Firsov Alexander A, Smirnova Maria V, Strukova Elena N, Vostrov Sergey N, Portnoy Yury A, Zinner Stephen H
Department of Pharmacokinetics & Pharmacodynamics, Gause Institute of New Antibiotics, Russian Academy of Medical Sciences, 11 Bolshaya Pirogovskaya Street, Moscow 119021, Russia.
Int J Antimicrob Agents. 2008 Dec;32(6):488-93. doi: 10.1016/j.ijantimicag.2008.06.031. Epub 2008 Sep 14.
Enrichment of resistant mutants at antibiotic concentrations above the minimum inhibitory concentration (MIC) but below the mutant prevention concentration (MPC), i.e. within the mutant selection window (MSW), might be dependent on the shape of the pharmacokinetic profile. To address this issue, two strains of Staphylococcus aureus were exposed to fluctuating (bolus administration) and constant (continuous infusion) concentrations of ciprofloxacin. Staphylococcus aureus ATCC 43300 and ATCC 6538 exhibiting different MPC/MIC ratios (4 and 16, respectively) were exposed to ciprofloxacin twice daily by bolus administration and continuous infusion for 3 days. With each organism and mode of administration, a series of pharmacokinetic profiles was simulated to have the same 24-h area under the concentration-time curve (AUC24) to MIC ratio. The simulated AUC24/MIC ratios were designed to provide ciprofloxacin concentrations within the MSW over most of the dosing interval (bolus administration) or over the entire dosing interval (continuous infusion). In all simulations, ciprofloxacin-resistant staphylococci were enriched in a concentration-dependent manner, i.e. the higher the AUC24/MIC, the later the onset of mutant selection and the smaller the area under the bacterial mutant curve (AUBC M). The relationships between AUC24/MIC and AUBC M were independent of the shape of the simulated pharmacokinetic profiles that corresponded to the different modes of ciprofloxacin administration. For mutants resistant to > or = 4 x MIC of ciprofloxacin, the AUC24/MIC was less predictive of the AUBC M than the AUC24/MPC ratio. This study indicates the mode of ciprofloxacin administration does not influence selection of resistant staphylococci, which is better predicted by AUC24/MPC than by AUC24/MIC.
在高于最低抑菌浓度(MIC)但低于突变预防浓度(MPC),即处于突变选择窗(MSW)内的抗生素浓度下,耐药突变体的富集可能取决于药代动力学曲线的形状。为解决这一问题,将两株金黄色葡萄球菌暴露于环丙沙星的波动浓度(推注给药)和恒定浓度(持续输注)下。对最低抑菌浓度/最低杀菌浓度比值不同(分别为4和16)的金黄色葡萄球菌ATCC 43300和ATCC 6538,通过推注给药和持续输注每天两次暴露于环丙沙星中,持续3天。对于每种菌株和给药方式,模拟了一系列药代动力学曲线,使其24小时浓度-时间曲线下面积(AUC24)与MIC的比值相同。模拟的AUC24/MIC比值设计为在大多数给药间隔(推注给药)或整个给药间隔(持续输注)内提供处于MSW内的环丙沙星浓度。在所有模拟中,耐环丙沙星的葡萄球菌以浓度依赖性方式富集,即AUC24/MIC越高,突变选择开始越晚,细菌突变曲线下面积(AUBC M)越小。AUC24/MIC与AUBC M之间的关系与对应于不同环丙沙星给药方式的模拟药代动力学曲线的形状无关。对于对环丙沙星耐药≥4×MIC的突变体,AUC24/MIC对AUBC M的预测性低于AUC24/MPC比值。本研究表明,环丙沙星的给药方式不影响耐药葡萄球菌的选择,AUC24/MPC比AUC24/MIC能更好地预测这一情况。