Intereactions between doripenem and clavulanate ­ Application of minimal inhibitory concentration analysis and cytometry flow for bactericidal studies

Background: In view of the current low efficacy of bacterial infection treatment the common trend towards searching for antibiotic systems exhibiting synergistic action is well justified. Among carbapenem analogues a particularly interesting option is provided by combinations of clavulanic acid with meropenem, which have proven to be especially effective. Results: Determination of the minimal inhibitory concentration (MIC) along with the method based on flow cytometry constitutes an important tool in the identification of bacterial sensitivity to active substances. Within this study the inhibitory effect of doripenem, clavulanic acid and the doripenem-clavulanate acid system was analyzed in relation to such bacteria as Salmonella enteritidis, Salmonella typhimurium, Staphylococcus aureus, Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, Proteus vulgaris, Clostridium butyricum and Clostridium pasteurianum, Acinetobacter baumannii, Enterobacter aerogenes. The lowest MIC, amounting to 0.03 µg/mL, was observed for the doripenem-clavulanate acid system in the case of E. coli ATCC 25922. In turn, the lowest MIC for doripenem applied alone was recorded for K. pneumoniae ATCC 31488, for which it was 0.1 µg/mL. The strain which proved to be most resistant both to doripenem and the doripenem-clavulanate acid system, was A. baumannii, with MIC of 32 µg/mL (clinical isolate) and 16 µg/mL (reference strain). Cytometric analysis for P. aeruginosa ATCC 27853 and S. aureus ATCC 25923 showed changes in cells following exposure to limiting concentrations of the active substance. Conclusions: Analysis of MIC supplies important information concerning microbial sensitivity to active substances, mainly in terms of limiting concentrations causing mortality or vitality of the tested species, which is essential when selecting appropriate antibiotic therapy.

Bioequivalencia de dos formulaciones de amoxicilina-ácido clavulánico para uso oral en perros / Bioequivalence of two amoxicillin-potassium clavulanate oral preparations in dogs

The aim of this trial was to carry out a bioequivalence (BE) study in dogs using a generic preparation of amoxicillin-potassium clavulanate vs a commercially available reference preparation, both claiming to achieve plasma concentrations that allow a 12 h dosing interval after oral administration. The oral pharmacokinetic profiles of a single dose of each preparation were carried out in 12 adult mongrel dogs in a crossover model with a 10 day washout period at a dose of 12.5 mg/kg of trihydrate amoxicillin and potassium clavulanate as tablets. A composite determination of amoxicillin-potassium clavulanate concentration in each sample of plasma was carried out in triplicate, using a microbiological agar diffusion analysis. Pharmacokinetic analysis was carried out with a non-compartmental model. Statistical analysis of pharmacokinetic variables was carried out by ANOVA and Bonferroni t test, setting a P < 0.05. In accordance with international standards, it was found that the generic preparation failed to be bioequivalent, i.e: AUC0-∞ 9.08 ± 0.26 μg h/ml and Cmax 5.48 ± 0.19 μg/ml for the generic preparation vs AUC0-∞ 13.28 ± 0. 30 μg h/ml and Cmax 2.9 ± 0.17 μg/ml for the reference one. A 0.25 μg/ml breakpoint can be set as minimum effective plasma concentration for amoxicillin; hence the generic preparation requires a dose interval of eight h.

El objetivo de este trabajo fue determinar la bioequivalencia entre dos preparados comerciales de amoxicilina-ácido clavulánico disponibles en forma de tableta para uso oral en perros, y cuyo intervalo de dosificación indicado por los fabricantes es de 12 horas. Se calculó el perfil farmacocinético de cada preparado, a una dosis oral de 12.5 mg/kg de amoxicilina y ácido clavulánico en doce perros adultos mediante un modelo cruzado. Se determinó la concentración activa de la combinación de ambos fármacos en cada muestra de plasma, utilizando un método de análisis microbiológico por difusión en agar. El cálculo farmacocinético se llevó a cabo con un modelo no compartamental y los valores obtenidos se analizaron mediante un ANDEVA y prueba T de Bonferroni, con una P < 0.05. Tomando en cuenta las pautas internacionales, la formulación genérica resultó no ser bioequivalente a la de referencia. Esto es, se obtuvieron valores de AUC0-∞ 9.08 ± 0.26 μg h/ml y Cmax 5.48 ± 0.19 μg/ml para el genérico vs AUC0-∞ 13.28 ± 0. 30 μg h/ml y Cmax 2.9 ± 0.17 μg/ml para el de referencia. Si se considera un punto de inflexión para bacterias susceptibles, de 0.25 μg/ml, el preparado genérico requiere un intervalo de dosificación de ocho horas.