Association between fluoroquinolone exposure and children's growth and development: A multisite biomonitoring-based study in northern China

BACKGROUND

Although animal experiments found that antibiotic exposure during early life increased adiposity, limited human epidemiological evidence is available for the effects of veterinary antibiotic exposure on children's growth and development.

OBJECTIVE

This study was conducted to examine the body burden of fluoroquinolones in northern Chinese children and assess its association with growth and development.

METHODS

After recruiting 233 children aged 0-15 years from 12 different sites in northern China in 2020, we measured urinary concentrations of 5 respective fluoroquinolones (fleroxacin, ofloxacin, norfloxacin, ciprofloxacin, and enrofloxacin) by high performance liquid chromatography. Categories of children's growth and development were identified based on the Z score of body mass index. The health risks of individual and combined antibiotic exposure were estimated by the hazard quotient (HQ) and hazard index (HI), respectively. The association between children's growth and development with antibiotic concentrations was evaluated via multiple logistic regression analysis.

RESULTS

In total, 4 antibiotics, fleroxacin, ofloxacin, ciprofloxacin, and enrofloxacin, were found in urine samples of northern Chinese children at an overall frequency of 57.08%. Due to diet and economic differences, antibiotic concentrations in urine samples differed by study area, and the highest concentrations were found in Tianjin, Henan, and Beijing. The percentage of the participants with HQ > 1 caused by ciprofloxacin exposure was 20.61%, and the HI values in 23.18% of samples exceeded 1, suggesting potential health risks. The odds ratio (95% confidence interval) of overweight or obesity risk of tertile 2 of enrofloxacin was 3.01 (1.12, 8.11), indicating an increase in overweight or obesity risk for children with middle-concentration enrofloxacin exposure.

CONCLUSION

This is the first study to show a positive association of enrofloxacin internal exposure with overweight or obesity risk in children, demonstrating that more attention should be given to the usage and disposal of fluoroquinolones to safeguard children's health.

Mass spectrometic study of speciation in aluminium-fluoroquinolone solutions

Fluoroquinolones (FQLs) are synthetic antibacterial agents containing a 4-oxo-1,4-dihydroquinoline skeleton. When concomintantly administered with other drugs which may contain metal ions, particularly Al(3+) (antacids, phosphate binders, vaccines etc) they may form metal-drug complexes. Pharmacokinetic studies showed that aluminium-quinolone interactions lead to reduced bio- availability and altered activity of the drug with possible development of the toxic effects of aluminum ion. Reliable speciation in Al(3+) - quinolone systems at micromolar concentration level is needed to better understand pharmaco- and toxicokinetics of the FQLs in the presence of Al. In this work, the speciation in solutions containing Al(3+) and FQL family members (fleroxacin, moxifloxacin and ciprofloxacin) was studied by electrospray mass spectrometry (ESI-MS), ESI-MS/MS, and laser desorption ionization (LDI) MS. The dominating species identified in all the three Al(3+)-FQL solutions, at ca 30-50 µmol L(-1) total Al concentration and 2:1 to 1:3 metal-to-ligand ratio in the pH range 3.0- 6.0, were the ions related to the complexes AlL(2+), AlL(2)(+) and AlL(3)(0) (L = ligand in the monodeprotonated form). Mixed protonated and hydroxo complexes were also formed at lower and higher pH values respectively and, as expected, dimeric and polymeric species were not observed in ESI spectra. LDI measurements confirmed the existence of the mononuclear complexes found by ESI, and indicated the formation of polymeric species. The ion [2Al(3+) +5(-)](+) was identified with all three FQLs. This ionic species most probably arises from Al(2)L(2) by clustering with free ligand anions. Comparison of literature potentiometric data with mass spectral data indicated good agreement between speciation schemes. The obtained results suggest the presence of strong interaction between FQLs and Al(3+) which may be important in affecting absorption of these drugs in the gastrointestinal tract.

1H and 19F NMR relaxation studies of fleroxacin with Micrococcus luteus

In order to investigate and characterize interaction processes between the fluoroquinolone fleroxacin and bacterial cells we used non-selective (all resonances are excited), selective (observed resonance is excited) spin-lattice relaxation rates and spin-spin relaxation measurements. The signals of three hydrogens at different moieties of the fleroxacin molecule were considered to get an insight in the complexation behavior. The enhancement of selective relaxation rates was observed with increasing fleroxacin concentrations and keeping the bacterial mass constant. The obtained relaxation rates of the affected hydrogens were analyzed via a Lineweaver-Burk-plot to determine the KD values. Furthermore, 19F NMR spectra were recorded and spin-spin relaxation rates (R2) were determined by a Carr-Purcell-Meiboom-Gill (CPMG) pulse sequence. Because of the dependency of the line width of NMR peaks on transversal relaxation time T2, we compared the line width at half-height at different fleroxacin concentrations in order to investigate the involvement of fluorine atoms in different positions in the complexation. All findings point to core quinolone moiety to be involved in the interaction with bacterial cells.

[Determination of fleroxacin by photochemical fluorescence of zinc-fleroxacin complex]

Based on the complex formed by Zn2+ which can strengthen the relative fluorescence intensity of fleroxacin evidently, a novel photochemical fluorescence method was developed. The effects of the acidity, the concentration ratio of Zn2+ to fleroxacin, and the time for illumination were studied. Under the optimum experiment conditions, the linear range of the determination was 5.00 x 10(-8) - 5.00 x 10(-6) mol x L(-1). The detection limit was 4.2 x 10(-8) mol x L(-1). The relative standard deviation of the determination of fleroxacin (5.0 x 10(-7) mol x L(-1)) was 1.7% (n = 20). The method was successfully applied to the determination of fleroxacin in specimens, and the recoveries were in the range of 95.0%-105%. The mechanism of this system is proposed.

[Ultraviolet spectral characteristics of charge-transfer reaction complex in micellar system and its application]

Charge-transfer (CT) reaction of chloranil (TCBQ) as a pi-electron acceptor with fleroxacin (FLX) as an electron donor has been studied by ultraviolet spectrophotometry method. Experiment showed that FLX reacted with TCBQ in sodium dodecyl sulfate (SDS) micellar systems, and a stable complex was formed and the absorbency was remarkably enhanced. Therefore, a simple, rapid, accurate and sensitive method for the determination of FLX has been developed. Beer's law is obeyed in the range of 0.6-24 mg x L(-1) of FLX and r = 0.9993. The apparent molar absorptivity of CT complexes at 326 nm is 3.3 x 10(4) L x mol(-1) x cm(-1). The composition of CT complex was found to be 1:1 by Bent-French and curved intersection methods. The proposed method has been applied to the determination of ESL in tablets. The recoveries are 99.2%-99.7%. The relative standard deviation is 0.7%-2.1%. The proposed methods are suitable for the routine quality control of drug alone and in tablets or capsules without fear of interference caused by the excipients expected to be present in tablets or capsules.

Validation of an HPLC method for the determination of fleroxacin and its photo-degradation products in pharmaceutical forms

HPLC determination of fleroxacin in dosage forms was carried out using either reversed-phase column YMC pack ODS-AQ or Supelco LC Hisep shielded hydrophobic phase column, with UV detection at 280 nm. The mobile phase for ODS column consisted of 50:50:0.5 v/v/v and for Hisep column 15:85:0.5 v/v/v acetonitrile-water-triethylamine. The pH of the mobile phase was adjusted to 6.30 for ODS column and to 6.85 for Hisep column, with H3PO4. Linear response was obtained in the concentration range of fleroxacin between 0.01 and 1.30 micrograms/mL. Detection limit was 4.8 ng/mL. Recovery test in the determination of fleroxacin in "Quinodis" tablets (Hoffmann La Roche, nominal mass 400 or 200 mg) was 98-101% for both columns. The effect of the composition and pH of the mobile phase on spectra, retention time and dissociation constants of fleroxacin was discussed. The proposed method could be also used for separation of the photo-degradation products of fleroxacin. Ten degradation products were separated on the ODS-AQ column, thus confirming the suitability of the proposed method for stability study of fleroxacin in pharmaceuticals.

[Fluorescence spectrometric determination of fleroxacin by charge-transfer reaction]

A simple and reliable fluorescence spectrometric method for the determination of fleroxacin (FLX) has been developed based on the charge-transfer reaction. The charge-transfer complex which formed between fleroxacin as the donor and 2, 3-dichloro-5, 6-dicyano-1, 4-benzoquinone (DDQ) as the acceptor has been studied by fluorimetry. Experiment shows that FLX is reacted with DDQ in a mixture of acetone and methanol at 30 degrees C for 30 min and a complex is formed. The composition of the charge-transfer complex is found to be 1:1 by Bent-French and curved intersection methods. The linear dynamic range is 0.4-8.4 mg.L-1, the detection limit is 0.1 mg.L-1 and the recovery of FLX is 96.6%-99.2%. At last, the charge-transfer reaction mechanism was explored. The method has been applied to the determination of FLX in tablets with satisfactory results.

Determination of fleroxacin in pure and tablet forms by liquid chromatography and derivative UV-spectrophotometry

Derivative UV-spectrophotometric and liquid chromatographic (LC) methods for fleroxacin determination were validated. In the spectrophotometric assay, first-, second-, third-, and fourth-order measurements were applied with the use of peak-zero and peak-peak techniques. The linear correlation between amplitude of the peak and concentration of the examined drug ranged from 2.0 to 12.0 micro/mL. An isocratic LC analysis was performed on a Purospher ODS column with an acidic mobile phase containing tetrabutylammonium hydroxide. Measurements were made at a wavelength of 285 nm with 4-aminobenzoic acid (PABA) as internal standard. The calibration curve was linear (r = 0.9999) in the studied range of concentration (1.0-10.0 microg/mL). The accuracy (mean recovery, about 100%), precision (relative standard deviation < 1%), selectivity, and sensitivity of the elaborated methods were satisfactory.

Spectrophotometric and HPLC determination of fleroxacin in tablets

The paper describes and compares spectrophotometric and HPLC determination of fleroxacin in commercial tablets. The optimum conditions for spectrophotometric assay were found to be at pH < 3.5 (0.1 M HCl) at a wave length of 286 nm. HPLC analysis was carried out on a Beckman ODS 5 microns column in a pH 3 phosphoric acid solution (detector wave length 254 nm).

Voltammetric analysis of certain 4-quinolones in pharmaceuticals and biological fluids

The voltammetric behaviour of Enrofloxacin (I), Sparfloxacin (II) and Fleroxacin (III) was studied using direct current (DCt), differential pulse (DPP) and alternating current (ACt). All the drugs manifest cathodic waves in Britton Robinson buffer over the pH range of 4.0-11.98. The waves were characterized as being irreversible, diffusion-controlled with limited adsorption properties. The diffusion current concentration relationships were found to be rectilinear over the ranges 4 x 10(-5) x 10(-4) M, 1 x 10(-5)-2 x 10(-4) M, 1 x 10(-5)-4 x 10(-4) M using DCt mode for I, II and III, respectively and 1 x 10(-6)-4 x 10(-5) M, 1 x 10(-6)-1 x 10(-4) M, and 2 x 10(-6)-8 x 10(-5) M, using DPP mode for I, II and III respectively, with minimum detectability (S/N = 3) of 1 x 10(-7) M for I, II and 2 x 10(-7) M for III. The proposed method was successfully applied to the determination of the studied compounds either per se or in formulations and biological fluids. The results obtained were concordant to those given using reference methods.

Voltammetric methods for analytical determination of fleroxacin in quinodis tablets

The direct current (dc) and differential pulse (dp) polarographic reduction of fleroxacin was done in a wide pH range from 2.48 to 13.00. The appropriate buffer choice was made for its dp polarographic determination in a range from 1.845 to 16.926 microg /ml, at pH 8.50. The adsorptive properties of fleroxacin were investigated in order to achieve an increase in sensitivity and a possibility of fleroxacin determination by applying the adsorptive stripping voltammetric method. The adsorptive processes at the hanging mercury drop electrode were investigated in Britton-Robinson and borate buffers. Adsorptive preconcentration followed by differential-pulse cathodic stripping showed one wave at approximately - 1.1 V being the most sensitive for analytical determination of fleroxacin. Two linear ranges were obtained, the first one from 18.465 to 258.51 ng/ml, and the second one from 3.693 to 18.465 ng/ml.

Formation of antigenic quinolone photoadducts on Langerhans cells initiates photoallergy to systemically administered quinolone in mice

Quinolone antibacterial agents are well known to cause photoallergy as a side-effect. Murine photoallergy to fluoroquinolones is a T cell-mediated immune response, evoked either by systemic fluoroquinolone and subsequent exposure of skin to ultraviolet A light or by subcutaneous injection of fluoroquinolone-photomodified epidermal cells. In this photosensitivity, epidermal Langerhans cells may be photomodified initially with the drug and thus present photohaptenic moieties to sensitize and restimulate T cells. Although we have shown that Langerhans cells photocoupled in vitro with fluoroquinolones are capable of stimulating sensitized T cells, it remains unclear whether systemically given fluoroquinolone photomodifies Langerhans cells upon ultraviolet A irradiation of the skin and the Langerhans cells become photohapten-bearing, T cell-stimulatory cells. In a murine model of fleroxacin photoallergy induced by intraperitoneal injection of the drugs plus ultraviolet A irradiation of skin, we found that Langerhans cells as well as keratinocytes are photoderivatized with fleroxacin as demonstrated with a fluoroquinolone-specific monoclonal antibody. Langerhans-cell-enriched epidermal cells prepared from mice treated with fleroxacin and ultraviolet A induced proliferation of sensitized T cells, indicating that photomodified Langerhans cells are functional. There was an optimal range of ultraviolet A dose to quantitatively and qualitatively form fleroxacin-photomodified Langerhans cells, as excess ultraviolet A rather reduced the photoantigen-presenting capacity of Langerhans cells presumably because of drug phototoxicity. Our study suggests that Langerhans cells serve as photoantigen-presenting cells in drug photoallergy.

Retention behaviour of quinolone derivatives in high-performance liquid chromatography. Effect of pH and evaluation of ionization constants

This paper examines the effect of solute ionisation on the retention behaviour of a series of quinolones and evaluates their pKa values using chromatographic data in acetonitrile-water mixtures with acetonitrile percentages of 30, 35, 40 and 50% (v/v). We also compare these pKa values with those previously obtained in acetonitrile-water mixtures from potentiometric measurements. In doing so, the pH values were measured in the hydroorganic mixture, which was used as the mobile phase, instead of in water, taking into account the effect of activity coefficients. The resulting equations permit the chromatographic determination of the pKa values of the quinolones in acetonitrile-water mixtures and also permit the prediction of the effect of pH on their chromatographic behaviour. These equations can be combined with those previously derived, which relate retention to the solvent composition of the mobile phase, to establish a general model that relates the elution behaviour of the solute to significant mobile phase properties: composition, pH and ionic strength.

The use of capillary electrophoresis to monitor the stability of a dual-action cephalosporin in solution

Ro 23-9424 is a broad-spectrum antibacterial agent consisting of a cephalosporin and a quinolone moiety which are held together by an ester linkage. This compound has limited solubility in water but is more soluble at alkaline pH. Such high pH values, however, lead to stability problems due to the lability of the ester linkage, and result in the formation of the free quinolone and cephalosporin moieties. The balance between solubility and stability presents a challenge in formulation development for this compound. Thus, it is important to effectively monitor the stability of Ro 23-9424 after it has been reconstituted in different solvent systems. In this manner, a diluent which does not lead to degradation of the drug can be identified. A capillary electrophoresis method was developed and validated to monitor the stability of Ro 23-9424. The method was found to meet acceptable criteria for method precision, system precision, linearity and limits of detection and quantitation. The method was used to monitor the stability and measure the half-life of Ro 23-9424 in water and in an L-arginine-sodium benzoate-saline diluent designed to mimic the drug delivery system. This work shows that capillary electrophoresis can be used to compare the stability of a drug in different solutions as an aid in formulation development.

Penetration of fleroxacin into human and animal tissues

Fleroxacin concentrations in human and rat tissues were determined by HPLC following extraction with dichloromethane:isopropanol. This method yielded a high recovery of more than 85%. In the investigated tissues the fleroxacin levels were equal to or higher than those concomitantly measured in plasma. The concentration ratios 'tissue/plasma' were 1.6-2.7 for lung, 1.9-2.1 for muscle, 1.1-1.9 for gynaecological tissues and 1.2 for bone. Only in the case of fat and lens/eye lower ratios of 0.05-0.5 were found. The actual measured fleroxacin concentrations in most tissues and in plasma were high. Following oral administration of the recommended therapeutic dose of 400 mg, once daily, peak concentrations of 5-6 mg/l were reached in human plasma at steady state. Even 24 h after drug intake the fleroxacin level was still approximately 1 mg/l and thus in the range of the MIC90 values of susceptible bacteria causative for many types of tissue infections.