Suboptimal ciprofloxacin dosing as a potential cause of decreased Pseudomonas aeruginosa susceptibility in children with cystic fibrosis.

STUDY OBJECTIVE: To assess the probability of achieving ciprofloxacin pharmacodynamic targets with currently recommended dosages in order to investigate the risk of ciprofloxacin underexposure in children with cystic fibrosis. DESIGN: Pharmacodynamic analysis using Monte Carlo simulations of three previously published population pharmacokinetic models. SETTING: Pediatric hospital in Paris, France. PATIENTS: A total of 120 pediatric outpatients with cystic fibrosis followed over a 2-year period (2007-2008), whose ages and body weights were within the range of the values observed in the three published studies. MEASUREMENTS AND MAIN RESULTS: The ciprofloxacin dosage regimens used for the simulations were those currently recommended for the treatment of pulmonary infections caused by Pseudomonas aeruginosa susceptible to ciprofloxacin: 10 mg/kg 3 times/day intravenously and 20 mg/kg twice/day orally. Pharmacodynamic targets for ciprofloxacin were defined as a 24-hour area under the plasma concentration-time curve (AUC):minimum inhibitory concentration (MIC) ratio of less than 110 for resistance acquisition and greater than 125 for bacterial eradication. For a P. aeruginosa isolate with an MIC close to the clinical breakpoint, the probability of the AUC:MIC ratio to be less than 110 achieved values of 74-100%, depending on the model used, whereas the probability to achieve an AUC:MIC ratio greater than 125 decreased to 0-22%. CONCLUSION: These results provide a pharmacologic hypothesis-that the current dosing recommendations of ciprofloxacin for cystic fibrosis children may be suboptimal-to explain the decrease in the susceptibility of P. aeruginosa to ciprofloxacin observed in children with cystic fibrosis. These results need to be confirmed in prospective pharmacokinetic-pharmacodynamic studies performed in children with cystic fibrosis in order to determine whether higher doses, with or without therapeutic drug monitoring, or a lower clinical breakpoint could be considered in this population.

[Human toxicokinetic of hexobarbital after acute multi-drug intoxication]. / Etude de la toxicocinétique de l'hexobarbital après intoxication aiguë polymédicamenteuse.

A 33-year-old man was hospitalized unconscious on suspicion of acute diazepam and hexobarbital intoxication, a barbiturate not marketed in France. Its quantification was developed by gas chromatography coupled with mass spectrometry detection and validated on one-hundred microL of plasma extracted by a liquid/liquid method. Hexobarbital and diazepam concentrations in initial plasma samples were at toxic levels, respectively 15 900 ng/mL and 13 800 ng/mL. Hexobarbital toxicokinetic was studied during 175 h and analysed with a non-compartmental model. Half-life value of 61,8 h was found, being much longer than already published hexobarbital half-lives (between 3.2 h and 6.9 h). The reasons of this long half-life were discussed according to metabolism and pharmacogenetic.

[Treatment of peritoneal carcinomatosis with surgery and hyperthermic peroperative intraperitoneal chemotherapy (HIPEC): new aspects and validated indications]. / Traitement des carcinoses péritonéales par chirurgie et chimiothérapie hyperthermique intrapéritonéale peropératoire (Chip): des nouveautés mais aussi des indications validées.

Hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) is now an entire part of treatment of peritoneal dissemination of colorectal malignancy, and it's possible to hope prolonged survival. This treatment is more and more codified. Four indications are recognized by some tree national evaluation committees: the French ANAES, the British NICE and the Canadian CEPO: colorectal carcinoma, carcinoma of the appendix, pseudomyxoma peritonei and mesothelioma. Last big published series results show a decrease of morbidity and mortality and interest of using new drugs like oxaliplatine. Indications have to be more homogeneous and based on evidences.

Morphine and 6-acetylmorphine concentrations in blood, brain, spinal cord, bone marrow and bone after lethal acute or chronic diacetylmorphine administration to mice.

The aim of this study was to evaluate postmortem incorporation of opiates in bone and bone marrow after diacetylmorphine (heroin) administration to mice. Mice were given acute (lethal dose of 300 mg/kg) or chronic (10 and 20 mg/kg/24 h for 20 days) intraperitoneal administration of diacetylmorphine. The two metabolites of diacetylmorphine, 6-acetylmorphine (6-AM) and morphine, were extracted from whole blood, brain, spinal cord, bone marrow and bone (after hydrolysis) using a liquid/liquid method. Quantification was performed by gas chromatography-mass spectrometry (GC/MS). Results showed that after acute administration, opiates were present in all studied tissues. Morphine concentrations appeared to be higher than those of 6-AM in blood (52.4 microg/mL versus 27.7 microg/mL, n=12), bone marrow (87.8 ng/mg versus 8.9 ng/mg, n=6) and bone (0.85 ng/mg versus 0.43 ng/mg, n=6), but 6-AM concentrations were higher than those of morphine in brain (14.0 ng/mg versus 7.4 ng/mg, n=12) and spinal cord (27.8 ng/mg versus 20.8 ng/mg, n=12). No correlation was found for both compounds between blood concentrations and either brain, spinal cord, bone or bone marrow concentrations while a significant one was found between brain and spinal cord concentrations either for morphine (r=0.89, n=12, p<0.001) or 6-AM (r=0.93, n=12, p<0.001), the concentration being higher in spinal cord than in brain. When bones were stored for 2 months, only 6-AM remained in bone marrow but not in bone. After chronic administration, mice being sacrificed by cervical dislocation 24 h after the last injection, no opiate was detected in any studied tissues. Further studies are required, in particular in human bones, but these results seem to show that 6-AM could be detect in bone marrow several weeks after the death and could be an alternative tissue for forensic toxicologist to detect a fatal diacetylmorphine overdose, even if no correlation between blood and bone marrow was observed. On the other hand, neither bone tissue nor bone marrow will allow the confirmation of a chronic diacetylmorphine use.

A novel LC-ESI-MS-MS method for sensitive quantification of colchicine in human plasma: application to two case reports.

A novel method based upon liquid chromatography coupled to ion trap mass spectrometry (MS) detection with electrospray ionization interface has been developed for the identification and quantification of colchicine in plasma or whole blood. Colchicine was isolated from plasma using a liquid-liquid extraction with dichloromethane at pH 8.0 and embutramide as an internal standard, with satisfactory extraction recoveries. Solutes were separated on a 3-microm C18 Uptisphere (Interchim) column (150 x 2.0-mm i.d.) using acetonitrile/2 mM NH4COOH pH 3.8 buffer (50:50, v/v) as the mobile phase with a flow-rate of 200 microL/min. Data were collected either in full-scan MS mode at m/z 100-450 or in full-scan MS-MS mode, selecting the ion m/z 400.1 for colchicine and m/z 294.1 for embutramide. The most intense daughter ion of colchicine (m/z 358.1) and embutramide (m/z 207.9) were used for quantification. Retention times were 2.40 and 4.25 min for colchicine and embutramide, respectively. Calibration curves were linear in the 0.50-50 ng/mL range. The limits of detection and quantification were 0.05 ng/mL and 0.50 ng/mL, respectively. The intra- and interassay precisions were < 14%, and the intra- and interassay accuracies were in the 97-105.8% range at either 2 or 20 ng/mL. A fatal case of colchicine self-poisoning with a lethal blood concentration of 60 ng/mL and nonfatal case with a plasma sample collected very late (at least 36 h after the ingestion) are presented. The described method enables the unambiguous identification and quantification of colchicine with a very good sensitivity, using only 1 mL of sample.

Study of 18S rRNA and rDNA stability by real-time RT-PCR in heat-inactivated Cryptosporidium parvum oocysts.

The public health problem posed by Cryptosporidium parvum has led the water supply industry to develop analytical tools for detecting viable oocysts in water. In this study, we report on a TaqMan real-time reverse transcription-polymerase chain reaction (RT-PCR) method that targets and quantifies C. parvum 18S rRNA. To study the suitability of 18S rRNA as an indicator of Cryptosporidium oocyst viability, the stability of 18S rRNA and rDNA was monitored by real-time RT-PCR following various Cryptosporidium heat treatments. Decay of 18S rRNA was first observed after a 20-min treatment of C. parvum oocysts at 95 degrees C and was still detectable after 4 h. In contrast, rDNA was more heat resistant. The stability of 18S rRNA and rDNA was also studied after oocyst lysis by thermal shocks in the presence and absence of Chelex-100. In the former case, both rRNA and rDNA were degraded whereas in the presence of Chelex-100 both molecules were protected from heat degradation and were still detected after 4 h at 95 degrees C following thermal shocks. Our results indicate that 18S rRNA detection may not be directly associated with viability following heat inactivation of Cryptosporidium oocysts even if in all the experiments 18S rRNA was less stable than rDNA.

An immunomagnetic separation-reverse transcription polymerase chain reaction (IMS-RT-PCR) test for sensitive and rapid detection of viable waterborne Cryptosporidium parvum.

The public health problem posed by the waterborne parasite Cryptosporidium parvum incited the water supply industry to develop very accurate analytical tools able to assess the presence of viable oocysts in drinking water. In this study, we report the development of a viability assay for C. parvum oocysts based on immunomagnetic separation and reverse transcription polymerase chain reaction (IMS-RT-PCR). The detection limit of the IMS-RT-PCR assay, which targets the hsp70 heat shock-induced mRNA, was in the range of ten viable oocysts per 100-l tap water samples. Purified Cryptosporidium parvum oocysts were exposed to heating, freezing and three chemical disinfection treatments namely, chlorination, chlorine dioxide treatment and ozonation under conventional doses used in water treatment plants, then detected by IMS-PCR and IMS-RT-PCR. The results obtained by IMS-PCR showed that none of the treatments had an effect on oocyst detection. The inactivation of oocysts by boiling resulted in no RT-PCR signal. Chlorine as well as chlorine dioxide did not influence oocyst viability as determined by IMS-RT-PCR. Ozone more effectively inactivated oocysts. The IMS-RT-PCR assay in conjunction with IMS-PCR marks the development of a combined detection and viability test which can be used for drinking water quality control as well as for reliable evaluation of treatment efficiency.

An immunomagnetic separation-real-time PCR method for quantification of Cryptosporidium parvum in water samples.

The protozoan parasite Cryptosporidium parvum is known to occur widely in both raw and drinking water and is the cause of waterborne outbreaks of gastroenteritis throughout the world. The routinely used method for the detection of Cryptosporidium oocysts in water is based on an immunofluorescence assay (IFA). It is both time-consuming and nonspecific for the human pathogenic species C. parvum. We have developed a TaqMan polymerase chain reaction (PCR) test that accurately quantifies C. parvum oocysts in treated and untreated water samples. The protocol consisted of the following successive steps: Envirochek capsule filtration, immunomagnetic separation (IMS), thermal lysis followed by DNA purification using Nanosep centrifugal devices and, finally, real-time PCR using fluorescent TaqMan technology. Quantification was accomplished by comparing the fluorescence signals obtained from test samples with those from standard dilutions of C. parvum oocysts. This IMS-real-time PCR assay permits rapid and reliable quantification over six orders of magnitude, with a detection limit of five oocysts for purified oocyst solutions and eight oocysts for spiked water samples. Replicate samples of spiked tap water and Seine River water samples (with approximately 78 and 775 oocysts) were tested. C. parvum oocyst recoveries, which ranged from 47.4% to 99% and from 39.1% to 68.3%, respectively, were significantly higher and less variable than those reported using the traditional US Environmental Protection Agency (USEPA) method 1622. This new molecular method offers a rapid, sensitive and specific alternative for C. parvum oocyst quantification in water.

Development of a TaqMan quantitative PCR assay specific for Cryptosporidium parvum.

A rapid detection method that is both quantitative and specific for the water-borne human parasite Cryptosporidium parvum is reported. Real-time polymerase chain reaction (PCR) combined with fluorescent TaqMan technology was used to develop this sensitive and accurate assay. The selected primer-probe set identified a 138-bp section specific to a C. parvum genomic DNA sequence. The method was optimized on a cloned section of the target DNA sequence, then evaluated on C. parvum oocyst dilutions. Quantification was accomplished by comparing the fluorescence signals obtained from test samples of C. parvum oocysts with those obtained from standard dilutions of C. parvum oocysts. This real-time PCR assay allowed reliable quantification of C. parvum oocysts over six orders of magnitude with a baseline sensitivity of six oocysts in 2 h.