Antibacterial effects of cefroxadine, cephalexin and cephradine in a new in vitro pharmacokinetic model

In vitro pharmacodynamic models to determine the effect of antibacterial drugs

In vitro pharmacodynamic (PD) models are used to obtain useful quantitative information on the effect of either single drugs or drug combinations against bacteria. This review provides an overview of in vitro PD models and their experimental implementation. Models are categorized on the basis of whether the drug concentration remains constant or changes and whether there is a loss of bacteria from the system. Further subdifferentiation is based on whether bacterial loss involves dilution of the medium or is associated with dialysis or diffusion. For comprehension of the underlying principles, experimental settings are simplified and schematically illustrated, including the simulations of various in vivo routes of administration. The different model types are categorized and their (dis)advantages discussed. The application of in vitro models to special organs, infections and pathogens is comprehensively presented. Finally, the relevance and perspectives of in vitro investigations in drug discovery and clinical research are elucidated and discussed.

Pharmacodynamic effects of sub-MICs of benzylpenicillin against Streptococcus pyogenes in a newly developed in vitro kinetic model

The pharmacodynamic effects of benzylpenicillin against Streptococcus pyogenes were studied in a new in vitro kinetic model in which bacterial outflow was prevented by a filter membrane. Following the administration of an initial dose of antibiotic, decreasing concentrations were produced by dilution of the medium. A magnetic stirrer was placed above the filter to avoid blockage of the membrane and to ensure homogeneous mixing of the culture. Repeated samplings were easily provided through a silicon diaphragm. Streptococci were exposed to a single dose corresponding to 1.5, 10, 100, or 500 x the MIC of benzylpenicillin and also to an initial concentration of 10 x the MIC of benzylpenicillin, followed by exposure to a repeated dose after 8 h yielding 10 or 1.5 x the MIC. Experiments were also performed with 10 x the MIC of benzylpenicillin with a half-life of 3 h or an initial half-life of 1.1 h that was altered to 3 h at the time point at which the antibiotic concentrations and MIC intersected. Bacterial killing and regrowth were followed by determining viable counts. The post-MIC effect (PME) was defined as the difference in time for the numbers of CFU in the culture vessel to increase 1 log10 CFU/ml, calculated from the numbers obtained at the time when the antibiotic concentration had declined to the MIC, and the corresponding time for a control culture, grown in a glass tube without antibiotic, to increase 1 log10 CFU/ml. To determine how much of the PME was attributable to subinhibitory concentrations, penicillinase was added to a part of the culture drawn from the flask at the time when the antibiotic concentration had fallen to the MIC. The longest PME was found in the experiments in which the half-life was extended from 1.1 to 3 h at the MIC. This illustrated that sub-MICs are sufficient to prevent regrowth. However, when the half-life was 3 h during the whole experiment, the PME was shorter, indicating that when concentrations decline slowly penicillin-binding proteins will already be present in amounts sufficient for regrowth at the time when the MIC is reached. The PME may prove to be a more reliable factor than the in vitro postantibiotic effect or postantibiotic sub-MIC effect for the design of optimal dosing schedules, since the PME, like the in vivo postantibiotic effect, includes the effects of subinhibitory concentrations and therefore better reflects the clinical situation with fluctuating antibiotic concentrations.

Quantitative analysis of antimicrobial effect kinetics in an in vitro dynamic model

Variants of the available methods for estimating antimicrobial effect kinetics in an in vitro dynamic model were analyzed. Two integral parameters characterizing antimicrobial effect duration (TE) and intensity (IE) are suggested to define and analyze the concentration-effect relationships in these models, irrespective of the method of recording. TE is defined by the time from the moment of antibiotic administration to the movement when the bacterial count again reaches its initial level. IE is defined by the area between the microbial growth curves in the presence and absence of an antibiotic. TE and IE were used to quantify the antimicrobial effects of sisomicin on Pseudomonas aeruginosa 58, Escherichia coli 93, and Klebsiella pneumoniae 5056, simulating the pharmacokinetic profiles of the drugs observed following intramuscular administration in therapeutic doses, including the variability of aminoglycoside concentrations in human blood.

Antibacterial activity of lomefloxacin in a pharmacokinetic in vitro model

An in vitro model simulating two-compartment pharmacokinetics was used to study the antibacterial activity of lomefloxacin after single oral doses of 200 and 400 mg. Lomefloxacin produced reliable bactericidal activity against gram-negative aerobic bacteria and staphylococci. Bacterial strains for which MICs were less than 0.5 microgram/ml were inhibited with both dosing schedules. Doubling the dose from 200 to 400 mg increased the bactericidal activity only against Pseudomonas aeruginosa. Against Enterococcus faecalis lomefloxacin showed no effect. Selection of resistant variants during the simulation of treatment was observed with Staphylococcus aureus and P. aeruginosa.

Antipseudomonal activity of simulated infusions of gentamicin alone or with piperacillin assessed by serum bactericidal rate and area under the killing curve

The objectives of this study were to (i) determine which of three simulated dosing regimens (gentamicin alone, simultaneous infusions of gentamicin and piperacillin, or staggered infusions of gentamicin and piperacillin) produced the fastest killing rate of Pseudomonas aeruginosa in serum, using the serum bactericidal rate (SBR) assay; and (ii) describe an alternative method of analysis of killing curves, the area under the killing curve (AUKC). Gentamicin alone or combined with piperacillin was added to heat-inactivated human serum to approximate drug concentrations achieved after the above-mentioned types of infusion. By a microdilution technique, seven strains of P. aeruginosa were exposed to no drug (control) and gentamicin alone or with piperacillin; colony counts were determined at hourly intervals for 5 h, and log10 CFU per milliliter was plotted versus time. Linear regression was used to calculate the slope (SBR) of each timed killing curve for each drug concentration tested alone or in combination. In addition, the AUKC for each curve was calculated. To compare simulated infusion regimens further, the cumulative AUKC (the sum of AUKCs for specific time points along the serum concentration-time curve for each simulated regimen) was calculated. With the SBR assay or AUKC determination, there was a significant increase in the rate of killing of all test strains by the combination compared with gentamicin alone only at gentamicin concentrations which exceeded the MIC (8, 5, and 2.5 micrograms/ml). Mean cumulative AUKC of the simultaneous-infusion regimen was significantly less (indicating faster killing) than either the staggered-infusion regimen or the gentamicin infusion alone. Both the SBR and AUKC have the potential for integration of in vitro microbiologic effects and in vivo pharmacokinetics of antimicrobial agents.

Efficacy of intermittent versus continuous administration of netilmicin in a two-compartment in vitro model

Several aminoglycoside dosage regimens were studied in a kinetic in vitro model. Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus were exposed in serially placed artificial capillary units to netilmicin concentrations that changed based on human two-compartment pharmacokinetics. The same total dose per 24 h was administered as a continuous infusion (3.7 micrograms/ml) or in 1-h infusions given every 24 (24 micrograms/ml) or 8 h (8 micrograms/ml). The once daily administration showed the best response in terms of either faster killing of E. coli, K. pneumoniae, and S. aureus or greater reduction of the inocula of P. aeruginosa. After 28 h of treatment, however, all regimens reduced the nonpseudomonads by more than 99.99%, whereas all three P. aeruginosa strains regrew to greater than 10(8) CFU/ml due to selection of resistant subpopulations. In contrast to the bactericidal effect of the first dose, no killing occurred after subsequent doses if the ratio of peak drug concentration to MIC was low (less than or equal to 6). These results support the concept of administering high doses of aminoglycosides once every 24 h.