Concentration-Dependent Enrichment of Linezolid-Resistant Staphylococcus aureus in an in vitro Dynamic Model.

To establish the relationships between the enrichment of resistant Staphylococcus aureus mutants and the ratio of daily area under the concentration - time curve (AUC24) to the MIC of linezolid, a mixed inoculum of linezolid-susceptible and -resistant cells of three strains of S.aureus was exposed to twice daily linezolid in an in vitro dynamic model. Simulated pharmacokinetic profiles mimicked five-day treatments with linezolid dosing over a 32-fold range of the AUC24/MIC ratio. Population analysis of linezolid-exposed staphylococci was performed daily over 120 h after the start of the treatments. Minor if any enrichment of mutants resistant to 2X, 4X and 8XMIC of antibiotic was observed at the lowest and the highest AUC24/MIC ratios in contrast to pro- nounced enrichment of resistant mutants at the intermediate AUC24/MICs. An integral parameter AUBCm, the area under the time course of resistance mutants, was shown to be a more appropriate endpoint to establish AUC24/MIC relationships with resistance than postexposure number of mutants (NM).

[PK/PD Modeling as a Tool for Predicting Bacterial Resistance to Antibiotics: Alternative Analyses of Experimental Data].

Postexposure number of mutants (NM) is a conventional endpoint in bacterial resistance studies using in vitro dynamic models that simulate antibiotic pharmacokinetics. To compare NM with a recently introduced integral parameter AUBC(M), the area under the time course of resistance mutants, the enrichment of resistant Staphylococcus aureus was studied in vitro by simulation of mono(daptomycin, doxycycline) and combined treatments (daptomycin + rifampicin, rifampicin + linezolid). Differences in the time courses of resistant S. aureus could be reflected by AUBC(M) but not N(M). Moreover, unlike AUBC(M), N(M) did not reflect the pronounced differences in the time courses of S. aureus mutants resistant to 2x, 4x, 8x and 16xMIC of doxycycline and rifampicin. The findings suggested that AUBC(M) was a more appropriate endpoint of the amplification of resistant mutants than N(M).

The antistaphylococcal pharmacodynamics of linezolid alone and in combination with doxycycline in an in vitro dynamic model.

To delineate the possible advantages of linezolid/doxycycline combinations over either drug alone, the in vitro pharmacodynamics of linezolid, doxycycline and linezolid plus doxycycline were studied with Staphylococcus aureus.S. aureus ATCC 43300 and a clinical isolate S. aureus 479 were exposed to twice-daily linezolid and once-daily doxycycline, alone and in combination, for five consecutive days. Three dosing regimens were simulated with each drug alone: linezolid (AUC(24)/MIC 30, 60 and 200 h-L30, L60 and L200, respectively) and doxycycline (AUC(24)/MIC 90, 180 and 520 h - D90, D180 and D520, respectively) and in combination: linezolid plus doxycycline (L30+D90; L60+D180 and L200+D520).With both S. aureus ATCC 43300 and S. aureus 479 exposed to linezolid or doxycycline, the area between the line crossing each time-kill curve at the level of 10(8) CFU/mL and the respective time-kill curve (I(E)) increased with increasing simulated AUC(24)/MIC ratios. Each of the combined treatments produced greater I(E)s than the sum of linezolid and doxycycline I(E)s observed in the respective single drug treatments.This study suggests that linezolid combinations with doxycycline may be synergistic in treating staphylococcal infections.