Ocular surface distribution and pharmacokinetics of a novel ophthalmic 1% azithromycin formulation.

PURPOSE: To investigate the ocular distribution of 1% azithromycin ophthalmic solution and the effect of polycarbophil-based mucoadhesive formulation on ocular tissue levels of azithromycin after single and multiple topical administrations in the rabbit eye. METHODS: Rabbits were treated with either a single administration of 1% azithromycin solution with or without polycarbophil, or with multiple administrations of 1% azithromycin solution in polycarbophil. Drug concentrations were measured using LC/MS/MS. Conjunctiva, cornea, aqueous humor, and tear samples were analyzed over a period of 144 h after a single administration of azithromycin with or without polycarbophil. Eyelid, conjunctiva, cornea, aqueous humor, and tear samples were collected over a period of 288 h during and after multiple administrations of azithromycin. RESULTS: Azithromycin was rapidly absorbed and distributed in the ocular tissues, reaching within 5 min, concentrations of 10,539 microg/mL in tear film, 108 microg/g in conjunctiva, and 40 microg/g in the cornea. The drug demonstrated tissue-specific half-lives of 15, 63, and 67 h, respectively. Following multiple administrations, the drug gradually accumulated. The polycarbophil formulation increased the bioavailability of the drug, producing peak concentrations that were between 5- and 12-fold higher than those without polycarbophil. Azithromycin also distributed rapidly in the eyelids, reaching peak concentrations of 180 mug/g at the end of the 7-day treatment, and was eliminated with a half-life of 125 h. Six days after treatment was discontinued, eyelid levels of azithromycin were above 40 microg/g. CONCLUSIONS: Sustained and high concentrations were encountered with 7-day approved administration of 1% azithromycin formulation (AzaSite, Inspire Pharmaceuticals, Inc., Durham, NC) within all ocular surface tissues, particularly the lids. Many ocular surface disorders involving the tear film, eyelids, and adnexal structures are associated with chronic, low-grade bacterial infection and may potentially lead to decreased vision secondary to corneal scarring. Various topical antibiotic and steroid combinations with or without oral tetracyclines are commonly used with variable clinical response and known potential side effects. The clinical relevance of this study is unknown; however, the long-lasting antibacterial and additional anti-inflammatory properties of topical azithromycin might offer an effective alternative treatment option and should be explored further in clinical studies.

Ocular pharmacokinetic study following single and multiple azithromycin administrations in pigmented rabbits.

PURPOSE: The aim of this study was to investigate whether the ocular pharmacokinetic parameters observed following systemic administration are also seen following topical administration. METHODS: Azithromycin concentrations were measured by HPLC-MS in pigmented rabbits' tears, cornea, bulbar conjunctiva, and aqueous humor following single instillation and twice-daily instillations for three consecutive days of topical 1.50% azithromycin dihydrate solution. RESULTS: Following a single administration, azithromycin levels were higher than the MIC 4 microg/g breakpoint for susceptible germs for at least 4 hr in tears, 1 hr in conjunctiva, and 1 hr in cornea after instillation. Following multiple administrations, azithromycin levels were higher than the MIC 4 microg/g for at least 16 hr in tears, 24 hr in conjunctivae, and 1 week in cornea after the last instillation. CONCLUSIONS: Both dosage regimens resulted in adequate and long-lasting azithromycin levels in the conjunctiva, the ocular target tissue relative to the expected therapeutic indication in man (bacterial conjunctivitis), and also in the cornea and tears.