scholarly journals Effect of Coadministered Fat on the Tolerability, Safety, and Pharmacokinetic Properties of Dihydroartemisinin-Piperaquine in Papua New Guinean Children with Uncomplicated Malaria

2014 ◽  
Vol 58 (10) ◽  
pp. 5784-5794 ◽  
Author(s):  
B. R. Moore ◽  
J. M. Benjamin ◽  
S. Salman ◽  
S. Griffin ◽  
E. Ginny ◽  
...  

ABSTRACTCoadministration of dihydroartemisinin-piperaquine (DHA-PQ) with fat may improve bioavailability and antimalarial efficacy, but it might also increase toxicity. There have been no studies of these potential effects in the pediatric age group. The tolerability, safety, efficacy, and pharmacokinetics of DHA-PQ administered with or without 8.5 g fat were investigated in 30 Papua New Guinean children aged 5 to 10 years diagnosed with uncomplicated falciparum malaria. Three daily 2.5:11.5-mg-base/kg doses were given with water (n= 14, group A) or milk (n= 16, group B), with regular clinical/laboratory assessment and blood sampling over 42 days. Plasma PQ was assayed by high-performance liquid chromatography with UV detection, and DHA was assayed using liquid chromatography-mass spectrometry. Compartmental pharmacokinetic models for PQ and DHA were developed using a population-based approach. DHA-PQ was generally well tolerated, and initial fever and parasite clearance were prompt. There were no differences in the areas under the concentration-time curve (AUC0–∞) for PQ (median, 41,906 versus 36,752 μg · h/liter in groups A and B, respectively;P= 0.24) or DHA (4,047 versus 4,190 μg · h/liter;P= 0.67). There were also no significant between-group differences in prolongation of the corrected electrocardiographic QT interval (QTc) initially during follow-up, but the QTctended to be higher in group B children at 24 h (mean ± standard deviation [SD], 15 ± 10 versus 6 ± 15 ms0.5in group A,P= 0.067) and 168 h (10 ± 18 versus 1 ± 23 ms0.5,P= 0.24) when plasma PQ concentrations were relatively low. A small amount of fat does not change the bioavailability of DHA-PQ in children, but a delayed persistent effect on ventricular repolarization cannot be excluded.

2015 ◽  
Vol 59 (7) ◽  
pp. 4260-4271 ◽  
Author(s):  
John M. Benjamin ◽  
Brioni R. Moore ◽  
Sam Salman ◽  
Madhu Page-Sharp ◽  
Somoyang Tawat ◽  
...  

ABSTRACTThe tolerability, safety, and disposition of dihydroartemisinin (DHA) and piperaquine (PQ) were assessed in 32 pregnant (second/third trimester) and 33 nonpregnant Papua New Guinean women randomized to adult treatment courses of DHA-PQ (three daily doses) or sulfadoxine-pyrimethamine (SP)-PQ (three daily PQ doses, single dose of SP). All dose adminstrations were observed, and subjects fasted for 2 h postdose. Plasma PQ was assayed by using high-performance liquid chromatography, and DHA was assessed by using liquid chromatography-mass spectrometry. Compartmental pharmacokinetic models were developed using a population-based approach. Both regimens were well tolerated. There was an expected increase in the rate-corrected electrocardiographic QT interval which was independent of pregnancy and treatment. Two pregnant and two nonpregnant women hadPlasmodium falciparumparasitemia which cleared within 48 h, and no other subject became slide positive for malaria during 42 days of follow-up. Of 30 pregnant women followed to delivery, 27 (90%) delivered healthy babies and 3 (10%) had stillbirths; these obstetric outcomes are consistent with those in the general population. The area under the plasma PQ concentration-time curve (AUC0–∞) was lower in the pregnant patients (median [interquartile range], 23,721 μg · h/liter [21,481 to 27,951 μg · h/liter] versus 35,644 μg · h/liter [29,546 to 39,541 μg · h/liter];P< 0.001) in association with a greater clearance relative to bioavailability (73.5 liters/h [69.4 to 78.4] versus 53.8 liters/h [49.7 to 58.2];P< 0.001), but pregnancy did not influence the pharmacokinetics of DHA. The apparent pharmacokinetic differences between the present study and results from other studies of women with uncomplicated malaria that showed no effect of pregnancy on the AUC0–∞of PQ and greater bioavailability may reflect differences in postdose fat intake, proportions of women with malaria, and/or racial differences in drug disposition.


2002 ◽  
Vol 46 (4) ◽  
pp. 1026-1031 ◽  
Author(s):  
Toufigh Gordi ◽  
Dinh Xuan Huong ◽  
Trinh Ngoc Hai ◽  
Nguyen Thi Nieu ◽  
Michael Ashton

ABSTRACT The immediate efficacies of two oral dosage regimens of artemisinin were investigated in 77 male and female adult Vietnamese falciparum malaria patients randomly assigned to treatment with either 500 mg of artemisinin daily for 5 days (group A; n = 40) or artemisinin at a dose of 100 mg per day for 2 days, with the dose increased to 250 mg per day for 2 consecutive days and with a final dose of 500 mg on the fifth day (group B; n = 37). Parasitemia was monitored every 4 h. The average parasite clearance time was longer in group B than in group A (means ± standard deviations, 50 ± 23 and 34 ± 14 h, respectively; P < 0.01). Artemisinin concentrations in saliva samples obtained on days 1 and 5 were quantified by high-performance liquid chromatography. The average oral clearance, based on saliva drug concentrations in group B patients, was twofold higher than that in group A patients on day 1 (P < 0.01), with no differences in drug half-lives (P = 0.40), indicating a saturable first-pass metabolism. Female patients had higher oral clearance values on day 1. Artemisinin's pharmacokinetic parameters were similar on day 5 in both groups, although a significant increase in oral clearance from day 1 to day 5 was evident. Thus, artemisinin exhibited both dose- and time-dependent pharmacokinetics. The escalating dose studied did not result in higher artemisinin concentrations toward the end of the treatment period.


2012 ◽  
Vol 56 (6) ◽  
pp. 3288-3297 ◽  
Author(s):  
Sam Salman ◽  
Madhu Page-Sharp ◽  
Kevin T. Batty ◽  
Kaye Kose ◽  
Susan Griffin ◽  
...  

ABSTRACTPharmacokinetic differences between piperaquine (PQ) base and PQ tetraphosphate were investigated in 34 Papua New Guinean children aged 5 to 10 years treated for uncomplicated malaria with artemisinin-PQ (ART-PQ) base or dihydroartemisinin-PQ (DHA-PQ) tetraphosphate. Twelve children received ART-PQ base (two daily doses of 3 mg of ART and 18 mg of PQ base as granules/kg of body weight) as recommended by the manufacturer, with regular clinical assessment and blood sampling over 56 days. PQ concentrations in plasma samples collected from 22 children of similar ages with malaria in a previously published pharmacokinetic study of DHA-PQ tetraphosphate (three daily doses of 2.5 mg of ART and 20 mg of PQ tetraphosphate as tablets/kg of body weight) were available for comparison. The disposition of ART was also assessed in the 12 children who received ART-PQ base. Plasma PQ was assayed by high-performance liquid chromatography with UV detection, and ART was assayed using liquid chromatography-mass spectrometry. Multicompartment pharmacokinetic models for PQ and ART were developed using a population-based approach. ART-PQ base was well tolerated, and initial fever abatement and parasite clearance were prompt. There were no differences between the two treatments in the values for the PQ area under the concentration-time curve from time zero to infinity (AUC0–∞), with medians of 49,451 (n= 12) and 44,556 (n= 22) μg · h/liter for ART-PQ base and DHA-PQ tetraphosphate, respectively. Recurrent parasitemia was associated with lower PQ exposure. Using a two-compartment ART model, the median AUC0–∞was 1,652 μg · h/liter. There was evidence of autoinduction of ART metabolism (relative bioavailability for the second dose, 0.27). These and previously published data suggest that a 3-day ART-PQ base regimen should be further evaluated, in line with World Health Organization recommendations for all artemisinin combination therapies.


2021 ◽  
Vol 28 (2) ◽  
pp. 54-72
Author(s):  
Abd-al-Salam Al-Hazragi ◽  
Assim Lateef

This article investigates the behaviour of strengthened concrete columns using jacketing ultra-high-performance fiber reinforced concrete (UHPFRC) and carbon fiber-reinforced polymer (CFRP) under uniaxial loaded. The jacket was connected to the column core using shear connectors and (CFRP) fixed as a strip on the tension zone between the column cores and the jacketing. Seven column samples of square cross-section (120 x120) mm at the midsection with overall length of 1250 mm were cast using normal strength concrete (NSC) and having similar longitudinal and transverse reinforcement. The samples were made and tested under axial load at eccentricity equal to 120 mm up to failure. Test parameters were the thickness of jackets (25 and 35) mm and the width of CFRP (0,8, and 12) cm. Column specimens were tested, one of them was reference without any strengthening, and the other specimens divided into two groups (A, and B), and each group included three specimens based on the parameters. Group (A) has UHPFRC jacket thickness 25 mm and CFRP width (0,8, and 12) cm respectively, and group (B) has UHPFRC jacket thickness 35 mm and CFRP width (0,8, and 12) cm respectively. The outcomes of the article show that increasing the thickness of jacket, and width of CFRP lead to increase in the load carrying capacity about (110.5%,168.4%, and 184.2%) for group A, and (157.9%,226.3%, and 263.2%) for group B compared with the reference column due to delay in the appearance of cracks and their distribution. The mid-height lateral displacement of columns was decreased about (66.6%,42.3%, and 35.9%) for group A, and (46.15%,38.46%, and 32.3%) for group B, also the axial deformation of specimens decreased about (71.7%,60.86%, and 55.86%) for group A, and (65.5%,60.5%, and 53.4) for group B compared with the reference column. The ductility of columns that were strengthened with UHPFRC jacket only was increased about (13.67%,19.66%) for thickness(25,35) mm respectively, because of that UHPFRC jacket was contented on steel fibers, and the percentage decrease of ductility was about (5.1%,and 12%) for group (A), (1%,and 9.4%) for group (B) when bonded CFRP in the tension zone with width (8 ,and 12) cm respectively. The results show improvement in the initial and secant stiffness when, increased the thickness of jacket, and width of CFRP because of increase in the size of columns and improvement in the modulus of elasticity. The toughness increase was about (273.97%,301.55%, and 304.5%) for group A, and (453.69%,511.93%, and 524.28%) for group B compared with the reference column because of increase in the size of specimens and delay the appearance of cracks.


2005 ◽  
Vol 49 (5) ◽  
pp. 1881-1889 ◽  
Author(s):  
Wolfgang A. Krueger ◽  
Jurgen Bulitta ◽  
Martina Kinzig-Schippers ◽  
Cornelia Landersdorfer ◽  
Ulrike Holzgrabe ◽  
...  

ABSTRACT Meropenem is a broad-spectrum carbapenem antibacterial agent. In order to optimize levels in plasma relative to the MICs, the ideal dose level and dosage regimen need to be determined. The pharmacokinetics of meropenem were studied in two groups, each comprising eight healthy volunteers who received the following doses: 500 mg as an intravenous infusion over 30 min three times a day (t.i.d.) versus a 250-mg loading dose followed by a 1,500 mg continuous infusion over 24 h for group A and 1,000 mg as an intravenous infusion over 30 min t.i.d. versus a 500-mg loading dose followed by a 3,000-mg continuous infusion over 24 h for group B. Meropenem concentrations in plasma and urine were determined by liquid chromatography-mass spectrometry/mass spectrometry and high-performance liquid chromatography with UV detection, respectively. Pharmacokinetic calculations were done by use of a two-compartment open model, and the data were extrapolated by Monte Carlo simulations for 10,000 simulated subjects for pharmacodynamic evaluation. There were no significant differences in total clearance and renal clearance between group A and group B or between the intermittent treatment and the continuous infusion. The analyses of the probability of target attainment by MIC for the high- and low-dose continuous infusions were robust up to MICs of 4 mg/liter and 2 mg/liter, respectively. The corresponding values for intermittent infusions were only 0.5 mg/liter and 0.25 mg/liter. When these observations were correlated with MICs obtained from the MYSTIC database, intermittent infusion results in adequate activity against two of the most common nosocomially acquired pathogens, Klebsiella pneumoniae and Enterobacter cloacae. However, against Pseudomonas aeruginosa, the evaluation shows a clear advantage of high-dose therapy administered as a continuous infusion. We believe that in the empirical therapy situation, the continuous-infusion mode of administration is most worth the extra efforts. We conclude that clinical trials for evaluation of the continuous infusions of meropenem in critically ill patients are warranted.


2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S586-S587
Author(s):  
Hsiu Wu ◽  
Liang Zhou ◽  
MINN M SOE ◽  
Jonathan R Edwards ◽  
Daniel Pollock

Abstract Background Selective reporting (SR), recommended by the 2016 IDSA/SHEA antimicrobial stewardship guidelines, is a strategy to guide prescribing decisions by limiting the antimicrobial susceptibility testing (AST) results available to prescribers. Yet, SR carries risks that cumulative antibiograms reflect only partial AST results. The Clinical Laboratory Standards Institute (CLSI) M100 performance standards stipulate that AST results should be routinely reported for some antimicrobials (Group A agents) while SR is appropriate for other antimicrobials (Group B agents). We assessed the extent of SR use and its impact on national antimicrobial resistance (AR) surveillance. Methods We used Enterobacteriaceae (EB) and Staphylococcus aureus (SA) blood culture AST results that hospitals reported for group A and B agents to the CDC’s National Healthcare Safety Network’s AR option from 2017 through 2018. Routine reporting for an organism-agent combination was defined as results reported for ≥ 90% isolates for the hospital’s most frequently reported agents. SR was defined as a shortfall of > 20% in results reported for an agent compared with a routinely reported agent in a hospital that reported ≥ 30 isolates. We compared hospital antibiograms between SR and non-SR hospitals. We also identified isolate characteristics associated with AST reporting in SR hospitals. Results Among 242 and 185 hospitals reported ≥ 30 isolates, many showed patterns of SR (Figure 1). Of 437 and 425 hospitals reported ≥ 1 isolate, only 112 (26%) and 152 (36%) routinely reported AST results for all group A agents for EB and SA, respectively. For EB, 345 (79%) hospitals routinely reported AST results for ciprofloxacin or levofloxacin, although both are group B agents. For SA, 324 (76%) routinely reported vancomycin (Figure 2). Antibiograms for many agents differed between SR and non-SR hospitals (Figure 3, 4). In SR hospitals, non-susceptibility to narrower-spectrum drugs, patient location, age, and some species among EB were associated with AST reporting. Conclusion AST results reporting vary across hospitals and agents, and CLSI’s SR standards are used inconsistently. For AR surveillance, complete reporting calls for solutions that bypass SR. In the meantime, SR should be taken into account in national AR benchmarking. Disclosures All authors: No reported disclosures.


2010 ◽  
Vol 54 (3) ◽  
pp. 1186-1192 ◽  
Author(s):  
Harin A. Karunajeewa ◽  
Sam Salman ◽  
Ivo Mueller ◽  
Francisca Baiwog ◽  
Servina Gomorrai ◽  
...  

ABSTRACT In order to determine the pharmacokinetic disposition of chloroquine (CQ) and its active metabolite, desethylchloroquine (DECQ), when administered as intermittent presumptive treatment in pregnancy (IPTp) for malaria, 30 Papua New Guinean women in the second or third trimester of pregnancy and 30 age-matched nonpregnant women were administered three daily doses of 450 mg CQ (8.5 mg/kg of body weight/day) in addition to a single dose of sulfadoxine-pyrimethamine. For all women, blood was taken at baseline; at 1, 2, 4, 6, 12, 18, 24, 30, 48, and 72 h posttreatment; and at 7, 10, 14, 28, and 42 days posttreatment. Plasma was subsequently assayed for CQ and DECQ by high-performance liquid chromatography, and population pharmacokinetic modeling was performed. Pregnant subjects had significantly lower area under the plasma concentration-time curve for both CQ (35,750 versus 47,892 μg·h/liter, P < 0.001) and DECQ (23,073 versus 41,584 μg·h/liter, P < 0.001), reflecting significant differences in elimination half-lives and in volumes of distribution and clearances relative to bioavailability. Reduced plasma concentrations of both CQ and DECQ could compromise both curative efficacy and posttreatment prophylactic properties in pregnant patients. Higher IPTp CQ doses may be desirable but could increase the risk of adverse hemodynamic effects.


2002 ◽  
Vol 20 (16) ◽  
pp. 3508-3521 ◽  
Author(s):  
E. Raymond ◽  
W.W. ten Bokkel Huinink ◽  
J. Taïeb ◽  
J.H. Beijnen ◽  
S. Faivre ◽  
...  

PURPOSE: The objectives were to determine the maximum-tolerated dose, the recommended dose, the dose-limiting toxicity, the pharmacokinetics, and the activity of E7070, a novel cell-cycle inhibitor. PATIENTS AND METHODS: E7070 was given as a 1-hour intravenous infusion every 3 weeks in two groups of patients with advanced solid tumors who met prespecified eligibility criteria (group A) or who met the same eligibility criteria but in addition were less heavily pretreated and had more favorable liver functions (group B). RESULTS: Forty patients (31 patients in group A and nine patients in group B) were entered. Dose escalation proceeded through eight levels (range, 50 to 1,000 mg/m2). In group A, neutropenia and thrombocytopenia were dose-limiting toxicities occurring during the first cycle in two of seven patients treated at the doses of 700 mg/m2 and two of four patients treated at 800 mg/m2. Identical dose-limiting toxicities were observed in zero of six and two of three patients from group B at doses of 800 and 1,000 mg/m2, respectively. Other toxicities included acne-like skin eruption, mucositis, conjunctivitis, nausea, fatigue, and alopecia. At doses greater than 400 mg/m2, the area under the concentration-time curve increased disproportionately to the administered dose. Tumor stabilization lasting ≥ 6 months was observed in six assessable patients. CONCLUSION: The recommended doses of E7070 in this schedule were 700 mg/m2 (group A) and 800 mg/m2 in patients who were less heavily pretreated (group B) with a moderate tumor burden. Prolonged disease stabilization observed in this study might warrant further investigation of E7070 in selected tumor types.


2009 ◽  
Vol 53 (10) ◽  
pp. 4368-4376 ◽  
Author(s):  
Harin A. Karunajeewa ◽  
Sam Salman ◽  
Ivo Mueller ◽  
Francisca Baiwog ◽  
Servina Gomorrai ◽  
...  

ABSTRACT To determine the pharmacokinetic disposition of sulfadoxine (SDOX) and pyrimethamine (PYR) when administered as intermittent presumptive treatment during pregnancy (IPTp) for malaria, 30 Papua New Guinean women in the second or third trimester of pregnancy and 30 age-matched nonpregnant women were given a single dose of 1,500 mg of SDOX plus 75 mg of pyrimethamine PYR. Blood was taken at baseline and 1, 2, 4, 6, 12, 18, 24, 30, 48, and 72 h and at 7, 10, 14, 28, and 42 days posttreatment in all women. Plasma samples were assayed for SDOX, N-acetylsulfadoxine (NASDOX), and PYR by high-performance liquid chromatography. Population pharmacokinetic modeling was performed using NONMEM v6.2.0. Separate user-defined mamillary models were fitted to SDOX/NASDOX and PYR. When the covariate pregnancy was applied to clearance, there was a significant improvement in the base model for both treatments. Pregnancy was associated with a significantly lower area under the concentration-time curve from 0 to ∞ for SDOX (22,315 versus 33,284 mg·h/liter), NASDOX (801 versus 1,590 mg·h/liter), and PYR (72,115 versus 106,065 μg·h/liter; P < 0.001 in each case). Because lower plasma concentrations of SDOX and PYR could compromise both curative efficacy and posttreatment prophylaxis in pregnant patients, IPTp regimens incorporating higher mg/kg doses than those recommended for nonpregnant patients should be considered.


1997 ◽  
Vol 22 (6) ◽  
pp. 598-608 ◽  
Author(s):  
Malcolm B. Doupe ◽  
Alan D. Martin ◽  
Mark S. Searle ◽  
Dean J. Kriellaars ◽  
Gordon G. Giesbrecht

A new equation to estimate muscle mass in males was developed using parameters common to the 1981 Canada Fitness Survey and the male cadaver data of Martin et al. (1990b). The cadavers (N = 12) were randomly divided into two groups. The equation was developed on cadaver Group A and then validated on Group B. Once the equation with the most suitable variables was validated on Group B, it was redeveloped on combined data from Groups A and B. The final equation is as follows: muscle mass (gm) = Ht (0.031MUThG2 + 0.064CCG2 + 0.089CAG2) −3.006; adjusted R2 = .96, SEE = 1,488 gm, F = 87.5, p = .0001. Variables (in cm) were Ht, height; MUThG, modified upper thigh girth; CCG, corrected calf girth; and CAG, corrected arm girth. The predictive ability of this equation was comparable to the original equation of Martin et al. (1990b) and can be a valuable tool for muscle mass estimation of male subjects in the 1981 Canada Fitness Survey. Key words: equation, estimation, body composition, body fat, fat free mass, lean body mass, Canada Fitness Survey


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