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Maan MK, Chaudhry TH, Sattar A, Shabbir MAB, Ahmed S, Mi K, Ahmed W, Xie S, Xin L, Huang L. Dose Optimization of Aditoprim-Sulfamethoxazole Combinations Against Trueperella pyogenes From Patients With Clinical Endometritis by Using Semi-mechanistic PK/PD Model. Front Pharmacol 2021; 12:753359. [PMID: 34867364 PMCID: PMC8635024 DOI: 10.3389/fphar.2021.753359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/20/2021] [Indexed: 11/13/2022] Open
Abstract
Combinations of two and more drugs with different target sites are being used as a new treatment regimen for resistant clones of bacteria. Though, achieving the right combination of the drugs for optimal dosage regimen is challenging. In our study, we studied the antimicrobial effect of aditoprim, a novel dihydrofolate reductase inhibitor, and its synergistic effect with sulfamethoxazole. Synergy testing was performed by checkerboard micro dilution method and validation of different checkerboard ratios by static and dynamic time-kill analysis and in vitro pharmacokinetic/pharmacodynamics (PK/PD) model, and semi mechanistic PK/PD modeling was used to calculate and validate the synergistic effect of drug combination. Both checkerboard and static time-kill assays demonstrated the greater synergistic effect [fractional inhibitory concentration index (FICI) = 0.37] of the aditoprim [minimum inhibitory concentration (MIC) = 0.25 µg/ml]-sulfamethoxazole (MIC=>64 µg/ml) combination against all T. Pyogenes isolates. In the in vitro PK/PD model, the dosage proportion of sulfamethoxazole 4 mg/ml twice a day in combination with steady-state aditoprim 1 mg/ml efficiently repressed the growth of bacteria in 24 h with the ratio of 2-log10 decrease, related to the early inoculum against three T. Pyogenes isolates. The semi mechanistic PK/PD model projected that a combination of a high dose of aditoprim (2 mg/ml) with sulfamethoxazole (2 mg/day) was necessary to attain the killing of bacteria below the detection limit (limit of detection (LOD); i.e., 1 log10 CFU/ml) at 24 h with an MIC sulfamethoxazole (SMZ) of 64 µg/ml. However, it is anticipated that a combination of high dose of aditoprim with sulfamethoxazole is critical to attain the suppressed bacterial growth to < LOD. This study represents essential PK/PD modeling for optimization of combination of aditoprim and sulfamethoxazole to suppress growth of T. Pyogenens.
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Affiliation(s)
- Muhammad Kashif Maan
- National Reference Laboratory of Veterinary Drug Residues/MAO Key Laboratory for the Detection of Veterinary Drug Residues, Wuhan, China.,Departement of Veterinary Surgery and Pet Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Tamoor Hamid Chaudhry
- Public Health Laboratory Division, National Institute of Health, Islamabad, Pakistan
| | - Adeel Sattar
- Department of Pharmacology and Toxicology, Faculty of Biosciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Muhammad Abu Bakr Shabbir
- Department of Microbiology, Faculty of Veterinary Medicine, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Saeed Ahmed
- Department of Biological Sciences, National University of Medical Sciences, Rawalpindi, Pakistan
| | - Kun Mi
- National Reference Laboratory of Veterinary Drug Residues/MAO Key Laboratory for the Detection of Veterinary Drug Residues, Wuhan, China
| | - Waqas Ahmed
- Department of Biomedical and Diagnostic Science, University of Tennessee, Knoxville, TN, United States
| | - Shuyu Xie
- National Reference Laboratory of Veterinary Drug Residues/MAO Key Laboratory for the Detection of Veterinary Drug Residues, Wuhan, China
| | - Li Xin
- National Reference Laboratory of Veterinary Drug Residues/MAO Key Laboratory for the Detection of Veterinary Drug Residues, Wuhan, China
| | - Lingli Huang
- National Reference Laboratory of Veterinary Drug Residues/MAO Key Laboratory for the Detection of Veterinary Drug Residues, Wuhan, China.,MOA Huazhong Agricultural University, Wuhan, China
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