It is very common to use Chinese medicine (CM) combined with Western medicine (WM) in clinical practice. The appropriate combination of CM with WM can reduce toxicity and enhance effects in order to make the best use of advantages and bypass the disadvantages. However, an inappropriate combination can not only affect the curative effect but even cause death. Therefore, strengthening the complementary advantages of the CM and WM to improve the therapeutic efficacy and reduce side effects has become an important research topic of clinical medicine and pharmacy. Many researchers try to clarify the effects of combining CM with WM on therapeutic efficacy and absorption, distribution, metabolism and excretion by pharmacodynamics and pharmacokinetics studies, providing evidence for clinical application. This review focuses on the new developments in the pharmacodynamics and pharmacokinetics of the combination of CM with WM in order to give references for clinical treatment.
Anti-Bacterial Agents ; pharmacology ; Blood Circulation ; drug effects ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; pharmacokinetics ; pharmacology ; Humans ; Medicine, Chinese Traditional

BACKGROUNDThe antibiotic meropenem is commonly administered in patients with severe sepsis and septic shock. We compared the pharmacokinetic, clinical, and bacteriological efficacies of continuous infusion of meropenem versus intermittent administration in such patients.

METHODSPatients admitted to the Intensive Care Unit (ICU) with severe sepsis or septic shock who received meropenem were randomly assigned to either the continuous (n = 25) or intermittent groups (n = 25). The continuous group received a loading dose of 0.5 g of meropenem followed by a continuous infusion of 3 g/day; the intermittent group received an initial dose of 1.5 g followed by 1 g for every 8 h. Clinical success, microbiological eradication, superinfection, ICU mortality, length of ICU stay, and duration of meropenem treatment were assessed. Serial plasma meropenem concentrations for the first and third dosing periods (steady state) were also measured.

RESULTSClinical success was similar in both the continuous (64%) and intermittent (56%) groups (P = 0.564); the rates of microbiological eradication and superinfection (81.8% vs. 66.7% [ P = 0.255] and 4% vs. 16% [ P = 0.157], respectively) showed improvement in the continuous group. The duration of meropenem treatment was significantly shorter in the continuous group (7.6 vs. 9.4 days; P= 0.035), where a better steady-state concentration was also achieved. Peak and trough concentrations were significantly different between the continuous and intermittent groups both in the first (Cmax: 19.8 mg/L vs. 51.8 mg/L, P= 0.000; Cmin: 11.2 mg/L vs. 0.5 mg/L, P= 0.000) and third dosing periods (Cmax: 12.5 mg/L vs. 46.4 mg/L, P= 0.000; Cmin: 11.4 mg/L vs. 0.6 mg/L, P= 0.000). For medium-susceptibility pathogens, continuous infusion concentrations above the minimal inhibitory concentration were 100%, which was better than that in the intermittent group.

CONCLUSIONSContinuous infusion of meropenem provides significantly shorter treatment duration and a tendency for superior bacteriological efficacy than intermittent administration. Continuous infusion may be more optimal against intermediate-susceptibility pathogens.

Aged ; Aged, 80 and over ; Anti-Bacterial Agents ; pharmacokinetics ; therapeutic use ; Female ; Humans ; Intensive Care Units ; statistics & numerical data ; Male ; Middle Aged ; Pilot Projects ; Prospective Studies ; Sepsis ; blood ; drug therapy ; Shock, Septic ; blood ; drug therapy ; Thienamycins ; pharmacokinetics ; therapeutic use

A study of amoxicillin pharmacokinetics was conducted in healthy goats and goats with chronic lead intoxication. The intoxicated goats had increased serum concentrations of liver enzymes (alanine aminotransferase and gamma-glutamyl transferase), blood urea nitrogen, and reactivated delta-aminolevulinic acid dehydratase compared to the controls. Following intravenous amoxicillin (10 mg/kg bw) in control and lead-intoxicated goats, elimination half-lives were 4.14 and 1.26 h, respectively. The volumes of distribution based on the terminal phase were 1.19 and 0.38 L/kg, respectively, and those at steady-state were 0.54 and 0.18 L/kg, respectively. After intramuscular (IM) amoxicillin (10 mg/kg bw) in lead-intoxicated goats and control animals, the absorption, distribution, and elimination of the drug were more rapid in lead-intoxicated goats than the controls. Peak serum concentrations of 21.89 and 12.19 microg/mL were achieved at 1 h and 2 h, respectively, in lead-intoxicated and control goats. Amoxicillin bioavailability in the lead-intoxicated goats decreased 20% compared to the controls. After amoxicillin, more of the drug was excreted in the urine from lead-intoxicated goats than the controls. Our results suggested that lead intoxication in goats increases the rate of amoxicillin absorption after IM administration and distribution and elimination. Thus, lead intoxication may impair the therapeutic effectiveness of amoxicillin.
Amoxicillin/blood/*pharmacokinetics/urine ; Animals ; Anti-Bacterial Agents/blood/*pharmacokinetics/urine ; Area Under Curve ; Chromatography, High Pressure Liquid/veterinary ; Goat Diseases/*chemically induced/metabolism ; Goats ; Half-Life ; Injections, Intramuscular/veterinary ; Injections, Intravenous/veterinary ; Lead Poisoning/etiology/metabolism/*veterinary ; Male

We developed a population pharmacokinetic model of vancomycin by integrating the effects of cystatin C and other demographic factors in a large population of Korean patients with normal serum creatinine concentrations to elucidate the precise role of serum cystatin C concentrations in the prediction of vancomycin clearance. A population pharmacokinetic model of vancomycin was developed using NONMEM software from a total of 1,373 vancomycin concentration measurements in 678 patients whose serum creatinine concentrations were lower than 1.2 mg/dL. Covariate selection revealed that cystatin C was the most influential factor and had negative influence (-0.78) in the relationship. Total body weight, sex, age, and serum creatinine were also significantly correlated with the clearance. The estimated intersubject variabilities of clearance and volume of distribution were 24.7% and 25.1%, respectively. A 14-fold difference in predicted trough concentrations was observed according to only cystatin C concentrations in a population of simulated individuals with median demographic characteristics. The use of serum cystatin C as marker of vancomycin clearance for more accurate predictions of serum vancomycin concentrations could be useful, particularly among patients with normal serum creatinine concentrations.
Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/blood/*pharmacokinetics ; Biological Markers/blood ; Body Weight ; Creatinine/*blood ; Cystatin C/*blood ; Demography ; Female ; Humans ; Male ; Middle Aged ; Models, Statistical ; Sex Factors ; *Software ; Vancomycin/blood/*pharmacokinetics ; Young Adult

The present study aimed to investigate the pharmacokinetic variation of ofloxacin based on gender-related difference in the expression of multidrug resistance-associated protein (Abcc2/Mrp2) in rat kidney. The concentrations of ofloxacin in rat plasma and urine were determined after tail vein administration (30 mg x kg(-1)) by high-performance liquid chromatography (HPLC) method. Expression of Mrp2 in kidney of male and female rats was qualitatively and quantitatively detected by immunohistochemistry and flow cytometry, separately. The results showed that AUC value of ofloxacin was lower in male rats than that in female rats and the total amount of ofloxacin excreted in the urine was higher in male rats than that in female rats. And the expression of Mrp2 in male rat kidney was higher than that in female rats. All results suggested that gender-related differences in pharmacokinetics of ofloxacin may be attributed to the differences in the expression of Mrp2 in kidney of male and female rats.
ATP-Binding Cassette Transporters ; metabolism ; Animals ; Anti-Bacterial Agents ; blood ; pharmacokinetics ; urine ; Area Under Curve ; Female ; Kidney ; metabolism ; Male ; Ofloxacin ; blood ; pharmacokinetics ; urine ; Rats ; Rats, Wistar ; Sex Characteristics

BACKGROUNDA new fluroquinolone antibacterial agent, antofloxacin hydrochloride, developed in China, is an 8-NH(2) derivant of levofloxacin. The purpose of the study was to evaluate the pharmacokinetic characteristics of single and multiple oral doses of antofloxacin hydrochloride in Chinese healthy male volunteers.

METHODSAn open-label, non-randomized, single and multiple dose clinical trial was conducted. In single dose study, 12 subjects took 200 mg antofloxacin hydrochloride. In multiple dose study, 12 subjects took antofloxacin hydrochloride 400 mg once on day 1 and 200 mg once daily from day 2 to day 7. HPLC was used to assay the serum and urinary concentrations of antofloxacin.

RESULTSIn single dose study, the maximum concentration of drug in serum (C(max)), the time to reach C(max) (T(max)), and the area under the serum concentration-time curve (AUC (0-∞)) of antofloxacin were (1.89 ± 0.65) mg/L, (1.29 ± 0.26) hours, and (25.24 ± 7.26) mg×h(-1)×L(-1), respectively. Accumulating elimination rate of antoflocaxin from urine within 120 hours was 39.1%. In multiple dose study, blood concentration of antofloxiacin achieved stable state on day 2 after dosing. The minimum concentration drug in serum (C(min)), AUCss, mean concentration of drug in serum (C(av)), and degree of fluctuation (DF) were (0.73 ± 0.18) mg/L, (47.59 ± 7.85) mg×h(-1)×L(-1), (1.98 ± 0.33) mg/L, and 1.74 ± 0.60, respectively. On day 7 after dosing, T(max), C(max), and AUC (0-∞) was (1.14 ± 0.50) hours, (2.52 ± 0.38) mg/L, and (48.77 ± 8.44) mg×h(-1)×L(-1), respectively. Accumulating elimination rate of antofloxaxin from urine within 120 hours after the last dosing was 60.06%.

CONCLUSIONSThe regimen of 400 mg loading dose given on the first treatment day and then 200 mg dose once daily results in satisfactory serum drug concentration.

Administration, Oral ; Adolescent ; Adult ; Anti-Bacterial Agents ; administration & dosage ; blood ; pharmacokinetics ; urine ; Chromatography, High Pressure Liquid ; Humans ; Levofloxacin ; Male ; Ofloxacin ; administration & dosage ; analogs & derivatives ; blood ; pharmacokinetics ; urine ; Young Adult

The rat single-pass intestinal perfusion model was applied to study the effect of CYP3A and P-glycoprotein on the absorption of buagafuran in lumen of rats. Buagafuran concentrations in intestinal perfusate and blood in vena mesenterica collected at different time points after perfusion were determined by GC-MS. Permeability coefficient of buagafuran was calculated by the equation [P(lumen) = -(Q/2pirl)Ln(C(out)/C(in)) and P(blood) = (deltaM(B)/deltat)/(2pirl)]. The effects of troleandomycin (TAO, CYP3A inhibitor), cyclosporin A (CYP3A/p-glycoprotein inhibitor) on the absorption of buagafuran in lumen were observed. After rat single-pass intestinal perfusion, the cumulative amount of buagafuran in mesenteric vein of rat was 73.4, 82.9, and 98.3 pmol x cm(-2) and were increased 3.9, 4.6, and 5.6 fold by addition of inhibitor of P-gp (LSN335984), CYP3A (TAO) or P-gp and CYP3A (CsA), respectively. Moreover, the metabolized fraction of buagafuran was decreased by 12%, 11% and 21% with inhibitors. The results suggested that the poor bioavailability of buagafuran was mostly due to the interplay of P-gp and CYP3A on the absorption, transport and metabolism of buagafuran in intestine of rats.
ATP-Binding Cassette, Sub-Family B, Member 1 ; antagonists & inhibitors ; metabolism ; Animals ; Anti-Bacterial Agents ; pharmacology ; Biological Availability ; Cyclosporine ; pharmacology ; Cytochrome P-450 CYP3A ; metabolism ; Cytochrome P-450 CYP3A Inhibitors ; Intestinal Absorption ; drug effects ; Male ; Mesenteric Veins ; metabolism ; Perfusion ; Permeability ; Rats ; Rats, Sprague-Dawley ; Sesquiterpenes ; blood ; chemistry ; pharmacokinetics ; Troleandomycin ; pharmacology

OBJECTIVETo investigate the distribution of ornidazole in the salivary and serum of healthy adults and explore the feasibility of monitoring serum drug concentration with salivary.

METHODSSix volunteers received a single dose of 0.6 g ornidazole via intravenous infusion. The concentrations of ornidazole in the saliva and serum were assayed by high-performance liquid chomatography, and the correlation of the drug concentrations in saliva to that in serum was analyzed.

RESULTSThe concentration of ornidazole in the saliva was strongly associated with that in the serum (r = 0.825-0.969), and the ratio of saliva-to-serum concentration (S/P) of ornidazole was 0.99 ± 0.13.

CONCLUSIONDetection of saliva ornidazole concentration is feasible for monitoring the therapeutic concentration of ornidazole.

Adult ; Anti-Bacterial Agents ; blood ; pharmacokinetics ; Chromatography, High Pressure Liquid ; Feasibility Studies ; Female ; Humans ; Male ; Ornidazole ; analysis ; blood ; pharmacokinetics ; Saliva ; metabolism ; Young Adult

The pharmacokinetics of orally administered pefloxacin were studied to evaluate the bio-enhancing effect of the herbal bio-enhancer, trikatu, in mountain Gaddi goats (n = 6). The findings of the study revealed a decreased plasma concentration (p > 0.05) of pefloxacin following trikatu administration during the absorption phase (10, 15, 20 min post pefloxacin administration). In contrast, the plasma concentrations of pefloxacin were significantly higher at 4, 6, 8 and 12 h (during the elimination phase) of the pefloxacin administration. The findings of the investigation revealed higher values for the area under the curve, the area under the first moment of the plasma drug concentration time curve, the mean residential time, the total duration of pharmacological action and bioavailability. Trikatu treatment, however, significantly reduced the elimination half life (t(1/2beta)) and zero time intercept of the elimination phase. The apparent volume of distribution based on the total area under the plasma drug concentration curve [(Vd((area))] and the apparent volume of distribution based on the zero time plasma concentration intercept of the elimination phase [Vd((B))] were significantly higher in trikatu treated animals indicating a better penetration of the drug. Based on the MIC of 0.8 microgram/ml of pefloxacin, a priming dose of 6.0 mg/kg and a maintenance dose of 2.21 mg/kg is required to be administered at 8 h intervals. For practical purposes in goats this would mean a priming dose of 6 mg/kg and a maintenance dose of 2 mg/kg given by the oral route, to be repeated at 8 h intervals.
Administration, Oral ; Animals ; Anti-Bacterial Agents/*administration & dosage/blood/*pharmacokinetics ; Biological Availability ; Cross-Over Studies ; Ginger ; Goats/*metabolism ; Herb-Drug Interactions ; Pefloxacin/*administration & dosage/blood/*pharmacokinetics ; Phytotherapy/*veterinary ; Piper ; Piper nigrum ; Plant Extracts/*pharmacology

OBJECTIVETo establish the rat model of chronic bacterial prostatitis and investigate the penetrability of amikacin to chronic inflammatory prostatic tissues.

METHODSA total of 180 male rats were randomly divided into a normal control group (NC, n=48), a chronic bacterial prostatitis group (CBP, n = 84) and a CBP treatment group (CBPT, n = 48). The prostates of the animals were injected with Xiaozhiling and E. coli respectively to make CBP and CBPT models. The animals of the CBPT group were treated with amikacin by intramuscular injection, their prostate tissues and sera isolated at 1-150 min after the treatment and detected for antibiotic activities, bacteria counts and pathological changes.

RESULTSObvious chronic inflammatory pathological changes including leukocyte invasion and fibre hyperplasia were observed and E. coli isolated from the prostate tissues of the rats in the CBP and CBPT groups, but no pathological changes, antibiotic activity and bacteria were detected in the the NC group. The numbers of E. coli in the prostate tissues markedly decreased with the time in the two model groups, 30 CFU/mg in the CBP rats at 28 days and 0 CFU/mg in the CBPT group at 10 days after the treatment. Obvious antibiotic activities were found in both the prostate tissues and sera at 2-150 min after the injection. No antimicrobial activities were detected at 12 hours after the treatment either in the sera or in the prostate samples. With the increase of the treatment time and decrease of the bacteria counts, the chronic inflammatory pathological changes were obviously alleviated in the CBPT group.

CONCLUSIONRat models of CBP with chronic inflammatory pathological changes can be successfully established by direct injection of Xiaozhiling and E. coli into the prostate. Amikacin, given by intramuscular injection, can penetrate into the prostate of the CBP rat and produce an antibiotic activity equal to or higher than that of the sera, which may kill sensitive bacteria in the prostate and help to reduce the inflammatory pathological changes and repair the damage to the prostate tissues.

Amikacin ; blood ; pharmacokinetics ; therapeutic use ; Animals ; Anti-Bacterial Agents ; administration & dosage ; pharmacokinetics ; therapeutic use ; Disease Models, Animal ; Escherichia coli ; drug effects ; Injections, Intramuscular ; Male ; Prostate ; drug effects ; metabolism ; microbiology ; Prostatitis ; drug therapy ; metabolism ; microbiology ; Random Allocation ; Rats ; Rats, Sprague-Dawley