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Effect of probenecid on the pharmacokinetics of moxalactam.

The effects of probenecid on the pharmacokinetics of moxalactam were studied in normal volunteers administered a 2-min l-g intravenous infusion. The results showed that probenecid did not alter the plasma or urinary concentrations of moxalactam, its apparent volume of distribution, plasma elimination half-life, elimination rate constant, or plasma and renal clearances. Therefore, moxalactam appears to be eliminated primarily by the kidney via glomerular filtration.

Adult↗

Renal disposition of ceftazidime illustrated by interferences by probenecid, furosemide, and indomethacin in rabbits.

Excretion of ceftazidime (C), a new cephalosporin antibiotic, has been reported to occur unexpectedly through glomerular filtration only, without being significantly affected by probenecid. We investigated renal tubular disposition of C in rabbits by calculating its rates of fractional excretion, net tubular secretion, and absolute excretion. During continuous intravenous infusion of C, 3 mg of furosemide (F), 15 mg of probenecid (P), or 2 mg of indomethacin (I) per kg was injected intravenously as a bolus. Equilibrium dialysis showed that the percentage of C bound to serum proteins (14 +/- 5%) was not altered by F, P, or I. Fractional excretion of C was 94 +/- 22, 65 +/- 21, 182 +/- 36, and 98 +/- 3% for the drug given alone and after injection of F, P, and I, respectively. For 15 min after P injection, we observed net tubular secretion of C (404 +/- 276 micrograms/min). The C absolute excretion rate was significantly reduced by I compared with the absolute excretion rate for the control (405 +/- 104 versus 696 +/- 157 micrograms/min). We conclude that (i) C undergoes bidirectional transport in the nephron, revealed by the effects of F and P, with a nil net C balance; (ii) F and P have opposite unexpected effects on tubular handling of C, possibly due to competition for C secretion processes; (iii) I reduces C excretion solely by decreasing its glomerular-filtered load; and (iv) tubular handling of C differs from that of previously studied cephalosporins.

Animals↗

Effects of probenecid and cimetidine on renal disposition of ofloxacin in rats.

The renal handling of ofloxacin in rats which were given ofloxacin either alone or in combination with probenecid or cimetidine was studied. In the presence of cimetidine or probenecid, ofloxacin's total and renal clearances were reduced and its half-life was prolonged. This suggests that ofloxacin is secreted by both the anionic and cationic transport systems.

Animals↗

Effects of rate of infusion and probenecid on serum levels, renal excretion, and tolerance of intravenous doses of cefoxitin in humans: comparison with cephalothin.

Using a randomized crossover design, 1-g intravenous doses of cephalothin and cefoxitin, a cephalosporinase-resistant cephamycin, were infused into 12 normal adult males over periods of 120, 30, and 3 min, the last with and without prior intravenous infusions of probenecid (1 g). Mean peak serum concentrations of antibiotic activity after cephalothin infusions were 23, 56, 103, and 102 mug/ml, respectively, and after cefoxitin infusions they were 27, 74, 115, and 125 mug/ml, respectively. Probenecid treatment prolonged the terminal serum half-life of cephalothin-like activity from 0.52 to 1.0 h, and of cefoxitin from 0.68 to 1.4 h. In contrast to cephalothin, which was found to be metabolized about 25% to the less active desacetyl form, cefoxitin was metabolized less than 2% to the virtually inactive descarbamyl form, as judged from urinary recoveries. Neither antibiotic displayed detectable organ toxicity. Of 300 recent clinical isolates of gram-negative bacilli other than Pseudomonas spp., 83% were susceptible to cephalothin but 95% were susceptible to cefoxitin. Organisms resistant to cephalothin but susceptible to cefoxitin included strains of Escherichia coli, Proteus vulgaris, Klebsiella spp., Serratia marcescens, Enterobacter spp., and Bacteroides spp.

Adult↗

Effects of pyrazinamide, probenecid, and benzbromarone on renal excretion of oxypurinol.

The effects of pyrazinamide, probenecid, and benzbromarone on renal excretion of oxypurinol were investigated. Pyrazinamide decreased the mean (SEM) fractional clearance of oxypurinol from 19.2 (2.1) to 8.8 (1.5). Probenecid increased the fractional clearance of oxypurinol from 14.1 (3.5) to 24.8 (4.1). Benzbromarone increased the fractional clearance of oxypurinol from 15.6 (2.3) to 33.8 (2.8). These results suggest that oxypurinol may be secreted by 'an organic acid system' and that oxypurinol is reabsorbed at a putative postsecretory site of the renal tubules.

Adult↗

Trimethoprim-sulphamethoxazole in gonorrhoea. A comparison with privampicillin combined with probenecid.

419 patients with uncomplicated gonorrhoea were treated with sulphamethoxazole 4 g. combined with trimethoprim 0-8 g. divided into two doses with an 8-hr interval. The failure rate was 1-9 per cent. Parallel with this trial, 319 patients received pivampicillin 1-4 g. combined with probenecid 1 g,; the failure rate was 0-9 per cent. Side-effects were few, four patients in the first group and one in the second group developing a rash. No recurrences were noted in nine patients treated for tonsillar gonorrhoea with the trimethoprim-sulphamethoxazole schedule, while two recurrences were found in thirteen patients treated with pivampicillin-probenecid. The frequency of post-gonococcal urethritis was 7-7 per cent. in the pivampicillin-pro-benecid group against 3-4 per cent. in the trimethoprim-sulphamethoxazole group, a difference which was not statistically significant.

Ampicillin↗

Advantages of adding a course of tetracycline to single dose ampicillin and probenecid in the treatment of gonorrhoea.

Chlamydia trachomatis was reisolated from 11 of 12 men with gonorrhoea who had initially yielded chlamydiae and who had been treated with ampicillin and probenecid (AMP) only, but from none of five such men treated with ampicillin and probenecid followed by tetracycline (AMPT). These results correlated with the absence of postgonococcal urethritis (PGU) in the group treated with AMPT. C trachomatis was isolated or reisolated from 20 of 25 women after treatment with AMP, compared with none of 14 women treated with AMPT. We recommend the addition of a course of tetracycline to the routine single dose treatment for gonorrhoea in men and women.

Ampicillin↗

Penicillin concentrations in serum and cerebrospinal fluid after intramuscular injection of aqueous procaine penicillin 0.6 MU with and without probenecid.

Paired specimens of cerebrospinal fluid and serum were taken from 21 patients to estimate penicillin concentrations two to three hours after the last dose of a course of 14-21 daily intramuscular injections of procaine penicillin 0.6 MU. Of 10 patients treated with procaine penicillin alone, eight had no detectable penicillin and two had sub-treponemicidal concentrations (less than 0.018 mg/l) in the cerebrospinal fluid. Of 11 patients treated with procaine penicillin as above and probenecid 2 g a day by mouth, three had no detectable penicillin, two had sub-treponemicidal concentrations, and six had treponemicidal concentrations of penicillin in the cerebrospinal fluid. All 21 patients had treponemicidal concentrations of penicillin in the serum. This dose of procaine penicillin alone or with probenecid is therefore not recommended for treating neurosyphilis.

Biological Assay↗

Renal tubular transport of prostaglandins: inhibition by probenecid and indomethacin.

With use of the Sperber technique in chickens, labeled prostaglandin E2 and F2alpha were infused and resulted in renal tubular excretion of the label into the urine. A labeled metabolite, 12,14-dihydro,15-keto-PGF2alpha, was infused exogenously and this label was also excreted by active tubular transport. Tubular excretion of the label from PGE2, PGF2alpha, and 13,14-dihydro,15-keto-PGF2alpha was inhibited by probenecid, indomethacin, and PAH. The PAH was 10 times weaker as an inhibitor than probenecid and indomethacin. These results indicate that the prostaglandins are actively transported across the renal tubule by the classic anionic transport system which transports PAH. Since the transport of the prostaglandins is blocked by nonsteroidal anti-inflammatory agents such as indomethacin, the anti-inflammatory action of indomethacin may be produced not only by the inhibition of prostaglandin synthesis but also by restriction of the distribution of endogenous prostaglnadins. Thin-layer chromatography of an ethyl acetate extract of urine collected during infusion of [3H]PGF2alpha revealed three discrete radioactive peaks, one of which corresponded to authentic PGF2alpha. This signified tubular excretion of PGF2alpha. One metabolite in the ethyl acetate extract was found to be of renal origin.

Animals↗

Hepatic and renal clearances of probenecid in the rat.

The elimination kinetics of probenecid in the rat was studied by using an in vitro liver perfusion system to estimate its basic elimination and in vivo to estimate its renal excretion by catheterization of the urinary bladder. In the liver perfusion study different amounts of probenecid were added to the perfusion medium yielding different initial concentrations (40, 200 and 400 micrograms/ml), and 4 different intravenous bolus doses (50, 75, 100 and 200 mg/kg) were administered in vivo to rats in order to evaluate the renal excretion. The results obtained were described by one-compartment models, with Michaelis-Menten elimination by the liver Vm = 67.4 +/- 14.0 (SD) micrograms/min and a slightly decreasing Km with increasing initial concentrations [from 76.5 +/- 9.0 to 53.2 +/- (SD) 18.4 micrograms/ml]. The excretion by the kidney was characterized by a saturable pathway in parallel with first-order elimination, the maximum rate of the active transports Tm = 0.04 +/- (SD) 0.09 micrograms/min, Km,r = 100.3 +/- (SD) 12.3 micrograms/ml and a linear renal clearance of 0.0008 +/- (SD) 0.0002 ml/min.

Animals↗

Familial hypouricemia due to isolated renal tubular defect. Attenuated response of uric acid clearance to probenecid and pyrazinamide.

A 37-year-old female was found to have hypouricemia (1.1-1.9 mg%) with markedly increased uric acid clearance (24.7039.5 ml/min). Uric acid excretion was only slightly affected by pyrazinamide, a drug which suppresses renal tubular uric acid secretion, and by probenecid, a drug which inhibits tubular uric acid reabsorption. The attenuated response in this subject to both drugs suggest a renal tubular defect in the proximal high capacity-high affinity uric acid reabsorption mechanism. No other renal tubular or metabolic abnormalities were detected. A survey of the family-three sisters and two brothers, revealed two similarly affected sisters. The abnormality described in this family is defined as familial renal hypouricemia due to an isolated renal tubular defect with attenuated response of uric acid clearance to probenecid and pyrazinamide.

Adult↗

Comparison of ticrynafen and probenecid in patients with elevated uric acid levels.

Ticrynafen, 125--250 mg/day was compared with probenecid 0.5--1.0 g/day in patients with elevated serum uric acid values in a randomized, double-blind crossover study. Each treatment period lasted 12 weeks. The mean reduction in serum uric acid from 9.4 +/- 1.2 to 6.22 +/- 1.2 mg/dl (33.8%) during ticrynafen was greater (p less than 0.01) than that from 9.46 +/- 1.1 to 7.0 +/- 1.3 mg/dl (26%) during probenecid treatment. There were slight increases in serum creatinine and BUN and decreases in body weight during ticrynafen treatment. There were no statistically significant changes in serum electrolytes. The hypouricemic effect of ticrynafen was well maintained during its subsequent open-label administration for 18 months without any deterioration of renal function.

Aged↗

Roles of hydrophobicity, protein binding and the probenecid-sensitive transport system in the cerebrospinal fluid delivery of nucleoside analogues with anti-viral activity.

Ten nucleoside analogues with anti-herpes or anti-HIV activity were investigated for their transport into the cerebrospinal fluid (CSF) following intravenous administration in rats. The novel anti-herpes agent 1-beta-D-arabinofuranosyl-2-thio-5-fluorocytosine (5F-araSC) showed the highest CSF/plasma concentration ratio (>20%), while that of acyclovir (ACV) was very low (<5%). A linear relationship was observed between the partition coefficient (chloroform/water) and CSF/unbound plasma concentration in 6 of 9 agents. The exceptions were DDI, AZT and ACV, which showed much lower concentrations in the CSF than expected from their hydrophobicity and protein binding activities. The effects of probenecid treatment on the CSF and plasma concentrations were measured with continuous intravenous administration of ACV, AZT, araC and 5F-araSC. Probenecid markedly increased the CSF concentrations of ACV and AZT, although the effect was minimal in araC and 5F-araSC. These results may provide useful information for molecular design of nucleoside analogues with better transport to the brain.

Animals↗

Effect of probenecid and ranitidine on urinary excretion of lomefloxacin in rats.

To examine the renal tubular transport pathways of lomefloxacin, a new quinolone antibiotic, the agent was injected intravenously with or without pretreatment with probenecid, an organic anion, or ranitidine, an organic cation, in rats. Urinary excretion of lomefloxacin significantly decreased in the probenecid-treated animals. However, no significant decrease was observed in this parameter by pretreatment with ranitidine. These results suggest that lomefloxacin is mainly secreted in urine by the organic anion transport system, while the pathway mediated by the organic cation transport system is negligible.

Animals↗

Calcinosis in dermatomyositis treated with probenecid.

Childhood dermatomyositis is frequently complicated by deposition of calcium salts in the soft tissues. This calcinosis represents a major problem, as severe disability may result. Various drugs have been tried to dissolve the calcinosis, but the results of these trials are disappointing. In this article we present a case report of a 9-year-old girl treated with probenecid. This treatment led to a dramatic decrease in subcutaneous and intermuscular calcinosis. The authors call for controlled studies of probenecid treatment in calcinosis.

Calcinosis↗

Dicloxacillin and flucloxacillin twice daily with probenecid in staphylococcal infections. A clinical and pharmakokinetic evaluation.

The therapeutic efficacy of decloxacillin or flucloxacillin, 1--2 g orally with probenecid twice daily was evaluated in staphylococcal infections. Excellent results were obtained with this as long-term maintenance therapy in 4 patients with relapsing chronic osteomyelitis and in 6 patients with postoperative infections. No side effects were observed in these patients. In 35 patients with furunculosis twice daily administration of dicloxacillin was used as a primary therapeutic regimen. All healed, but 4 recurrencies occurred during a 3-month observation period after therapy. In 5 patients allergic reactions were noted. The unbound fraction of flucloxallin in serum exceeded MIC values of methicillin-susceptible Staphylococcus aureus during 11 of 24 h. Pharmacokinetic data on flucloxallin with and without probenecid are given.

Cloxacillin↗

Sodium-sensitive, probenecid-insensitive p-aminohippuric acid uptake in cultured renal proximal tubule cells of the rabbit.

In the intact kidney, renal proximal tubule cells accumulate p-aminohippurate (PAH) via a basolateral, probenecid- and sodium-sensitive transport system. Primary cultures of rabbit proximal tubule cells retain sodium-glucose co-transport in culture, but little is known about PAH transport in this system. Purified proximal tubule cells from a rabbit were grown in culture and assessed for PAH and alpha-methyl-D-glucoside uptake capacities as well as proximal tubule marker enzyme activities. Control PAH uptake on collagen-coated filters (20 +/- 3 pmol/mg protein.min; n = 8) was not significantly different from uptake in the presence of 1 mM probenecid (19 +/- 4 pmol/mg protein.min; n = 8). Uptake from the basal side of the cell was 3.9 +/- 0.7 times greater than that from the apical side. In multi-well plate studies, the uptake was significantly reduced by removing sodium from the medium and stimulated by coating the wells with collagen. Glutarate (10 mM) had no effect on the uptake of PAH. Other differentiated proximal tubule characteristics were retained in culture, including the ability to form domes and to transport glucose by a phlorizin-sensitive system. Phlorizin-sensitive 1 mM alpha-methyl-D-glucoside uptake was 134 +/- 42 pmol/mg protein.min (n = 7; P less than 0.02). The proximal tubule marker enzymes alkaline phosphatase and gamma-glutamyltranspeptidase, increased in activity in the cultures after confluence. It was concluded that whereas some differentiated properties were retained during primary culture of rabbit proximal tubule cells, the PAH transport system was selectively lost or modified from that present in the intact kidney.

Alkaline Phosphatase↗