)) population than in the Asian Indian one (33.29 +/- 4.97 microg ml(-1); P = 0.045). This difference could be explained by the higher average body weight of the Chinese population. There was no other significant difference in cephalexin pharmacokinetics between either ethnic or PEPT2 genotype groups. CONCLUSION PEPT2 polymorphism distributions differ significantly between Chinese, Malay and Asian Indian populations. However, cephalexin pharmacokinetics is not meaningfully different between Chinese and Asian Indians. The association between the PEPT2 haplotype and cephalexin pharmacokinetics could not be confirmed, and future studies under better controlled conditions are needed.
Collapse
|
8
|
Granados‐Soto V, Aguilar‐Cota ME, Reyes‐Garcia G, Medina‐Santillán R, Flores‐Murrieta FJ. Simple Method for the Determination of Cefaclor in Human Plasma Samples by HPLC. J LIQ CHROMATOGR R T 2007. [DOI: 10.1081/jlc-120025526] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- V. Granados‐Soto
- a Departamento de Farmacobiología, Centro de Investigación y de Estudios Avanzados , Instituto Politécnico Nacional , Calzada Tenorios 235, Col. Granjas Coapa, 14330, México, D.F., México
- b Laboratorio de Farmacología, IIQB, UMSNH , Morelia, Michoacán, Mexico
| | | | - G. Reyes‐Garcia
- d Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina , Instituto Politécnico Nacional , México, D.F., México
| | - R. Medina‐Santillán
- d Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina , Instituto Politécnico Nacional , México, D.F., México
| | - F. J. Flores‐Murrieta
- d Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina , Instituto Politécnico Nacional , México, D.F., México
- e Instituto Nacional de Enfermedades Respiratorias, SSA , México, D.F., México
| |
Collapse
|
9
|
Turner JV, Maddalena DJ, Cutler DJ. Pharmacokinetic parameter prediction from drug structure using artificial neural networks. Int J Pharm 2004; 270:209-19. [PMID: 14726136 DOI: 10.1016/j.ijpharm.2003.10.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Simple methods for determining the human pharmacokinetics of known and unknown drug-like compounds is a much sought-after goal in the pharmaceutical industry. The current study made use of artificial neural networks (ANNs) for the prediction of clearances, fraction bound to plasma proteins, and volume of distribution of a series of structurally diverse compounds. A number of theoretical descriptors were generated from the drug structures and both automated and manual pruning were used to derive optimal subsets of descriptors for quantitative structure-pharmacokinetic relationship models. Models were trained on one set of compounds and validated with another. Absolute predicted ability was evaluated using a further independent test set of compounds. Correlations for test compounds ranged from 0.855 to 0.992. Predicted values agreed closely with experimental values for total clearance, renal clearance, and volume of distribution, while predictions for protein binding were encouraging. The combination of descriptor generation, ANNs, and the speed and success of this technique compared with conventional methods shows strong potential for use in pharmaceutical product development.
Collapse
Affiliation(s)
- Joseph V Turner
- Faculty of Pharmacy, The University of Sydney, Sydney 2006, Australia.
| | | | | |
Collapse
|
10
|
Turner JV, Maddalena DJ, Cutler DJ, Agatonovic-Kustrin S. Multiple pharmacokinetic parameter prediction for a series of cephalosporins. J Pharm Sci 2003; 92:552-9. [PMID: 12587116 DOI: 10.1002/jps.10314] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The goal of quantitative structure-pharmacokinetic relationship analyses is to develop useful models that can predict one or more pharmacokinetic properties of a particular compound. In the present study, a multiple-output artificial neural network model was constructed to predict human half-life, renal and total body clearance, fraction excreted in urine, volume of distribution, and fraction bound to plasma proteins for a series of cephalosporins. Descriptors generated solely from drug structure were used as inputs for the model, and the six pharmacokinetic parameters were simultaneously predicted as outputs. The final 10 descriptor model contained sufficient information for successful predictions using both internal and external test compounds. Descriptors were found to contribute to individual pharmacokinetic parameters to differing extents, such that descriptor importance was independent of the relationships between pharmacokinetic parameters. This technique provides the advantage of simultaneous prediction of multiple parameters using information obtained by nonexperimental means, with the potential for use during the early stages of drug development.
Collapse
Affiliation(s)
- Joseph V Turner
- Faculty of Pharmacy, The University of Sydney, NSW 2006, Australia.
| | | | | | | |
Collapse
|
11
|
Sinko PJ, Leesman GD, Amidon GL. Mass balance approaches for estimating the intestinal absorption and metabolism of peptides and analogues: theoretical development and applications. Pharm Res 1993; 10:271-5. [PMID: 8456076 DOI: 10.1023/a:1018999130076] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A theoretical analysis for estimating the extent of intestinal peptide and peptide analogue absorption was developed on the basis of a mass balance approach that incorporates convection, permeability, and reaction. The macroscopic mass balance analysis (MMBA) was extended to include chemical and enzymatic degradation. A microscopic mass balance analysis, a numerical approach, was also developed and the results compared to the MMBA. The mass balance equations for the fraction of a drug absorbed and reacted in the tube were derived from the general steady state mass balance in a tube: [formula: see text] where M is mass, z is the length of the tube, R is the tube radius, Pw is the intestinal wall permeability, kr is the reaction rate constant, C is the concentration of drug in the volume element over which the mass balance is taken, VL is the volume of the tube, and vz is the axial velocity of drug. The theory was first applied to the oral absorption of two tripeptide analogues, cefaclor (CCL) and cefatrizine (CZN), which degrade and dimerize in the intestine. Simulations using the mass balance equations, the experimental absorption parameters, and the literature stability rate constants yielded a mean estimated extent of CCL (250-mg dose) and CZN (1000-mg dose) absorption of 89 and 51%, respectively, which was similar to the mean extent of absorption reported in humans (90 and 50%). It was proposed previously that 15% of the CCL dose spontaneously degraded systematically; however, our simulations suggest that significant CCL degradation occurs (8 to 17%) presystemically in the intestinal lumen.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- P J Sinko
- College of Pharmacy, Rutgers University, Piscataway, New Jersey 08855-0789
| | | | | |
Collapse
|
12
|
|
13
|
St Peter WL, Redic-Kill KA, Halstenson CE. Clinical pharmacokinetics of antibiotics in patients with impaired renal function. Clin Pharmacokinet 1992; 22:169-210. [PMID: 1559311 DOI: 10.2165/00003088-199222030-00002] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Many antibiotics are eliminated renally and dosage adjustments are commonly made in patients with renal insufficiency. This is a critical review of antibiotic pharmacokinetics in patients with various degrees of renal function. Detailed information regarding pharmacokinetic alterations with specific antibiotics or antibiotic classes has been compiled and tabulated. From pharmacokinetic evidence, recommendations for dosage adjustments of antibiotics are supplied. The criteria used for assigning rating levels to specific pharmacokinetic articles as well as the grading system for dosage adjustments are outlined. In addition, a basic review of pharmacokinetic alterations in renal failure and factors affecting the removal of drugs by haemodialysis is included.
Collapse
Affiliation(s)
- W L St Peter
- Drug Evaluation Unit, Hennepin County Medical Center, Minneapolis, Minnesota
| | | | | |
Collapse
|
14
|
Shyu WC, Pittman KA, Wilber RB, Matzke GR, Barbhaiya RH. Pharmacokinetics of cefprozil in healthy subjects and patients with renal impairment. J Clin Pharmacol 1991; 31:362-71. [PMID: 2037710 DOI: 10.1002/j.1552-4604.1991.tb03719.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Cefprozil, a new broad-spectrum oral cephalosporin, is composed of cis and trans isomers in an approximate 90:10 ratio. The pharmacokinetics of a single oral 1000-mg dose of cefprozil were evaluated in 6 healthy subjects and 24 patients with various degrees of renal impairment. Six of these subjects were studied both while receiving hemodialysis and during an interdialytic period. Plasma, urine, and hemodialysate that were collected at predetermined times were analyzed for concentrations of the cis and trans isomers of cefprozil using reverse-phase HPLC assay with UV detection. The maximum plasma concentration of the cis isomer ranged from 12.3 micrograms/mL in subjects with normal renal function to 36.7 micrograms/mL in hemodialysis patients. Similarly the area under the plasma concentration-time curve and the elimination half-life increased from 46 micrograms.h/mL to 373 micrograms.h/mL and from 1.72 hours to 5.94 hours, respectively. Renal clearance of the cis isomer decreased from 198 mL/min in normal subjects to 19 mL/min in volunteers with creatinine clearances of less than or equal to 30 mL/min; there was a strong correlation (r2 greater than or equal to .93) between the renal clearance of the cis isomer and creatinine clearance. Urinary recovery of the cis isomer decreased from 57% in those with normal renal function to 24% in the group with a creatinine clearance of less than or equal to 30 mL/min. Hemodialysis decreased the half-life of the cis isomer to 2 hours and removed approximately 55% of it from the body during a 3-hour dialysis period (hemodialysis clearance equaled approximately 87 mL/min). The pharmacokinetics of the trans isomer were similar to those observed for the cis isomer and were affected similarly by declining renal function. A reduction in dosage is recommended in patients with a creatinine clearance of 30 mL/min or less. It may be necessary to administer a dose after hemodialysis to maintain therapeutic plasma concentrations.
Collapse
Affiliation(s)
- W C Shyu
- Department of Metabolism and Pharmacokinetics, Bristol-Myers Squibb Pharmaceutical Research Institute Syracuse, New York 13221-4755
| | | | | | | | | |
Collapse
|
15
|
Smith GH, Smith GH. Oral cephalosporins in perspective. DICP : THE ANNALS OF PHARMACOTHERAPY 1990; 24:45-51. [PMID: 2405586 DOI: 10.1177/106002809002400111] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Oral cephalosporins, after 25 years of use, continue to present the clinician with a therapeutic challenge. The older agents have been extensively prescribed for ambulatory adult and pediatric patients with a wide variety of infections caused by gram-positive and some gram-negative organisms. The newer agents, cefaclor, cefuroxime axetil, and cefixime, have increased in vitro activity against beta-lactamase-secreting strains of Haemophilus influenzae and Branhamella catarrhalis which has made them more popular for the treatment of otitis media and respiratory tract infections in children. The new agents are also more active against most gram-negative organisms. However, clinical trials have failed to show a clear-cut superiority over older, proven therapy when used to treat infections of the respiratory tract, middle ear, skin and soft tissue, urinary tract, and bone and joints when caused by sensitive organisms. Published reports of clinical trials continue to support the recommendation that oral cephalosporins, especially the newer and more expensive agents, be reserved for second- or third-line therapy when amoxicillin, penicillin V, or trimethoprim/sulfamethoxazole have either failed or produced patient intolerance. Erythromycin/sulfisoxazole and amoxicillin/clavulanate potassium are equally efficacious and also less expensive than cefaclor, cefuroxime axetil, and cefixime and could be considered second-line therapy prior to the use of the newer cephalosporins for infections in the ambulatory patient.
Collapse
Affiliation(s)
- G H Smith
- Division of Clinical Pharmacy, University of Arizona, Tucson 85721
| | - Gary H. Smith
- Division of Clinical Pharmacy; and Drug Information Center, College of Pharmacy, University of Arizona, Tucson, AZ 85721
| |
Collapse
|
16
|
Najib NM, Suleiman MS, el-Sayed YM, Abdulhameed ME. High performance liquid chromatographic analysis of cephalexin in serum and urine. J Clin Pharm Ther 1987; 12:419-26. [PMID: 3440814 DOI: 10.1111/j.1365-2710.1987.tb00556.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A rapid, highly sensitive high performance liquid chromatographic method has been developed for the determination of cephalexin in serum and urine. Serum protein was precipitated with 1% zinc sulphate solution containing cephradine as the internal standard. The drugs were eluted from a 5 micron, C-18 reversed-phase column at ambient temperature with a mobile phase consisting of acetonitrile-methanol-acetate buffer of pH 4.2 (10:10:80%), at a flow rate of 1.4 ml/min with ultraviolet detection at 254 nm. Each analysis lasted 9 min. Quantification was achieved by the measurement of the peak-height ratio and the relative and absolute recoveries varied from 98 to 103%. Detection limits for cephalexin were 1 microgram/ml in serum and 5 micrograms/ml in urine. Within-run coefficient of variation ranged from 0.73 to 5.63% at three different concentrations for the serum and urine assay.
Collapse
Affiliation(s)
- N M Najib
- Faculty of Pharmacy, Jordan University of Science and Technology, Irbid
| | | | | | | |
Collapse
|
17
|
Nahata MC. Determination of cefaclor by high-performance liquid chromatography. JOURNAL OF CHROMATOGRAPHY 1982; 228:429-33. [PMID: 7076773 DOI: 10.1016/s0378-4347(00)80468-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
18
|
Spyker DA, Gober LL, Scheld WM, Sande MA, Bolton WK. Pharmacokinetics of cefaclor in renal failure: effects of multiple doses and hemodialysis. Antimicrob Agents Chemother 1982; 21:278-81. [PMID: 7073265 PMCID: PMC181873 DOI: 10.1128/aac.21.2.278] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The pharmacokinetics of cefaclor were characterized in 15 functionally anephric patients on hemodialysis. Each patient received a 500-mg oral dose of cefaclor every 8 h for 10 days. Multiple serum drug levels were measured by bioassay on day 0 (no hemodialysis), day 10 during hemodialysis, and as single determinations 1 h after administration on days 1, 3, and 5. Analysis of cefaclor kinetics in these 15 patients along with kinetics from 24 previously studied patients showed that weight was the best single predictor of volume of distribution. The corrected creatinine clearance (calculated from serum creatinine, age, and sex) proved to be the best predictor of drug half-life (r = 0.969). Thus, a single serum creatinine test provided a better estimated of cefaclor half-life than a 24-h urine collection. Cefaclor was cleared with an average serum half-life of 2.9 h without hemodialysis and 1.5 h during hemodialysis. Cefaclor serum levels measured 1 h after administration on days 0, 1, 3, and 5 showed no evidence of accumulation. Thus, cefaclor may be administered orally in multiple doses without accumulation in functionally anephric patients. In patients on dialysis, dosage interval or quantity should be increased to compensate for doubled drug clearance dialysis.
Collapse
|
19
|
Kammer RB. Cefaclor in management of streptococcal pharyngitis, otitis media, and skin infections. THE ANNALS OF OTOLOGY, RHINOLOGY & LARYNGOLOGY. SUPPLEMENT 1981; 90:79-81. [PMID: 6791569 DOI: 10.1177/00034894810903s219] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Cefaclor, a semisynthetic cephalosporin antibiotic for oral use, was studied by 62 clinical investigators in six countries in 3,084 adult and pediatric patients. The pooled data reveal that satisfactory clinical responses were obtained in 96% of the streptococcal pharyngitis cases, 93% of the cases of otitis media, and 97% of skin infections. Administration of this antibiotic was associated with a low incidence of adverse reactions, including 73 gastrointestinal and 34 hypersensitivity reactions. Of particular clinical interest were the outstanding results obtained in the treatment of otitis media.
Collapse
|
20
|
|
21
|
Bolton WK, Scheld WM, Spyker DA, Overby TL, Sande MA. Pharmacokinetics of moxalactam in subjects with various degrees of renal dysfunction. Antimicrob Agents Chemother 1980; 18:933-8. [PMID: 6453555 PMCID: PMC352992 DOI: 10.1128/aac.18.6.933] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
We have examined the pharmacokinetics of moxalactam (LY127935) in 36 subjects with various degrees of renal dysfunction. Creatinine clearance (Ccr)/1.73 m2 ranged from zero to 135.8 ml/min. After a 1-g administration of moxalactam intravenously, the volume of distribution was 20.6 /+- 9.5 liters (0.28 liter/kg), and the mean half-life ranged from 3.1 h for subjects with Ccr greater than 65 ml/min to 19.3 h for subjects with Ccr less than 10 ml/min. The moxalactam clearance was closely correlated to Ccr (r = 0.93, P less than 0.0001) and excretion of antibiotic was 73.6 +/- 13% in normal subjects. Renal clearance accounted for 90% of moxalactam clearance in the normal subjects. A dosage schedule for administering moxalactam to patients with various degrees of renal dysfunction is provided.
Collapse
|
22
|
Lode H, Stahlmann R, Dzwillo G, Koeppe P. Vergleichende Pharmakokinetik oraler Cephalosporine: Cephalexin, Cefaclor und Cefadroxil. Infection 1980. [DOI: 10.1007/bf01639669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
23
|
Chapter 29. Altered Drug Disposition in Disease States. ANNUAL REPORTS IN MEDICINAL CHEMISTRY 1980. [DOI: 10.1016/s0065-7743(08)60390-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register]
|
24
|
Abstract
Cefaclor, a new semisynthetic cephalosporin antibiotic for oral use, was studied by 62 clinical investigators in six countries in 1493 adult and paediatric patients. The pooled data reveal that satisfactory clinical responses were obtained in 80% of urinary tract infections, 87% of upper respiratory tract infections, 90% of cases of otitis media, 99% of lower respiratory tract infections, and 96% of skin and skin structure infections. Administration of this antibiotic was associated with a low incidence of adverse reactions including gastrointestinal (2.6%) and hypersensitivity (1.5%). Of particular clinical interest were the outstanding results obtained in the treatment of otitis media and lower respiratory tract infections.
Collapse
|
25
|
Ullmann U, Diekmann HW. [Thin layer and high pressure liquid chromatography investigations with cefaclor in urine and serum (author's transl)]. Infection 1979; 7 Suppl 6:554-6. [PMID: 399248 DOI: 10.1007/bf01659734] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
After oral administration of 500 mg cefaclor, antibacterially active metabolites could not be detected in human urine using thin layer chromatography followed by bioautography. Degradation products of cefaclor could also not be detected in the serum of human volunteers (n = 10) using high pressure liquid chromatography with a reversed phase system. Cefaclor was eluated as a single and homogenous peak with a retention period of 2.9 min. High pressure liquid chromatography for the measurement of cefaclor serum levels and a technique for preparation of serum samples are described. After administration of 500 mg cefaclor to volunteers (n = 10), the average peak serum concentration of 9.8 mg/l, determined by high pressure liquid chromatography, was observed after one hour. Four hours later the serum level was 0.3 mg/l. Using microbiological methods no statistically significant difference was obtained in comparison with the chromatography results. Some of the sera stored at -75 degrees C for four weeks showed a substantial loss of activity of cefaclor.
Collapse
|
26
|
Lode H, Stahlmann R, Koeppe P. Comparative pharmacokinetics of cephalexin, cefaclor, cefadroxil, and CGP 9000. Antimicrob Agents Chemother 1979; 16:1-6. [PMID: 475366 PMCID: PMC352777 DOI: 10.1128/aac.16.1.1] [Citation(s) in RCA: 75] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
In a randomized crossover study, the pharmacokinetics of three new cephalosporin antibiotics, cefaclor, cefadroxil, and CGP 9000, in comparison to cephalexin, were determined after oral administration, by capsules, of 1,000 mg on an empty stomach in 12 normal subjects. Serum concentrations were measured during a period of 8 h, and urine recovery was measured during 24 h. The significant parameters of bioavailability of an orally administered substance were determined. The maximal serum concentrations (y(max)) for cephalexin, cefaclor, cefadroxil, and CGP 9000 (in milligrams per liter) were: 38.8 +/- 8.1; 34.6 +/- 7.8; 33.0 +/- 5.4; and 23.3 +/- 7.3, respectively. The areas under the curve (in hours x milligrams per liter) were: 93.0 +/- 14.8; 74.5 +/- 9.9; 70.1 +/- 9.0; and 108.5 +/- 18.4, respectively. In a further crossover study with six subjects, 1,000 mg of cephalexin and of cefadroxil were given during a standard breakfast. The y(max) of cephalexin decreased to 23.1 +/- 6.6 mg/liter, in contrast to cefadroxil, with an unchanged y(max) of 32.7 +/- 3.4 mg/liter.
Collapse
|