Pharmacokinetics of sequential doses of capreomycin powder for inhalation in guinea pigs.

The global control of tuberculosis (TB) is at risk by the spread of multidrug-resistant TB (MDR TB). Treatment of MDR TB is lengthy and involves injected drugs, such as capreomycin, that have severe side effects. It was previously reported that a single daily dose of inhaled capreomycin had a positive effect on the bacterial burden of TB-infected guinea pigs. The modest effect observed was possibly due to a dose that resulted in insufficient time of exposure to therapeutic systemic and local levels of the drug. In order to determine the length of time that systemic and local drug concentrations are above therapeutic levels during the treatment period, the present study investigated the disposition of capreomycin powders after sequential pulmonary administration of doses of 20 mg/kg of body weight. Capreomycin concentrations in bronchoalveolar lavage fluid and lung tissue of animals receiving a series of one, two, or three doses of capreomycin inhalable powder were significantly higher (50- to 100-fold) at all time points than plasma concentrations at the same time points or those observed in animals receiving capreomycin solution by intramuscular (i.m.) injection (10- to 100-fold higher). Notably, at the end of each dosing period, capreomycin concentrations in the lungs were approximately 100-fold higher than those in plasma and severalfold higher than the MIC, suggesting that sufficient capreomycin remains in the lung environment to kill Mycobacterium tuberculosis. No accumulation of capreomycin powder was detected in the lungs after 3 pulmonary doses. These results indicate that the systemic disposition of capreomycin after inhalation is the same as when injected i.m. with the advantage that higher drug concentrations are present at all times in the lungs, the primary site of infection.

Preparation and in vivo evaluation of a dry powder for inhalation of capreomycin.

PURPOSE: To develop an aerosol system for efficient local lung delivery of a tuberculostatic drug. METHODS: The antibiotic, capreomycin sulfate, was spray dried to form a dry powder aerosol. The chemical content and physical properties of resulting particles were assessed under various storage conditions. Plasma concentrations of capreomycin after insufflation into guinea pigs were evaluated at three doses, and compared to IV and IM administration of a capreomycin solution. RESULTS: Dry powder aerosols containing capreomycin were formulated to enable efficient delivery of large drug masses to the lungs of guinea pigs. Aerosols loaded with 73% CS were shown to possess good aerosolization properties and physical-chemical stability for up to 3 months at room temperature. Upon insufflation into guinea pigs, the amount of CS reaching the bloodstream was significantly lower compared to IV or IM administration, but resulted in a significantly longer drug half-life. CONCLUSIONS: The results indicate that large doses of capreomycin in dry powder form can be efficiently delivered to the lungs of guinea pigs, which may result in high local drug exposure but significantly reduced systemic exposure as suggested by plasma concentrations in the present studies. These systems have considerable potential to provide more effective therapy for MDR-TB.