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Wang Y, Liu X, Li K, Fan Y, Yu J, Wu H, Li Y, Wu X, Guo B, Li X, Hu J, Wu J, Cao G, Zhang J. Pharmacokinetics and Safety of Doripenem in Healthy Chinese Subjects and Monte Carlo Dosing Simulations. Antibiotics (Basel) 2022; 11:antibiotics11070958. [PMID: 35884212 PMCID: PMC9311841 DOI: 10.3390/antibiotics11070958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/08/2022] [Accepted: 07/14/2022] [Indexed: 02/01/2023] Open
Abstract
The aim of this study was to investigate the pharmacokinetics (PK) of doripenem in healthy Chinese subjects and evaluate the optimal dosage regimens of doripenem. A randomized, single-dose, three-period, self-crossover controlled extended-infusion clinical trial was conducted with 12 healthy Chinese subjects. Plasma and urine samples were collected to determine doripenem concentrations. Non-compartmental and population PK analysis were performed to characterize the PK of doripenem. The Monte Carlo simulation was employed to optimize dosing regimens based on the probability of target attainment of doripenem against pathogens with different minimum inhibitory concentrations (MIC). All 12 healthy Chinese subjects completed the study, and the doripenem was well tolerated. The study showed linearity relationships in the peak plasma concentration and the area under the concentration-time curve after intravenous infusion of doripenem from 0.25 g to 1.0 g. The cumulative urinary recovery rate of doripenem was 68.1–72.0% within 24 h. PPK modeling showed a two-compartmental model, with first-order elimination presenting the best fit for doripenem PK. Monte Carlo simulation results showed that 1.0 g q12h or 0.5 g q8h was an optimal regimen for pathogens susceptible to doripenem (MIC ≤ 1 mg/L); while high dose and extended infusion (1 g, q8h, 4 h infusion) was proposed for unsusceptible pathogens (2 ≤ MIC ≤ 8 mg/L). In the dose range of 0.25 to 1.0 g, doripenem showed linear pharmacokinetics. Doripenem at 1.0 g with a prolonged infusion time of 4 h was predicted to be effective against pathogens with MICs as high as 8 mg/L.
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Affiliation(s)
- Yu Wang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China; (Y.W.); (X.L.); (Y.F.); (H.W.); (Y.L.); (B.G.); (X.L.); (J.H.)
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People’s Republic of China, Shanghai 200040, China; (J.Y.); (X.W.); (J.W.)
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Xiaofen Liu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China; (Y.W.); (X.L.); (Y.F.); (H.W.); (Y.L.); (B.G.); (X.L.); (J.H.)
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People’s Republic of China, Shanghai 200040, China; (J.Y.); (X.W.); (J.W.)
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Kun Li
- Chia Tai Tianqing Pharmaceutical Group Co., Ltd., Nanjing 210042, China;
| | - Yaxin Fan
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China; (Y.W.); (X.L.); (Y.F.); (H.W.); (Y.L.); (B.G.); (X.L.); (J.H.)
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People’s Republic of China, Shanghai 200040, China; (J.Y.); (X.W.); (J.W.)
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Jicheng Yu
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People’s Republic of China, Shanghai 200040, China; (J.Y.); (X.W.); (J.W.)
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
- Phase I Clinical Research Center, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Hailan Wu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China; (Y.W.); (X.L.); (Y.F.); (H.W.); (Y.L.); (B.G.); (X.L.); (J.H.)
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People’s Republic of China, Shanghai 200040, China; (J.Y.); (X.W.); (J.W.)
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Yi Li
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China; (Y.W.); (X.L.); (Y.F.); (H.W.); (Y.L.); (B.G.); (X.L.); (J.H.)
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People’s Republic of China, Shanghai 200040, China; (J.Y.); (X.W.); (J.W.)
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Xiaojie Wu
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People’s Republic of China, Shanghai 200040, China; (J.Y.); (X.W.); (J.W.)
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
- Phase I Clinical Research Center, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Beining Guo
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China; (Y.W.); (X.L.); (Y.F.); (H.W.); (Y.L.); (B.G.); (X.L.); (J.H.)
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People’s Republic of China, Shanghai 200040, China; (J.Y.); (X.W.); (J.W.)
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Xin Li
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China; (Y.W.); (X.L.); (Y.F.); (H.W.); (Y.L.); (B.G.); (X.L.); (J.H.)
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People’s Republic of China, Shanghai 200040, China; (J.Y.); (X.W.); (J.W.)
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Jiali Hu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China; (Y.W.); (X.L.); (Y.F.); (H.W.); (Y.L.); (B.G.); (X.L.); (J.H.)
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People’s Republic of China, Shanghai 200040, China; (J.Y.); (X.W.); (J.W.)
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Jufang Wu
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People’s Republic of China, Shanghai 200040, China; (J.Y.); (X.W.); (J.W.)
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
- Phase I Clinical Research Center, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Guoying Cao
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People’s Republic of China, Shanghai 200040, China; (J.Y.); (X.W.); (J.W.)
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
- Phase I Clinical Research Center, Huashan Hospital, Fudan University, Shanghai 200040, China
- Correspondence: (G.C.); (J.Z.)
| | - Jing Zhang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China; (Y.W.); (X.L.); (Y.F.); (H.W.); (Y.L.); (B.G.); (X.L.); (J.H.)
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of the People’s Republic of China, Shanghai 200040, China; (J.Y.); (X.W.); (J.W.)
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
- Phase I Clinical Research Center, Huashan Hospital, Fudan University, Shanghai 200040, China
- Correspondence: (G.C.); (J.Z.)
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Huang C, Chen I, Yang Y. Doripenem in the Treatment of Patients with Nosocomial Pneumonia: A Meta-Analysis. J Clin Med 2022; 11:jcm11144014. [PMID: 35887777 PMCID: PMC9319354 DOI: 10.3390/jcm11144014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/28/2022] [Accepted: 07/07/2022] [Indexed: 01/11/2023] Open
Abstract
Introduction: Clinically, doripenem therapy for nosocomial pneumonia remains a serious concern. The purpose of this meta-analysis was to explore the efficacy and the safety of doripenem therapy for nosocomial pneumonia in comparison with other antimicrobial agents. Methods: Studies were eligible for inclusion only if they directly compared the clinical effectiveness of doripenem and other antimicrobial agent therapies for nosocomial pneumonia in adult patients between 1 January 2000 and 30 April 2022. All studies were included if they reported one or more of the following outcomes: clinical cure rate, microbiological cure rate, all-cause mortality, and adverse events. Results: Six randomized controlled trials and three retrospective studies were included in the meta-analysis. There were 952 patients in the doripenem group and 1183 patients in the comparator group. The comparator antimicrobial agents included imipenem/cilastatin, meropenem, and piperacillin/tazobactam. Seven studies had a high risk of bias. Doripenem therapy for nosocomial pneumonia had a microbiological cure rate, a clinical cure rate, an all-cause mortality, and adverse events similar to those of comparators. Conclusions: The efficacy and the safety of doripenem therapy for nosocomial pneumonia were comparable with those of comparators. Randomized controlled trials are needed to confirm the role of doripenem in nosocomial pneumonia therapy.
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Affiliation(s)
- Chienhsiu Huang
- Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan;
- Correspondence: or ; Tel.: +886-9-2155-2418
| | - Ihung Chen
- Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan;
| | - Yalun Yang
- Department of Nursing, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan;
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Matovina M, Abram M, Repac-Antić D, Knežević S, Bubonja-Šonje M. An outbreak of ertapenem-resistant, carbapenemase-negative and porin-deficient ESBL-producing Klebsiella pneumoniae complex. Germs 2021; 11:199-210. [PMID: 34422692 DOI: 10.18683/germs.2021.1257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/24/2021] [Accepted: 05/24/2021] [Indexed: 11/08/2022]
Abstract
Introduction Carbapenem-resistant Klebsiella pneumoniae is an emerging healthcare-associated pathogen with dynamic molecular epidemiology. This study presents a retrospective analysis of the distribution and antibiotic resistance patterns of ertapenem-resistant ESBL-producing K. pneumoniae strains recovered during an outbreak from 2012 to 2014 in a Croatian University hospital. Methods We aimed to estimate genetic relatedness of clinical isolates and underlying mechanisms that conferred the ertapenem-resistant phenotype. Results Expression analysis of genes involved in the antibiotic resistance showed reduced expression of major non-selective porin channel OmpK35. Reduced expression of OmpK36 porin channel in isolates resistant to at least one more carbapenem, apart from the ertapenem, was found to a lesser degree. Pulsed-field gel electrophoresis analysis of genomic DNA revealed that almost all isolates belonged to the same genetic clone. Conclusions Caution regarding ertapenem-resistant, carbapenemase-negative porin-deficient mutants of K. pneumoniae is required as they are widespread, and under selective pressure this could result in a local clonal outbreak.
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Affiliation(s)
- Mihaela Matovina
- PhD, Division of Organic Chemistry and Biochemistry, Rudjer Bošković Institute, Bijenička cesta 54, 10 000 Zagreb, Croatia
| | - Maja Abram
- MD, PhD, Department of Microbiology, Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51 000 Rijeka, Croatia and Department of Clinical Microbiology, Clinical Hospital Center Rijeka, Krešimirova 40, 51 000 Rijeka, Croatia
| | - Davorka Repac-Antić
- MD, Department of Microbiology, Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51 000 Rijeka, Croatia and Department of Clinical Microbiology, Clinical Hospital Center Rijeka, Krešimirova 40, 51 000 Rijeka, Croatia
| | - Samira Knežević
- MD, Department of Infectology, Clinical Hospital Center Rijeka, Krešimirova 40, 51 000 Rijeka, Croatia
| | - Marina Bubonja-Šonje
- MD, PhD, Department of Microbiology, Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51 000 Rijeka, Croatia and Department of Clinical Microbiology, Clinical Hospital Center Rijeka, Krešimirova 40, 51 000 Rijeka, Croatia
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