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Biosynthesis and biotransformation of glutathione S-conjugates to toxic metabolites.

The material presented in this review deals with the hypothesis that the nephrotoxicity of certain halogenated alkanes and alkenes is associated with hepatic biosynthesis of glutathione S-conjugates, which are further metabolized to the corresponding cysteine S-conjugates. Some glutathione or cysteine S-conjugates may be direct-acting nephrotoxins, but most cysteine S-conjugates require bioactivation by renal, pyridoxal phosphate-dependent enzymes, such as cysteine conjugate beta-lyase (beta-lyase). The biosynthesis of glutathione S-conjugates is catalyzed by both the cytosolic and the microsomal glutathione S-transferases, although the latter enzyme is a better catalyst for the reaction of haloalkenes with glutathione. When glutathione S-conjugate formation yields sulfur mustards, as occurs with vicinal-dihaloethanes, the S-conjugates are direct-acting toxins. In contrast, the S-conjugates formed from fluoro- and chloroalkenes yield S-alkyl- or S-vinyl glutathione conjugates, respectively, which are metabolized to the corresponding cysteine S-conjugates by gamma-glutamyltransferase and dipeptidases; inhibition of these enzymes blocks the toxicity of the glutathione S-conjugates. The cysteine S-conjugates must be metabolized by beta-lyase for the expression of toxicity; the beta-lyase inhibitor aminooxyacetic acid blocks the toxicity of cysteine S-conjugates, and the corresponding alpha-methyl cysteine S-conjugates, which cannot be metabolized by beta-lyase, are not toxic. Moreover, probenecid, an inhibitor of renal anion transport system, blocks the toxicity of cysteine S-conjugates, which cannot be metabolized by beta-lyase, are not toxic. Moreover, probenecid, an inhibitor of renal anion transport system, blocks the toxicity of cysteine S-conjugates. Homocysteine S-conjugates are also potent cyto- and nephrotoxins. The high renal content of gamma-glutamyltransferase and the renal anion transport system are probably determinants of kidney tissue as a target site. Biochemical studies indicate that renal mitochondrial dysfunction is produced by the cysteine S-conjugates. Finally, some of the glutathione and cysteine conjugates are mutagenic in the Ames test, and reactive intermediates formed by the action of beta-lyase may contribute to the nephrocarcinogenicity of certain chloroalkenes.

Animals↗

Improved brain delivery of a nonsteroidal anti-inflammatory drug with a synthetic glyceride ester: a preliminary attempt at a CNS drug delivery system for the therapy of Alzheimer's disease.

1,3-Diacetyl-2-ketoprofen glyceride (DAKG), a prodrug of ketoprofen, was synthesized as a model compound in our attempt to develop a central nervous system (CNS) drug delivery system to treat Alzheimer's disease. The primary purpose of the present study is to test whether DAKG improves the delivery of ketoprofen to the brain and to quantitatively evaluate several factors that influence the brain distribution of this prodrug. ddY mice were injected with either ketoprofen or DAKG at a dose of 40 micromol/kg and then the plasma and brain pharmacokinetics of these agents were assessed. The brain uptake clearance of ketoprofen and DAKG across the BBB was measured by in situ mouse brain perfusion. In addition, the efflux permeability of ketoprofen through the BBB was evaluated using the in vivo mouse brain microdialysis technique. The in vivo metabolism of DAKG in the brain was assessed by a short infusion into the internal carotid artery coupled with the brain metabolism index (BMI) method. Administration of DAKG produced an approximately 3-fold increase in the area under the brain concentration - time curve of ketoprofen, compared with administration of ketoprofen itself. The brain uptake clearance (CL(in) ) of ketoprofen across the BBB was 0.0308 +/- 0.0046 mL/min/g whereas the CL(in) of DAKG was 1.60 +/- 0.16 mL/min/g, suggesting a marked increase in BBB permeability following lipidization of ketoprofen. The BMI method confirmed that DAKG is taken up by the brain to rapidly release ketoprofen in a dose-dependent manner. The in vitro metabolism studies revealed that isolated bovine brain capillaries as well as whole brain homogenate have the hydrolysis activity to DAKG. In addition, the brain concentration of ketoprofen after DAKG administration was maintained for a significant period following co-administration of probenecid. These results suggest that DAKG improves the delivery of ketoprofen to the brain, and this improved delivery is due to avid uptake of DAKG across the BBB followed by rapid hydrolysis to ketoprofen within the brain. The ketoprofen produced in the brain was probably cleared by the active efflux system operating in the BBB. Significant inhibition of this efflux system by co-administration of probenecid could result in a sustained concentration of ketoprofen in the brain following DAKG administration.

Alzheimer Disease↗

Long-term follow-up of patients with AIDS treated with parenteral cidofovir for cytomegalovirus retinitis: the HPMPC Peripheral Cytomegalovirus Retinitis Trial. The Studies of Ocular Complications of AIDS Research Group in collaboration with the AIDS Clinical Trials Group.

OBJECTIVE: To evaluate patients with cytomegalovirus (CMV) retinitis treated with intravenous cidofovir for long-term outcomes. DESIGN: Patients with CMV retinitis enrolled in a randomized, controlled clinical trial of intravenous cidofovir as treatment for retinitis were followed for long-term outcomes, including 21 patients initially enrolled in the deferral group who received cidofovir therapy after progression of retinitis. SETTING: Thirteen tertiary care clinics specializing in AIDS care and ophthalmology. PARTICIPANTS: Fifty-eight patients with AIDS and small peripheral CMV retinitis lesions. INTERVENTIONS: Cidofovir 5 mg/kg once weekly for 2 weeks followed by low-dose maintenance cidofovir therapy (3 mg/kg) in 35 patients or high-dose maintenance (5 mg/kg) in 23 patients. MAIN OUTCOME MEASURES: Time to progression of retinitis, drug toxicities. RESULTS: Median time to progression of retinitis was 2.5 months. Median time to discontinuation of cidofovir because of intolerance was 6.6 months, and did not differ significantly between the two maintenance doses. Median time to discontinuation of cidofovir for intolerance other than probenecid reaction was 16.3 months for patients treated with low-dose maintenance and 5.0 months for patients treated with high-dose maintenance (P = 0.021). Proteinuria of 2+ or more occurred at a rate of 1.22/person-year. In patients with sufficient follow-up to determine resolution of proteinuria, 89.9% of episodes resolved, and the median time to resolution was 20 days. Rates of probenecid intolerance and of cidofovir-associated uveitis were 0.35/person-year, and 0.20/person-year, respectively. CONCLUSION: Although effective for the treatment of CMV retinitis, cidofovir has potential toxicity. Toxicity typically resolves with discontinuation of therapy, but careful attention to both concomitant therapy and monitoring for toxicity is required.

AIDS-Related Opportunistic Infections↗

Nonsteroidal anti-inflammatory drugs efficiently reduce the transport and cytotoxicity of adefovir mediated by the human renal organic anion transporter 1.

Adefovir is a nucleotide analog with anti-human immunodeficiency virus (HIV) activity that has been extensively studied in clinical trials. While on prolonged anti-HIV therapy with adefovir, some patients may develop drug-associated nephrotoxicity manifested by changes in laboratory markers of renal tubular functions that are reversible upon drug discontinuation. It has been recently shown that adefovir is efficiently transported by the human renal organic anion transporter 1 (hOAT1), a membrane transport protein localized in the kidney, that presumably mediates the accumulation of adefovir in renal proximal tubules. In an effort to look for novel inhibitors of this transport process, we used a cell line stably expressing hOAT1 to demonstrate that nonsteroidal anti-inflammatory drugs (NSAIDs) efficiently inhibit hOAT1-specific transport of adefovir at clinically relevant concentrations. Diflunisal, ketoprofen, flurbiprofen, indomethacin, naproxen, and ibuprofen were equally or more effective (IC(50) = 0.85-8 microM) than probenecid or betamipron, two known potent inhibitors of hOAT1 (IC(50) = 8 and 6 microM, respectively) with in vivo nephroprotective effects. Importantly, NSAIDs significantly reduced the shift in adefovir cytotoxicity observed upon hOAT1 expression with ketoprofen and naproxen being 2- to 3-times more effective than probenecid. Transport experiments with [(3)H]ketoprofen and [(3)H]ibuprofen revealed that NSAIDs themselves were not efficiently transported by hOAT1. None of the NSAIDs tested showed any interference with the anti-HIV activity of adefovir. In conclusion, these observations suggest that NSAIDs may reduce or delay the emergence of adefovir nephrotoxicity.

Adenine↗

Multidrug resistance-associated protein-1 functional activity in Calu-3 cells.

The purpose of this work was to determine whether the in vitro bronchiolar epithelial cell model, Calu-3, possesses efflux pump activity by the multidrug resistance-associated protein-1 (MRP1). Reverse transcription-polymerase chain reaction demonstrated MRP1 gene expression in Calu-3 cells. Indirect fluorescence studies showed a basolateral membrane localization of MRP1 compared with P-glycoprotein (Pgp) that was found on the apical side of these cells. An increase in the rate of accumulation of the MRP1 substrate calcein was observed following treatment with the organic anion/MRP1 inhibitor indomethacin, the Pgp inhibitors cyclosporin A (CsA) and vinblastine, as well as conditions of energy depletion. Total calcein efflux was significantly decreased with the MRP1 inhibitors probenecid and indomethacin, while total efflux was unchanged following treatment with CsA. In the latter case, however, intracellular calcein levels postefflux were significantly greater. Probenecid and indomethacin increased calcein net secretion 2.4- and 3.5-fold, respectively. The efflux of etoposide, a known substrate for both Pgp and MRP1, was shown to be mainly Pgp-mediated by using the multidrug-resistant inhibitors quinidine (mixed Pgp/MRP1), CsA (Pgp), and MK571 (MRP1). Together, these data suggest that Calu-3 cells possess MRP1 functional activity that is subordinate to Pgp efflux. We present here kinetic analysis of calcein efflux from Calu-3 cells to support our findings.

ATP Binding Cassette Transporter, Subfamily B, Mem↗

Experimental therapeutics with a new 10-deazaaminopterin in human mesothelioma: further improving efficacy through structural design, pharmacologic modulation at the level of MRP ATPases, and combined therapy with platinums.

Studies described here sought to evaluate the therapeutic potential of a new 10-deazaaminopterin analogue, 10-propargyl-10-deazaaminopterin (PDX), alone and in combination with platinum compounds in the treatment of human pleural mesothelioma. In vitro studies documented 25-30-fold and 3-fold, respectively, greater cytotoxic potency of PDX compared with methotrexate and another 10-deazaaminopterin, edatrexate, against VAMT-1 and JMN cell lines derived from human mesothelioma. These tumor cell lines were also inhibited by platinum compounds. Cisplatin (CDDP) was somewhat more inhibitory than oxaloplatin and >1 log order in magnitude more inhibitory than carboplatin (CBCDA). Against the JMN tumor xenografted in nude mice, whereas methotrexate and, more so, edatrexate, were potently growth inhibitory, only PDX brought about substantial regression. By comparison, CDDP and CBCDA, but not oxaloplatin were markedly growth inhibitory to this same tumor in vivo. This high level of therapeutic activity of PDX could be additionally enhanced by coadministration of probenecid, an inhibitor of canicular multispecific organic anion transporter/multidrug resistance-related protein (MRP)-like ATPases, which increased the number of complete regressions by >-3 fold. Canicular multispecific organic anion transporter/MRP genes, primarily 1, 3, 4, 5, and 7, were in fact expressed in these human mesothelioma cell lines as determined by real-time reverse transcription-PCR. These same MRP genes, including, to a lesser extent, MRP-4, were also expressed in pleural mesotheliomas derived from patients as shown by the same methodology. When combined with CDDP or CBCDA, PDX achieved 2-fold greater overall regression of the JMN tumor with a 3-4-fold increase in complete regressions, although some attenuation of dosages of each were required in the combination. These results strongly suggest that PDX has significant potential in the treatment of human pleural mesothelioma, particularly when coadministered with probenecid or combined with platinum compounds.

Adenosine Triphosphatases↗

Renal handling of uric acid assessed by means of pharmacological tests in obese women.

The aim of this study was to compare the renal handling of uric acid by means of pyrazinamide and probenecid tests between obese and non-obese women. A cross-sectional study was carried out in 8 obese women and in 8 non-obese women as control group. Metabolic profile and renal handling of uric acid including clearance, fractional excretion and excretion rates, were assessed. Due to technical problems, pyrazinamide and probenecid tests were performed only in 5 women of each group to evaluate presecretory reabsorption, secretion and post-secretory reabsorption of uric acid. Uric acid clearance had a tendency to be lower in the obese women than in the control group. There were no significant differences between the groups in fractional excretion and excretion uric acid rates. Pre- and post-secretory reabsorptions of uric acid did not differ between the obese and the non-obese women. Tubular secretion of uric acid was significantly lower in the obese women compared with the control group (6.4 vs 13.6%; p=0.02). Tubular secretion of uric acid negatively correlated with body mass index (r=-0.73; p<0.05). In conclusion, tubular secretion of uric acid possibly plays an important role in uric acid homeostasis in obese women.

Absorption↗

The influence of alkaline elements on the metabolism of 5-hydroxytryptamine in rat's brain.

A single or four time-administration of Li, Na, K, Rb and Cs chlorides at the doses of 2-5 and 5 mEq/kg ip does not significantly affect 5-HT level. The level of 5-hydroxyindoleacetic acid (5-HIAA) increase only after the administration of LiCl. This increase occurs already after 1 hr and persists up to 24 hrs after the last injection. LiCl given together with probenecid induces the increase in 5-HIAA level greater than that after probenecid alone. The decrease in 5-HIAA level after pargyline-induced inhibition in MAO is more rapid in animals submitted to two action of Li. The increase 5-HIAA level in rat's brain results from Li ions-increased 5-HT turnover.

Animals↗

Influence of bile flow, theophylline and some organic anions on the biliary excretion of 3H-ouabain in rats.

The influence of some organic anions and theophylline on the biliary excretion of 3H-ouabain in bile-fistula rats (treated with 55 nmoles X kg(-1) 3H-ouabain i.p.) was investigated. Compared with controls (31.5 +/- 1.6 nmoles X kg(-1) per 3 hr) the excreted amounts of the glycoside within 3 hr were decreased to the following values: 22.3 +/- 0.9 nmoles X kg(-1) by taurocholic acid (0.7 nmoles X kg(-1) X hr(-1); 25.6 +/- 1.7 nmoles X kg(-1) by sulfobromophthalein (0.15 nmoles X kg(-1); 19.3 +/- 2.0 nmoles X kg(-1) by phenolphthalein (0.5 nmoles X kg(-1) and 20.9 +/- 2.1 nmoles X kg(-1) by probenecid (1.5 nmoles X kg(-1). Taurocholic acid and probenecid increased the bile flow by about 50 per cent compared to the controls as well as the biliary excretion of Na+, K+ and Cl-. Ethacrynic acid (0.2 nmoles X kg(-1) and the phospho-diesterase inhibitor theophylline (1.1 nmoles X kg(-1) had no influence on bile flow, electrolyte-and ouabain excretion. Therefore no relation between the biliary transport of ouabain and the bile flow could be observed. The interference of the hepatic transport of ouabain with organic anions is discussed in view of the current concept of a specific hepatic transport for steroid compounds.

Animals↗

Prodrugs and mutual prodrugs: synthesis of some new pyrazolone and oxadiazole analogues of a few non-steroidal anti-inflammatory drugs.

Naproxen, probenecid, diclofenac, ibuprofen and indomethacin were converted to hydrazide derivatives via their methyl ester by reacting with hydrazine hydrate, which were further condensed with beta-keto esters to get the pyrazolone derivatives. The hydrazide derivatives of probenecid and diclofenac were also reacted with biphenyl acetic acid while naproxen hydrazide was reacted with p-chloro benzoic acid besides biphenyl acetic acid to synthesize their oxadiazole analogues. Some selected members of the compounds prepared were screened for their anti-inflammatory and analgesic activity.

Analgesics↗

[Incidence and the results of treatment of beta-lactamase-positive gonorrhea with spectinomycin (trobicin)].

Beta-lactamase-positive gonorrhoea was rather sporadic in Poland. In spring 1988 a marked rise was observed in the proportion of therapeutic failures in the treatment of gonorrhoea with procaine penicillin (4.8 million u) with probenecid among patient treated in the outpatient clinic of the Venereology Institute in Warsaw. The cause was infection with beta-lactamase producing gonococci. Up to June 1989 beta-lactamase production ability was tested in gonococci cultured from 415 patients (363 men and 52 women) with positive results in 73 cases (61 men and 11 women) that is in 18%. Most (85%) patients were treated with spectinomycin (2 g intramuscularly in men and 4 g in women in one dose) with cure in all cases. Treatment with tetracycline (2 g daily for 7 days) given to 12 patients failed in 2 cases. These results, if confirmed in other parts of the country, will cause the necessity of revision of the presently accepted indications for gonorrhoea treatment with penicillin with probenecid as the basic method.

Female↗

[The mechanisms of elimination of o-125I-benzoate in rabbits].

An analysis of the mechanisms of elimination of o-125I-benzoate in the rabbit kidney on the basis of the inhibition of the secretionary transport by probenecid has shown that o-125I-benzoate is eliminated in the kidneys not only by glomerular filtration but by tubular secretion as well. An effect on the total amount of the drug excreted in the urine is exerted by tubular resorption (apparently by the process of passive diffusion), which exceeds tubular secretion. A comparison of the chromatograms of the plasma and urine before and after the competitive inhibition of the tubular active transport by probenecid revealed a higher share of o-125I-benzylglucuronide in the urine in the case of inhibition. The results suggested a partial share of the kidneys in total biotransformation of o-125I-benzoate. Excretion of the original drug and metabolites in the bile forms a negligible share (less than 1%) of total clearance in rabbits.

Animals↗

Tryptophan in hepatic coma.

The concentrations of tryptophan in serum and CSF, as well as that of 5-HIAA in CSF were investigated in various group of patients. Those with hepatic cirrhosis have normal total serum tryptophan. However, because of the low concentration of serum albumin the percentage of nonalbumin-bound tryptophan is elevated about 50 percent above the mean control value. By contrast tryptophan in the CSF was increased by 50 to over 800 percent. This suggests that there is also an increase in brain tryptophan and serotonin in the cirrhotic patients. No significant difference was found for the concentrations of tryptophan in CSF of patients in coma and those not in coma. Patients with hepatic coma had an elevated concentration of 5-HIAA in the lumbar CSF which may reflect the increase in this compound and in serotonin reported by Jellinger and Riederer (1977). However, following treatment with probenecid in order to block the egress of 5-HIAA from the CSF, the concentration of 5-HIAA in relation to that of probenecid was not significantly different for the group with hepatic coma as compared with the control group.

Hepatic Encephalopathy↗

2-Bromo-(diglutathion-S-yl)hydroquinone nephrotoxicity: physiological, biochemical, and electrochemical determinants.

2-Bromo-(diglutathion-S-yl)hydroquinone [2-Br-(diGSyl)HQ] causes severe necrosis of the proximal renal tubules in the rat, elevations in blood urea nitrogen (BUN) and increased urinary excretion of protein, glucose, and lactate dehydrogenase. In contrast, 2-Br-3-(GSyl)HQ, 2-Br-5-(GSyl)HQ, and 2-Br-6-(GSyl)HQ caused differentially less toxicity than the diglutathionyl conjugate. None of these conjugates had any apparent effect on liver pathology and serum glutamate-pyruvate transaminase remained within the normal range. Pretreatment of rats with probenecid, an organic anion transport inhibitor, offered only slight protection against 2-Br-(diGSyl)HQ-mediated elevations in BUN, proteinuria, or glucosuria. In contrast, quinine, an organic cation transport inhibitor, potentiated the nephrotoxicity of 2-Br-(di-GSyl)HQ. Thus, in contrast to other nephrotoxic sulfur conjugates, probenecid-sensitive organic ion transport systems do not contribute to the kidney-specific toxicity of 2-Br-(diGSyl)HQ. However, inhibition of renal gamma-glutamyl transpeptidase by AT-125 completely protected rats from the nephrotoxic effects of 2-Br-(diGSyl)HQ. Aminooxyacetic acid, an inhibitor of cysteine conjugate beta-lyase, caused a 20-25% decrease in 2-Br-(diGSyl)HQ-mediated elevations in BUN and urinary excretion parameters. The isomeric 35S conjugates covalently bound to rat kidney 10,000 x g homogenate in the order 2-Br-6-(GSyl)HQ greater than 2-Br-5-(GSyl)HQ greater than 2-Br-3-(GSyl)HQ greater than 2-Br-(diGSyl)HQ. AT-125 (0.4 mM) decreased covalent binding by 25%, 17%, 33%, and 28%, respectively. Aminooxyacetic acid (0.1 mM) inhibited covalent binding by 26%, 10%, 17%, and 17% respectively. Ascorbic acid (1.0 mM) inhibited covalent binding by 63%, 87%, 62%, and 28%, respectively, and this inhibition correlated, inversely, with the redox potential of the conjugates. Thus, the covalent binding is mediated preferentially by oxidation of the quinol moiety, although the formation of reactive thiols cannot be excluded. In addition, the initial conjugation of 2-BrHQ with GSH does not result in the formation of a less redox-active species. However, the subsequent addition of a second molecule of GSH results in the formation of a more redox-stable compound, which, paradoxically, enhances toxicity. The metabolism of 2-Br-(diGSyl)HQ by renal proximal tubular gamma-glutamyl transpeptidase and trans-membrane transport of the cysteine conjugate(s) followed by oxidation of the quinol moiety is probably responsible for the target organ toxicity of this compound.

Animals↗

Arginyl and histidyl groups are essential for organic anion exchange in renal brush-border membrane vesicles.

The effect of side chain modification on the organic anion exchanger in the renal brush-border membrane was examined to identify what amino acid residues constitute the substrate binding site. One histidyl-specific reagent, diethyl pyrocarbonate (DEPC), and 2 arginyl-specific reagents, phenylglyoxal and 2,3-butanedione, were tested for their effect on the specifically mediated transport of p-amino[3H]hippurate (PAH), a prototypic organic anion. The specifically mediated transport refers to the difference in the uptake of [3H]PAH in the absence and presence of a known competitive inhibitor, probenecid, and was examined in brush-border membrane vesicles isolated from the outer cortex of canine kidneys. The experiments were performed utilizing a rapid filtration assay. DEPC, phenylglyoxal, and 2,3-butanedione inactivated the specifically mediated PAH transport, i.e. probenecid inhibitable transport with IC50 values of 160, 710, and 1780 microM, respectively. The rates of PAH inactivation by DEPC and phenylglyoxal were suggestive of multiple pseudo first-order reaction kinetics and were consistent with a reaction mechanism whereby more than 1 arginyl or histidyl residue is inactivated. Furthermore, PAH (5 mM) did not affect the rate of phenylglyoxal inactivation. In contrast, PAH (5 mM) affected the rate of DEPC inactivation. The modification by DEPC was specific for histidyl residues since transport could be restored by treatment with hydroxylamine. The results demonstrate that histidyl and arginyl residues are essential for organic anion transport in brush-border membrane vesicles. We conclude that the histidyl residue constitutes the cationic binding site for the anionic substrate, whereas the arginyl residue(s) serves to guide the substrate to or away from the histidyl site.

Aldehydes↗

[Homovanilic acid accumulation in the brain of rats as a possible cause of the inhibitory action of psychotropic substances on behavior and motor activity].

In experiments on rats injection of haloperidol and levopromazine at growing doses (1--25 mg/kg) resulted in inhibition of the orienting-motor activity and catalepsy accompanied by accumulation of homovanilinic acid (HVA) in the forebrain. The dopaminergic drug apomorphine antagonized the inhibitory effects of the neuroleptics on behavior and simultaneously blocked the accumulation of HVA in the rab brain. Combined injection of haloperidol and probenecid potentiated catalepsy induced by the neuroleptic and led to a much higher level of HVA. levopromazine combined with probenecid elicited a deep inhibition of motility and myorelaxation. Bilateral microinjection of HVA at a dose of 50 micrograms into the caudate nucleus of the rabbit brain produced a clear-cut inhibition of the orienting-motor activity. It is suggested that the inhibitory action of the neuroleptics on behavior is partially mediated through accumulation of HVA by CNS synapses, i. e. HVA possesses its own neurotropic activity.

Animals↗

[Bacteriological and clinical evaluation of ceftizoxime in male gonorrheal urethritis].

Forty-one male patients with gonorrheal urethritis were treated with ceftizoxime (CZX) administered concomitantly probenecid at the urological ward of Tokyo Metropolitan Taito Hospital during the period from October, 1982 to February, 1983, and clinically evaluated. Eighty strains of Neisseria gonorrhoeae isolated from the clinical specimens of these patients were bacteriologically studied. Of the 80 strains, 12(15%) were PPNG strains and the other 68 strains were non-PPNG strains. MICs of PCG to the 12 PPNG strains were 3.13 - 25 micrograms/ml and to the 68 non-PPNG strains were 0.0122 - 3.13 micrograms/ml. While MICs of CZX to the PPNG strains were less than or equal to 0.003 - 0.024 micrograms/ml and to the non-PPNG strains were less than or equal to 0.003 - 0.05 micrograms/ml. Those patients with gonorrheal urethritis were given a single 0.5 g intramuscular dose of CZX and a single 1 g oral dose of probenecid. The following clinical findings were obtained: The clinical efficacy rate of 41 cases was 98%; excellent in 24, good in 16, poor in 1 case. All 3 patients with gonorrheal urethritis caused by PPNGs were cured with the treatment. No subjective side effects were found.

Adult↗

Renal excretion and distribution of ceftizoxime in rats.

A clearance method for ceftizoxime (CZX), a new cephalosporin antibiotic, was designed and utilized to assess the mechanism of renal excretion and evaluate kidney distribution under steady-state serum level. Renal clearance ratio of CZX to inulin, when corrected for protein binding, was 1.6 at serum level of 13 micrograms/ml and was decreased to around unity with a serum level of 700 micrograms/ml or higher or by infusing p-aminohippuric acid or probenecid. The clearance ratio appeared to be independent of urinary pH or changes in urinary flow. The kidney/serum concentration ratio for CZX decreased from 2.5 to 1.5 in proportion to the extent of reduction of the clearance ratio. p-Aminohippuric acid and probenecid further reduced the kidney/serum ratio to about 1.0 with concomitant inhibition of tubular transport of CZX. Cortex/serum and medulla/serum ratios were also reduced similarly to that of the whole kidney. It is concluded that the tubular transport of CZX is similar to that for p-aminohippuric acid transport system and that passive reabsorption from the tubular lumen may not necessarily be present.

Animals↗