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HPLC determination of amoxicillin comparative bioavailability in healthy volunteers after a single dose administration.

PURPOSE: An accurate, precise and sensitive HPLC assay was developed for the determination of amoxicillin in human plasma samples, to compare the bioavailability of two amoxicillin capsule (500mg) formulations (Amoxicilina from Brazil, as a test formulation and Amoxil from SmithKline Beecham Laboratories Ltda., Brazil, as a reference formulations) in 24 volunteers of both sexes. METHODS: Amoxicillin concentrations were analyzed by combined reversed phase liquid chromatography and UV detection (lambda=229 nm). Amoxicillin and cefadroxil (internal standard) were extracted from the plasma by addition of cold methanol. The separation was achieved using the Lichrosorb 10 microm, C18 reversed phase column at room temperature. The mobile phase consisted of a 95% phosphate buffer (0.01 mol/L), pH=4.8 and 5% acetonitrile mixture. The study was conducted using an open randomized 2-period crossover balanced design with a 1-week washout period between the doses. Plasma samples were obtained over an 8-hour period. The bioequivalence between the two formulations was assessed by calculating individual peak plasma concentrations (C(max) ) and area under the curve (AUC(0-8h) ) ratios (test/reference). The statistical interval proposed was 80-125%, as established by the US Food and drug administration Agency. RESULTS: The internal standard and amoxicillin eluted about 4.2 and 5.2 min, respectively at a flow rate of 1.3ml/min. The mean absolute recovery of AMO in plasma was 90.0% at 3 microg/ml, 98.6% at 25 microg/ml and 95.3 at 50 microg/ml. The assay showed excellent relationships between peak height ratios and plasma concentrations (r(2)>or= 0.999). The limit of quantification was 1g/ml, based on 200l of plasma. The geometric mean of Amoxicilina/Amoxil 500 mg capsules individual percentage ratio was 101.4% for AUC(0-8h), and 99.9% for C(max). The 90% confidence intervals were 98.3-104.4% and 95.7-103.9%, respectively. CONCLUSION: This simple, rapid and selective method is suitable for pharmacokinetic, bioavailability and bioequivalence studies. Since the 90% CI for both C(max )and AUC(0-8h) lies within the 80-125% interval proposed by the Food and Drug Administration, it was concluded that Amoxicilina 500 mg capsules was bioequivalent to Amoxil capsules 500 mg, in terms of both the rate and extent of absorption.

Amoxicillin↗

Cephalosporins can be prescribed safely for penicillin-allergic patients.

The widely quoted cross-allergy risk of 10% between penicillin and cephalosporins is a myth. Cephalothin, cephalexin, cefadroxil, and cefazolin confer an increased risk of allergic reaction among patients with penicillin allergy. Cefprozil, cefuroxime, cefpodoxime, ceftazidime, and ceftriaxone do not increase risk of an allergic reaction.

Anti-Bacterial Agents↗

Antimicrobial activity of seven oral antibiotics against selected community- and hospital-acquired pathogens.

The in vitro activity of seven oral antibiotics (ciprofloxacin, cephalexin, cefaclor, cefadroxil, cefuroxime, cefixime, and amoxicillin/clavulanate) was tested against 355 hospital-acquired pathogens and 342 community-acquired organisms. Whereas Staphylococcus aureus and Escherichia coli were the most common pathogens isolated in community-acquired infections, Enterobacter, Klebsiella, and Pseudomonas were isolated most frequently in hospital-acquired infections. All antibiotics with the exception of cefixime were active against the methicillin-susceptible staphylococci. Ciprofloxacin was the most active antibiotic against the members of the family Enterobacteriaceae and Pseudomonas. The community-acquired organisms tended to be more susceptible to antibiotics than the hospital-acquired organisms. Thus selection of oral antibiotics for the management of patients with hospital-acquired infections should be based on knowledge of the susceptibility patterns of hospital isolates.

Administration, Oral↗

Continuous activity of significant antibiotics.

Respiratory tract infections (RTIs) are the primary cause of antibiotic use in general practice. Since the first penicillin was introduced for therapeutic purposes, several classes of antibiotics have been used in the treatment of community-acquired RTIs. The phase when penicillins G and V could be active in RTIs was relatively short lived due to the early emergence of resistant organisms. Ampicillin and amoxicillin have been used successfully for more than 20 years in the treatment of RTIs. In the late 1950s and 1960s, erythromycin, tetracyclines, and co-trimoxazole were also prescribed for RTIs. In the 1970s, other molecules belonging to the cephalosporin class of antibiotics, such as cephalexin, cephaloglycin, cefadroxil, and cephradine, were introduced in general practice for the same indication. Susceptibility of the predominant respiratory pathogens to these antimicrobial agents lasted for many years. However, Haemophilus influenzae responded poorly to erythromycin, and up to 30% of pneumococcal and streptococcal strains are resistant to macrolides, tetracyclines, and co-trimoxazole. Since 1976, increasing percentages of beta-lactamase producers (up to 20% in 1989) were found among Haemophilus species, and Moraxella catarrhalis, a frequent beta-lactamase producer, is increasingly isolated as a respiratory pathogen. These problems have led to the development of additional compounds, most characterized by their stability in the presence of beta-lactamases, such as amoxicillin + clavulanic acid, or exhibiting relative resistance to enzymatic inactivation, such as cefaclor. Treatment today of most RTIs also takes into account the cost-effectiveness relationship of these antibiotics.

Anti-Bacterial Agents↗

Pyoderma caused by Peptostreptococcus tetradius in a pup.

Pyoderma caused by Peptostreptococcus tetradius in a pup was successfully treated with cefadroxil. Although this bacterium is rarely found in veterinary medicine, it is a known pathogen in human beings and should be considered as a potential causative agent in pyodermas in which anaerobes are suspected.

Animals↗

Use of analgesics and antibiotics in endodontics: current concepts.

In this review, the principal drugs used for prevention and treatment of pain--analgesics, and swelling--antibiotics, are examined. The rationale for prevention of pain and swelling is given. Then the specific drugs are considered. The analgesics evaluated include: the non-steroidal anti-inflammatory agents (e.g., aspirin, acetaminophen, ibuprofen, diflunisal); and the narcotics (e.g., codeine, oxycodone, hydrocodone, meperidine). The antibiotics evaluated include: the penicillins (e.g., penicillin V, ampicillin, methicillin); the cephalosporins (e.g., cephalexin, cefadroxil); the erythromycins (e.g., erythromycin stearate, erythromycin base); clindamycin; metronidazole; and some rarely used drugs (e.g., ciprofloxacin).

Analgesics↗

[Bacteriological, pharmacokinetic and clinical studies on cefpodoxime proxetil in the pediatric field].

Bacteriological, pharmacokinetic and clinical studies on cefpodoxime proxetil (CPDX-PR, CS-807), a new oral cephem antibiotic, were carried out in the field of pediatrics. The results obtained are summarized as follows. 1. Antibacterial activities of R-3746 (Na-salt of cefpodoxime (CPDX] against clinically isolated strains of Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus, Enterococcus faecalis, Branhamella catarrhalis, Escherichia coli, Proteus mirabilis and Haemophilus influenzae were compared with those of cefaclor, cephalexin and cefadroxil. R-3746 is superior to other antibiotics against S. pneumoniae, S. pyogenes, B. catarrhalis and Gram-negative rods. 2. Serum concentrations of CPDX after administration of CPDX-PR at doses of 3 mg/kg (fasting), 6 mg/kg (non-fasting) and 6 mg/kg (fasting) were determined. Mean AUC (area under curve)'s of CPDX obtained were 9.60, 31.35 and 17.89 micrograms.hr/ml, respectively for the 3 dosages. The mean half-lives of CPDX were 3.35, 1.88 and 1.76 hours, respectively. The mean urinary recovery rate within 8 hours after administration of CPDX-PR at a dose of 3 mg/kg (fasting) was 39.2%. 3. CPDX-PR was administered to 37 pediatric patients with various bacterial infections (pyelonephritis 9, cystitis 4, pneumonia 7, acute bronchitis 3, otitis media 2, tonsillitis 10, subcutaneous abscess 1 and purulent lymphadenitis 1). The overall clinical efficacy rate was 91.9% and the overall bacteriological eradication rate was also 91.9%. 4. No adverse reactions were observed. Abnormal laboratory findings were moderate, eosinophilia in 2 and slight elevation of GOT and GPT in 1. The taste and the odor of the CPDX-PR preparation was sufficiently tolerable. From the above results we have concluded that CPDX-PR is a useful oral antibiotic in the treatment of bacterial infections in children.

Bacteria↗

[Interpretation of the influence of immunoglobulins and glycine on bacterial sensitivity to antibiotics in vitro].

The effect of human immunoglobulins (Ig) and of glycine, often added to commercial preparations as a stabilizer, have been examined in vitro on the growth of E. coli strains in the absence or presence of antibiotics in subminimal inhibitory concentrations (subMic). The Ig's (= 7S or 5S = F(ab')2 as well as glycine had no effect by themselves on bacterial growth at concentrations up to 32 mg and 4.5 mg per ml respectively. In contrast, in the presence of ampicillin, glycine induced a concentration dependent increase of bacterial sensitivity to antibiotics. This is apparently more pronounced in serosensitive than in seroresistant E. coli strains. Such a synergism could equally be shown with cefadroxil and fosfomycin, i.e. with other antibiotics interacting with cell wall synthesis, but not with those of another mode of action, as ciprofloxacin, polymyxin B or chloramphenicol.

Ampicillin↗

[Pharmacokinetic and clinical studies on cefpodoxime proxetil dry syrup in the field of pediatrics].

Cefpodoxime proxetil (CPDX-PR, CS-807) is a new oral cephem derivative drug in which carboxylic acid was esterified to the 4-position of CPDX (oxime type cephem antibiotic). CPDX-PR is hydrolyzed mainly with esterase in intestinal wall and CPDX exists as an active form in body fluid. While there are numerous study reports using CPDX-PR in tablet forms in Japan, the dry syrup formula for pediatric use was newly developed. The dry syrup of CPDX-PR was orally administered 20 minutes after meal to the 6 boys of ages from 8 years and 1 month to 10 years and 10 months, with doses of 3 and 6 mg/kg, respectively, for 3 cases each. Serum concentrations and urinary concentrations and recovery rate of the drug were investigated. In addition to the above, the clinical and bacteriological studies were performed in a total of 105 cases consisting of children with ages ranging from 2 months to 11 years and 8 months, upon administering an average dose of 3.4 mg/kg, 3 to 4 times per day (96 cases of 3 times and 9 cases of 4 times). The 105 cases included 13 cases of pharyngitis, 21 cases of tonsillitis, 4 cases of acute bronchitis, 6 cases of pneumonia, 1 case of pleurisy, 13 cases of scarlet fever, 41 cases of urinary tract infection, 3 cases of posthitis and 3 cases of bacillary dysentery. Drug sensitivity test was performed for the following strains: (i) Strains retained by our department; 52 strains of Streptococcus pyogenes, 18 strains of Streptococcus agalactiae, and 11 strains of Bordetella pertussis, and (ii) strains isolated from cases to which CPDX-PR was administered; 2 strains of Staphylococcus aureus, 8 strains of S. pyogenes, 2 strains of Haemophilus influenzae, 10 strains of Escherichia coli, and 1 strain of Proteus mirabilis. Drug sensitivities of the strains retained by our department were tested with the inoculum sizes of 10(8) and 10(6) cfu/ml for R-3746 (Na-salt of CPDX), cefaclor (CCL), cephalexin (CEX), amoxicillin (AMPC), and methicillin (DMPPC), and those against strains separated from the cases to which CPDX-PR was administered were tested with the same inoculum sizes for R-3746, CCL, CEX, cefadroxil, ampicillin (ABPC), DMPPC and cloxacillin (MCIPC). Adverse reactions and abnormal clinical laboratory test results were also examined.(ABSTRACT TRUNCATED AT 400 WORDS)

Absorption↗

[Clinical study of cefpodoxime proxetil dry syrup for skin and soft tissue infections in the field of pediatrics].

Concurrently with administering a newly developed cephem derivative antibiotic (CEP), cefpodoxime proxetil (CPDX-PR, CS-807) dry syrup, to children with skin and soft tissue infections, activities of 7 drugs against a group of microorganisms were tested. The drugs tested included 4 drugs of the cephem group, R-3746, a Na-salt form of CPDX, cefaclor (CCL), cephalexin (CEX) and cefadroxil (CDX), and 3 drugs of the penicillin group, ampicillin (ABPC), methicillin (DMPPC) and cloxacillin (MCIPC). The bacterial strains tested were 71 strains of Staphylococcus aureus and 1 strain of Streptococcus pyogenes, all isolated from the above cases of pediatric infections. Inoculum sizes used in these tests were 10(6) and 10(8) cfu/ml. Ages of children in those cases to which the drug was administered ranged from 2 months to 15 years. A total of 66 cases were treated, including 60 cases of impetigo, 5 cases of subcutaneous abscess and 1 case of phlegmon. The drug was administered for an average of 6 days with a daily average dose level of 9.4 mg/kg divided into 3 doses except 1 case where a twice daily dose regimen was used. Clinical and bacteriological effects were examined, and the occurrence of adverse reactions and abnormal laboratory test results were recorded. The results of these tests are summarized below. 1. The activity test for R-3746 (Na-salt of CPDX) against 71 strains of S. aureus performed at an inoculum level of 10(8) cfu/ml showed 2 peaks of MIC values, one in a range of 1.56 to 6.25 micrograms/ml and the other higher than 100 micrograms/ml. The most prevalent MIC value was 3.13 micrograms/ml with MIC against 51 strains or 71.8% of the strains tested showing this value, and MIC values of 25 micrograms/ml or higher were obtained for 13 strains or 18.3% of the strains tested. The MIC80 was 6.25 micrograms/ml. Thus, R-3746 showed an antibacterial activity slightly weaker than MCIPC and DMPPC but similar to CCL, CEX and CDX. MIC values obtained at an inoculum level of 10(6) cfu/ml also had 2 peaks, one in a range of 1.56 to 3.13 micrograms/ml and the other higher than 25 micrograms/ml. Strains against which R-3746 had the MIC value of 3.13 micrograms/ml were the most numerous with 47 strains or 66.2%, and strains against which the MIC value of higher than 25 micrograms/ml was obtained were next with 13 strains or 18.3%.(ABSTRACT TRUNCATED AT 400 WORDS)

Abscess↗

[Can septicemia and ascitic fluid infections in cirrhotic patients be treated by the oral route alone?].

The aim of this study was to determine the efficacy of oral antibiotics in the treatment of severe infections in cirrhosis. Twenty-two patients (17 males, 5 females) with spontaneous bacteremia (n = 7) or bacterial peritonitis (n = 15) were treated with oral pefloxacin 400 mg per 24 hr alone (n = 1) or in combination with another oral antibiotic, trimethoprimsulfamethoxazole (n = 13), amoxicillin (n = 6), cefadroxil (n = 2), or metronidazole (n = 1). In patients with spontaneous bacteremia, all organisms were found to be sensitive to oral antibiotics, and a favorable response was elicited in 6 out of 7 (86 p. cent) within 3 days (mean) of treatment. In patients with spontaneous peritonitis, ascitic fluid cultures were positive in 11 cases, and organisms were sensitive to pefloxacin in 9 out of 11 cases. A favorable response was elicited in 13 out of 15 within 2 to 8 days of treatment. Fourteen patients died (64 p. cent), 3 of infection (bacteremia n = 1, peritonitis n = 2), and 11 patients of causes unrelated to infection, mainly variceal hemorrhage, hepatorenal syndrome or hepatocellular carcinoma, although the clinical symptoms of infection were controlled. One-year survival was 57 p. cent in patients with bacteremia and 33 p. cent in those with bacterial peritonitis. Oral treatment was well tolerated in all patients. We suggest that most bacteremia and spontaneous bacterial peritonitis in cirrhotic patients can be treated with oral antibiotics. In some patients, this may be accomplished on an out patient basis.

Administration, Oral↗

[Effects of antibiotics on the production of prostaglandins by macrophages in vitro].

Many reports have pointed out a relationship between antibiotics and immunity. It has been shown that antibiotics are able to modify polynuclear chemotactism, bacteria phagocytosis by macrophages, lymphocyte proliferation and the production of various cytokines (interleukins I, II...). On the other hand, the immunoregulatory activity of metabolites of arachidonic acid is proposed to explain, in part, these properties. For example it is well established that PGE2 has a negative retro control on Interleukin production by monocytes. Moreover eicosanoids are probably involved in the inflammatory and vasoactive reactions during the septic shock syndrome observed frequently during phagocytosis and bacterial lysis of Gram negative bacteria. Thus it seems interesting to evaluate the antibiotics activity on eicosanoid monocyte production. We have studied the influence of ciprofloxacin, ofloxacin, pefloxacin, imipenem, doxycycline, clindamycin and cefadroxil at various concentrations on eicosanoid production by A 13187 calcium ionophore activated mouse peritoneal macrophages (P 388 D1). The analyzed prostaglandins are: 6 keto (PGI2), PGE1, PGE2, F2 alpha, A2, B2, TxB2 et PG D2. All the antibiotics tested show either an inhibiting or a stimulating action on eicosanoid production. These immunomodulatory and pro-inflammatory effects must be considered, together with anti-infectious activity before the prescription of an antibiotic.

Animals↗

H+ coupled uphill transport of aminocephalosporins via the dipeptide transport system in rabbit intestinal brush-border membranes.

The transport characteristics of aminocephalosporin antibiotics, possessing an alpha-amino group and a carboxyl group, in brush-border membranes isolated from rabbit small intestine have been studied by a rapid filtration technique. The uptake of cephradine by brush-border membrane vesicles was stimulated by the countertransport effect of dipeptides, which indicates the existence of a common carrier transport system. An inward H+ gradient ([pH]i = 7.5 to 8.4, [pH]o = 6.0) stimulated cephradine uptake against a concentration gradient (overshoot phenomenon), and this stimulation was reduced when the H+ gradient was subjected to rapid dissipation by the presence of carbonyl cyanide p-trifluoromethoxyphenylhydrazone, a protonophore. A valinomycin-induced K+ diffusion potential (interior-negative) stimulated H+ gradient-dependent cephradine uptake without altering the equilibrium value. The uptake of other aminocephalosporins (cefadroxil, cefaclor, cephalexin) was also stimulated in the presence of an inward H+ gradient, while the uptake of cephalosporins without the alpha-amino group (cefazolin, cefotiam) was not changed in the presence or absence of the H+ gradient. These results suggest that the transport of aminocephalosporins can be driven actively by an inward H+ gradient via the dipeptide transport system in the intestinal brush-border membranes, and that the process results in the transfer of a positive charge.

Animals↗

Omphalophlebitis and osteomyelitis associated with Klebsiella septicemia in a premature foal.

Gram-negative neonatal septicemia was diagnosed in a premature Standardbred colt. Clinical signs included lethargy, weakness, loss of suckle reflex, tachypnea, and injected mucous membranes. Sequelae included pneumonia, omphalophlebitis, septic arthritis, and osteomyelitis. Prepartum maternal uterine infection, premature delivery, abnormal parturition with premature fetal membrane separation, and failure of passive transfer of colostral immunoglobulins increased the foal's risk for developing sepsis. Treatment included administration of moxalactam disodium and cefadroxil. The clinical efficacy of cephalosporin antibiotics in the treatment of gram-negative sepsis is discussed.

Animals↗

Reverse-phase liquid chromatographic analysis of cephalosporins.

A simple and rapid reverse-phase liquid chromatographic method was developed for the qualitative and quantitative analysis of 13 cephalosporin compounds. A mixture of cefaclor, cefadroxil, cefamandole nafate, cefamandole sodium, cefazolin, cefoperazone, cefotaxime, cefoxitin, ceftizoxime, cephalothin, cephalexin, cephapirin, and cephradine was resolved into its components in raw material and dosage form samples by using a C18 column, a methanol-water-acetic acid (30 + 70 + 0.1) mobile phase, and a UV detector set at 254 nm. The proposed method is suited both for the determination of cephalosporins in a wide variety of commercial dosage forms and for the investigation of related compounds and other impurities in samples of 7 of the cephalosporins.

Cephalosporins↗

[Effect of antibiotics on IL-1 in vitro production by human monocytes].

The effects of penicillin, macrolides (spiramycin and erythromycin), cephalosporins (cefaclor and cefadroxil), cycline (doxycycline) and quinolones (pefloxacin, ciprofloxacin and ofloxacin) on extracellular and cell-associated interleukin-1 activity from human monocytes were investigated in vitro. When cells were treated with 10 micrograms/ml of quinolones, cephalosporins or penicillin, no effect on IL-1 production could be detected. Using 100 micrograms/ml, extracellular IL-1 activity was found to be decreased by quinolones (about 35% of the control without antibiotic) without modification of the cell-associated IL-1 activity. Extra and intracellular IL-1 was only slightly decreased by cephalosporins, while penicillin did not alter the IL-1 activities. Spiramycin and doxycycline using 100 micrograms/ml increased extracellular IL-1 while cell-associated was decreased. A toxic effect may have been exerted by these antimicrobial agents.

Anti-Bacterial Agents↗

[In vitro susceptibilities of BRL 25000 (clavulanic acid-amoxicillin) against causative organisms in the field of obstetrics and gynecology].

The in vitro susceptibilities of various causative organisms recently isolated from patients with genital infections to BRL 25000 (a formulation with 2 parts of amoxicillin and 1 part of potassium clavulanate), amoxicillin (AMPC), cefaclor (CCL), cephalexin (CEX), cefadroxil (CDX) and cefroxadine (CXD) were determined. beta-Lactamase-producing strains were detected by the nitrocefin disc method. Frequencies of isolation of beta-lactamase producing strains of E. coli, K. pneumoniae and B. fragilis were 36%, 96% and 100%, respectively. The activity of BRL 25000 against S. agalactiae and anaerobic GPC (anaerobic Streptococci, Peptostreptococcus spp.) was slightly less than that of AMPC but was 2- to 4-fold higher than CCL and 8- to 16-fold higher than CEX, CDX and CXD. Against E. coli and K. pneumoniae, the activity of BRL 25000 was superior to that of AMPC and approximately equal to CEX, CDX and CXD but 2-fold less than CCL. Against the B. fragilis group, BRL 25000 was much more active than AMPC or any of the cephalosporins tested, clearly demonstrating the beta-lactamase inhibitory properties of the clavulanic acid in BRL 25000. At inocula of 10(6) CFU/ml, MIC values of BRL 25000 were 12.5-50 micrograms/ml against some strains of E. coli, K. pneumoniae and B. fragilis. A mechanism of resistance other than beta-lactamase production is obviously prevalent in these strains. It is speculated that the resistance may be due to a low affinity of the drug to target proteins. Mixed infections of B. fragilis and E. coli or K. pneumoniae are commonly found in the obstetric and gynecological patients. BRL 25000 shows activity against these strains and also against both aerobic and anaerobic GPC. Therefore, BRL 25000 is considered useful for the treatment of genital infections.

Amoxicillin↗

In vitro susceptibility of upper respiratory tract pathogens to 13 oral antimicrobial agents.

An in vitro comparison of the activities of 13 oral antimicrobial agents against clinical isolates of bacteria commonly responsible for causing upper respiratory tract infections was performed. With regard to Haemophilus influenzae, beta-lactamase-negative strains were susceptible to amoxycillin, augmentin, cefaclor, erythromycin, trimethoprim, cotrimoxazole and tetracycline, with CL 284,635 being the most active agent. With the exception of amoxycillin these drugs were also active against beta-lactamase-producing strains. CL 284,635 was also very active against Branhamella catarrhalis isolates, including beta-lactamase-producing strains, but was less active against the Gram-positive bacteria tested. Cefadroxil, cephradine and cephalexin were mainly active against Gram-positive pathogens. Based on minimum inhibitory concentration determinations, cefaclor, augmentin and co-trimoxazole would be appropriate drugs for the treatment of those cases of otitis media and sinusitis where H. influenzae and Streptococcus pneumoniae are important pathogens provided they are susceptible to these agents.

Anti-Bacterial Agents↗