Diss. (sammanfattning) Uppsala : Uppsala universitet, 2006. / Härtill 5 uppsatser.

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Made available in DSpace on 2014-06-11T19:32:09Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-08-16Bitstream added on 2014-06-13T20:03:10Z : No. of bitstreams: 1 vieira_dcm_dr_arafcf.pdf: 1317618 bytes, checksum: ac08bac3ba14ebc0cb17729af3a88219 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Universidade Estadual Paulista (UNESP) / A cefuroxima sódica (CAS 56238-63-2) é uma cefalosporina de segunda geração, indicada nas infecções provocadas por micro-organismos Gram-positivos e Gram-negativos. Apesar deste fármaco ser altamente estudado e pesquisado no que concerne à atividade antimicrobiana, farmacocinética e farmacodinâmica, há poucos estudos na literatura em relação ao desenvolvimento de metodologia analítica para esta cefalosporina. Desta forma, pesquisas envolvendo métodos analíticos são de fundamental importância e altamente relevantes para otimizar sua análise na indústria farmacêutica e garantir a qualidade do produto já comercializado. Neste trabalho foram desenvolvidas e validadas técnicas de análise para cefuroxima sódica forma farmacêutica injetável: (i) espectrofotometria na região do UV a 280,0 nm com faixa de concentração 5,0 a 14,0 μg/mL, utilizando água como solvente, com exatidão de 100,82% e teor de 99,49%; (ii) doseamento microbiológico, método de difusão em ágar na faixa de concentração de 30,0 a 120,0 μg/mL, utilizando Micrococcus luteus ATCC 9341, com exatidão de 100,77% e teor de 99,96%; (iii) doseamento microbiológico, método turbidimétrico na faixa de concentração de 30,0 a 120,0 μg/mL, utilizando Micrococcus luteus ATCC 9341, com exatidão 100,21% e teor de 99,97%; (iv) espectrofotometria na região do visível a 510,0 nm, com concentração de 100,0 a 300,0 μg/mL utilizando o-fenantrolina como ligante, com exatidão de 99,98% e teor de 99,82%; (v) espectrofotometria na região do IV, com exatidão de 99,83% e teor de 100,25%; (vi) acidimetria, com exatidão de 100,32% e teor de 100,51%; (vii) volumetria em meio nãoaquoso, com exatidão de 100,40% e teor de 100,86%; (viii) iodometria, com exatidão de 99,97% e teor de 100,27%; (ix) cromatografia líquida de alta eficiência com detector UV a 280,0 nm, utilizando metanol:água (70:30) como fase... / Cefuroxime sodium (CAS 56238-63-2) is a second generation cephalosporin indicated in the infections caused by Gram-positive and Gram-negative microorganisms. Although this drug highly to be studied and to be searched with respect to the antimicobial pharmacokinetics and pharmacodynamics activity, there are few studies in relation to the development of analytical methodology for this cephalosporin in literature. In such a way, research involving highly excellent analytical methods is very important to optimize its analysis in the pharmaceutical industry and to guarantee the commercialized product quality. In this work, analytical methods for determination of cefuroxime injectable were validated: (i) UV spectrophotometry at 280 nm with concentration range of 5.0 a 14.0 μg/mL using water as solvent, with accuracy of 100.8% and quantitation of 99.49%; (ii) microbiological assay, agar diffusion method and (iii) turbidimetric method at concentration range 30.0 to 120.0 μg/mL, using Micrococcus luteus ATCC 9341 as indicator microorganism, accuracy 100.77%, quantitation of 99.96% and accuracy of 100.21% and quantitation 99.97%, respectively; (iv) visible spectrophotometric method at 510.0 nm with concentration range of 100.0 at 300.0 μg/mL, using o-phenantrolin as reagent, with accuracy of 99.98% and quantitation of 99.82%; (v) IR spectrophotometry, accuracy of 99.83% and quantitation of 100.25%; (vi) acidimetry, accuracy of 100.32% and quantitation of 100.51%; (vii) volumetry ina a non aqueous, accuracy of 100.40% and quantitation of 100.86%; (viii) iodometry accuracy of 99.97% and quantitation of 100.27%; (ix) HPLC method with UV detector at 280.0 nm using methanol and water (70:30), v/v) as mobile phase and concentration range of 10.0 a 15.0 μg/mL, flow of 0.8 ml/min, accuracy of 100.10% and quantitation of 99.84% and mean retention time of 1.8 minutes. Preliminary study of sodium cefuroxime...(Complete abstract click electronic access below)

Resumo: A cefuroxima sódica (CAS 56238-63-2) é uma cefalosporina de segunda geração, indicada nas infecções provocadas por micro-organismos Gram-positivos e Gram-negativos. Apesar deste fármaco ser altamente estudado e pesquisado no que concerne à atividade antimicrobiana, farmacocinética e farmacodinâmica, há poucos estudos na literatura em relação ao desenvolvimento de metodologia analítica para esta cefalosporina. Desta forma, pesquisas envolvendo métodos analíticos são de fundamental importância e altamente relevantes para otimizar sua análise na indústria farmacêutica e garantir a qualidade do produto já comercializado. Neste trabalho foram desenvolvidas e validadas técnicas de análise para cefuroxima sódica forma farmacêutica injetável: (i) espectrofotometria na região do UV a 280,0 nm com faixa de concentração 5,0 a 14,0 μg/mL, utilizando água como solvente, com exatidão de 100,82% e teor de 99,49%; (ii) doseamento microbiológico, método de difusão em ágar na faixa de concentração de 30,0 a 120,0 μg/mL, utilizando Micrococcus luteus ATCC 9341, com exatidão de 100,77% e teor de 99,96%; (iii) doseamento microbiológico, método turbidimétrico na faixa de concentração de 30,0 a 120,0 μg/mL, utilizando Micrococcus luteus ATCC 9341, com exatidão 100,21% e teor de 99,97%; (iv) espectrofotometria na região do visível a 510,0 nm, com concentração de 100,0 a 300,0 μg/mL utilizando o-fenantrolina como ligante, com exatidão de 99,98% e teor de 99,82%; (v) espectrofotometria na região do IV, com exatidão de 99,83% e teor de 100,25%; (vi) acidimetria, com exatidão de 100,32% e teor de 100,51%; (vii) volumetria em meio nãoaquoso, com exatidão de 100,40% e teor de 100,86%; (viii) iodometria, com exatidão de 99,97% e teor de 100,27%; (ix) cromatografia líquida de alta eficiência com detector UV a 280,0 nm, utilizando metanol:água (70:30) como fase... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Cefuroxime sodium (CAS 56238-63-2) is a second generation cephalosporin indicated in the infections caused by Gram-positive and Gram-negative microorganisms. Although this drug highly to be studied and to be searched with respect to the antimicobial pharmacokinetics and pharmacodynamics activity, there are few studies in relation to the development of analytical methodology for this cephalosporin in literature. In such a way, research involving highly excellent analytical methods is very important to optimize its analysis in the pharmaceutical industry and to guarantee the commercialized product quality. In this work, analytical methods for determination of cefuroxime injectable were validated: (i) UV spectrophotometry at 280 nm with concentration range of 5.0 a 14.0 μg/mL using water as solvent, with accuracy of 100.8% and quantitation of 99.49%; (ii) microbiological assay, agar diffusion method and (iii) turbidimetric method at concentration range 30.0 to 120.0 μg/mL, using Micrococcus luteus ATCC 9341 as indicator microorganism, accuracy 100.77%, quantitation of 99.96% and accuracy of 100.21% and quantitation 99.97%, respectively; (iv) visible spectrophotometric method at 510.0 nm with concentration range of 100.0 at 300.0 μg/mL, using o-phenantrolin as reagent, with accuracy of 99.98% and quantitation of 99.82%; (v) IR spectrophotometry, accuracy of 99.83% and quantitation of 100.25%; (vi) acidimetry, accuracy of 100.32% and quantitation of 100.51%; (vii) volumetry ina a non aqueous, accuracy of 100.40% and quantitation of 100.86%; (viii) iodometry accuracy of 99.97% and quantitation of 100.27%; (ix) HPLC method with UV detector at 280.0 nm using methanol and water (70:30), v/v) as mobile phase and concentration range of 10.0 a 15.0 μg/mL, flow of 0.8 ml/min, accuracy of 100.10% and quantitation of 99.84% and mean retention time of 1.8 minutes. Preliminary study of sodium cefuroxime...(Complete abstract click electronic access below) / Orientador: Hérida Regina Nunes Salgado / Coorientador: Magali Benjamim de Araújo / Banca: Maria Virginia Costa Scarpa / Banca: Taís Maria Bauab / Banca: Pierina Sueli Bonato / Banca: Maria José Vieira Fonseca / Doutor

Este estudo teve como objetivo desenvolver e validar micrométodo simples e sensível para quantificação de cefuroxima plasmática utilizando CLAE-UV com a finalidade de aplicação no monitoramento das concentrações de cefuroxima de pacientes submetidos à cirurgia de revascularização do miocárdio (RM) com CEC no esquema de doses administradas em bolus. Os tempos de retenção para o fármaco e padrão interno (guaifenesina) foram 5,3 e 8,7 minutos respectivamente, com um tempo de corrida de 15 minutos, utilizando coluna de fase reversa C18 (25 cmX4,6 mm, 5 micra) e fase móvel binária constituída de tampão acetato de amônio e trietilamina 0,025 M pH 4,2 e acetonitrila (80:20, v/v), fluxo de 1,0 mL/min, detecção no ultravioleta, λ=274nm em sistema isocrático de eluição. A validação deste método analítico investigada através dos limites de confiança apresentou sensibilidade de 0,1 µg/mL (LD) e limite inferior de quantificação (LIQ) de 0,20 µg/mL, linearidade na faixa compreendida 0,2 µg/mL a 200 µg/mL e 4,37% e 2,95% para precisão intra- e inter-dias, respectivamente. Boa exatidão (98,75%) e alta seletividade foram registradas para o método. Através de um protocolo de estudo para antibioticoprofilaxia das infecções cirúrgicas investigaram-se dez pacientes com indicação de cirurgia eletiva de revascularização do miocárdio com circulação extracorpórea. Realizou-se o monitoramento das concentrações plasmáticas após a dose de ataque de 1,5 g, seguido da manutenção realizada através de bolus em tres doses de 0,75 g 6/6 horas. Uma vez que as concentrações plasmáticas de cefuroxima obtidas na sexta hora (vale) foram inferiores à recomendada 16 µg/mL (4x MIC), recomenda-se o aumento de 0,75 g 6/6 horas para 1,5 g mantendo-se o intervalo entre doses de forma a atingir aquela requerida na antibioticoprofilaxia das cirurugias cardíacas. / The objective of the study was to validate na analytical method to determine cefuroxime in plasma by high performance liquid chromatography (HPLC - UV) for clinical purposes in surgical patients submitted to elective cardiac surgery of myocardial revascularization with cardiopulmonary bypass after drug administration as IV boluses. Retention times for the analite and its internal standard (guaifenesin) were 5.3 and 8.7 minutes, respectively; run time was 15 minutes, using a reversed phase colunm C18 (250X4.6 mm, 5 micron) and a binary mobile phase of ammonium acetate/trietilamine 0.025 M pH 4.2 and acetonitrile (80:20, v/v), flow rate 1 mL/min, ultraviolet detector, λ=274nm isocratic elution system. Validation of confidence limits presented 0.1 µg/mL sensitivity (LD) and lower limit of quantification (LLOQ) of 0.20 µg/mL, linearity in the range 0.2 µg/mL to 200 µg/mL and 4.37% e 2.95% for intra- / interday precisions, respectively. Good accuracy (98.75%) and high selectivity were obtained. The study protocol for antibiotic prophylaxis of surgical infections was designed for ten patients with indication of elective cardiac surgery of myocardial revascularization with cardiopulmonary bypass. Loading dose of 1.5 g followed by maintenance dose of 0.75 g every six hours by IV boluses were applied and plasma drug monitoring was done. Based on data obtained cefuroxime plasma concentrations at time dose interval were lower than 16 µg/mL (4x MIC) at the trough, consequently it is recommended to increase the maintainance dose from 0.75 g 6/6 h up to 1.5 g 6/6h, to reach the minimum required for the antibiotic prophylaxis of cardiac surgeries.

Introdução e Objetivos: A circulação extracorpórea (CEC) pode alterar a cinética de fármacos, inclusive dos antibióticos. O objetivo deste estudo foi avaliar influência da CEC sobre a farmacocinética da cefuroxima e verificar se o esquema posológico proposto: 1, 5g em bolus, seguido por três bolus de 750 mg 6/6 horas por 24 horas, mantém concentrações plasmáticas adequadas em pacientes submetidos à revascularização do miocárdio (RM). Método: Foi realizado estudo prospectivo observacional com grupo controle comparando 10 pacientes submetidos à RM com CEC e 9 pacientes submetidos à RM sem CEC (Registro Clincal trials: NCT0122882). Amostras sanguineas foram coletadas sequencialmente após cada dose de antibiótico e analisadas por meio do método de cromatografia líquida de alta pressão (HPLC). Análise de variância (ANOVA) foi utilizada para a comparação das concentrações plasmáticas e Log-rank para comparar as curvas que avaliaram o tempo, após a administração da cefuroxima, para que fossem atingidas concentrações abaixo de 16 g/mL (quatro vezes a MIC- mínima inhibitory concentration); considerando p< 0,05. Resultados: A CEC com tempo médio de 59,7 min 21,1 minutos não alterou a farmacocinética ou as concentrações plasmáticas da cefuroxima. O clearance médio dp (mL/ Kg/ min) e a mediana da concentração mínima (mg/ dL) do grupo RM com CEC versus RM sem CEC foram 1,7 0,7 versus 1,6 0,6 (p= 0,67) e 6,1 versus 5,7 (p= 0,77), respectivamente. Ambos os grupos apresentaram diminuição nas concentrações plasmáticas influenciadas somente pelo tempo, após cada bolus de cefuroxima (p< 0,001). Concentrações acima de quatro vezes a MIC foram mantidas por três horas, por todos os pacientes, porém, após seis horas do primeiro bolus a probabilidade de manutenção das mesmas concentrações foi de 0,2 para o grupo RM com CEC e de 0,44 para o grupo RM sem CEC, p= 0,867. Após os demais bolus concentrações abaixo de 16 g/mL foram atingidas antes de três horas. Conclusão: A CEC não influenciou as concentrações plasmáticas ou a farmacocinética da cefuroxima. Os resultados da farmacocinética devem ser considerados para a escolha de um melhor esquema posológico / Background and Objectives: Cardiopulmonary bypass (CPB) can alter the kinetic of drugs, including antibiotics. The aim of this study was evaluation of the CPB influence on the plasma concentrations and pharmacokinetics of cefuroxime and assess whether the dosing regimen 1.5 g dose, followed by 750 mg 6/6h for 24h is adequate for antibiotic prophylaxis. Methods: A prospective controlled observational study compared 10 patients undergoing surgery with CPB and 9 submitted to off-pump surgery, (Clinical trials identifier: NCT0122882). After each cefuroxime dose, blood samples were sequentially collected and analyzed using high-efficiency chromatography (HPLC). Plasma concentrations were compared using variance analysis and log-rank test was employed to evaluate the differences between curves that quantified the fraction of patients with a remaining plasma concentration above 16 mg/L within 6 h after each bolus; considering P < 0.05 significant. Results: After each cefuroxime bolus, both groups presented a significant decrease in plasma concentration over time (p< 0.001). Mean CPB time of 59.7 ± 21.1 min did not change cefuroxime pharmacokinetics or plasma concentrations. The mean clearance ± SD (mL/kg/min) and median of minimum concentration (mg/dL) of the CPB group versus the off-pump group were 1.7 ± 0.7 versus 1.6 ± 0.6 (p= 0.67) and 6.1 versus 5.7 (p= 0.77), respectively. Up to 3 h, but not after 6 h, following the first bolus, all patients had plasma concentrations above 16 mg/L (CPB group= 0.2 and off-pump group= 0.44, p=0.867). After another bolus, concentrations below 16 mg/dL were reached before 3 h. Conclusions: CPB does not influence cefuroxime plasma concentration, but pharmacokinetic data should be considered when choosing intervals between doses

<p>Cefuroxime is a renally eliminated antibiotic used against a variety of different bacterial infections. The pharmacokinetics (PK) for cefuroxime was studied in 97 hospitalized patients using population analysis. To be able to measure cefuroxime in human serum a new sensitive analytical method was developed using mass spectrometry detection. The method was validated and shown to be sensitive and selective. Cystatin C was found to be a better covariate for cefuroxime clearance compared to the traditionally used creatinine clearance (CLcr). This relation might be useful when designing dosing strategies for cefuroxime and other renally eliminated drugs. </p><p>The time-courses of the biomarkers C-reactive protein (CRP), serum amyloid A (SAA), interleukin-6 (IL-6) and body temperature were studied for the first 72 hours of cefuroxime treatment and was related to the duration of illness previous treatment with cefuroxime and to time to step-down of treatment. When duration of illness was short, CRP and SAA were showed increasing levels. None of the biomarkers could be used to differentiate between early or late step-down of therapy.</p><p>By use of known PK and pharmacodynamic (PD) principles, dosing strategies based on CLcr for cefuroxime were estimated using minimization of a risk function. The risk function was constructed with the aim to expose patients to cefuroxime concentration above minimum inhibitory concentration (MIC) for 50 % of the dosing interval and to minimize the amount of drug administered in excess to reach the aim. Based on evaluation using wild type MIC distributions for <i>Escherichia coli</i> and <i>Streptococcus pneumoniae</i> improved dosing strategies were selected.</p><p>In vitro experiments were performed exposing <i>Streptococcus pyogenes</i> to constant concentration of benzylpenicillin, cefuroxime, erythromycin, moxifloxacin or vancomycin. A semi-mechanistic PK/PD model characterizing the time-course of the antibacterial effect was developed using all data simultaneously. Internal validation showed the model being predictive and robust. </p>

Cefuroxime is a renally eliminated antibiotic used against a variety of different bacterial infections. The pharmacokinetics (PK) for cefuroxime was studied in 97 hospitalized patients using population analysis. To be able to measure cefuroxime in human serum a new sensitive analytical method was developed using mass spectrometry detection. The method was validated and shown to be sensitive and selective. Cystatin C was found to be a better covariate for cefuroxime clearance compared to the traditionally used creatinine clearance (CLcr). This relation might be useful when designing dosing strategies for cefuroxime and other renally eliminated drugs. The time-courses of the biomarkers C-reactive protein (CRP), serum amyloid A (SAA), interleukin-6 (IL-6) and body temperature were studied for the first 72 hours of cefuroxime treatment and was related to the duration of illness previous treatment with cefuroxime and to time to step-down of treatment. When duration of illness was short, CRP and SAA were showed increasing levels. None of the biomarkers could be used to differentiate between early or late step-down of therapy. By use of known PK and pharmacodynamic (PD) principles, dosing strategies based on CLcr for cefuroxime were estimated using minimization of a risk function. The risk function was constructed with the aim to expose patients to cefuroxime concentration above minimum inhibitory concentration (MIC) for 50 % of the dosing interval and to minimize the amount of drug administered in excess to reach the aim. Based on evaluation using wild type MIC distributions for Escherichia coli and Streptococcus pneumoniae improved dosing strategies were selected. In vitro experiments were performed exposing Streptococcus pyogenes to constant concentration of benzylpenicillin, cefuroxime, erythromycin, moxifloxacin or vancomycin. A semi-mechanistic PK/PD model characterizing the time-course of the antibacterial effect was developed using all data simultaneously. Internal validation showed the model being predictive and robust.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 6 uppsatser.

Este estudo teve como objetivo desenvolver e validar micrométodo simples e sensível para quantificação de cefuroxima plasmática utilizando CLAE-UV com a finalidade de aplicação no monitoramento das concentrações de cefuroxima de pacientes submetidos à cirurgia de revascularização do miocárdio (RM) com CEC no esquema de doses administradas em bolus. Os tempos de retenção para o fármaco e padrão interno (guaifenesina) foram 5,3 e 8,7 minutos respectivamente, com um tempo de corrida de 15 minutos, utilizando coluna de fase reversa C18 (25 cmX4,6 mm, 5 micra) e fase móvel binária constituída de tampão acetato de amônio e trietilamina 0,025 M pH 4,2 e acetonitrila (80:20, v/v), fluxo de 1,0 mL/min, detecção no ultravioleta, &#955;=274nm em sistema isocrático de eluição. A validação deste método analítico investigada através dos limites de confiança apresentou sensibilidade de 0,1 &#181;g/mL (LD) e limite inferior de quantificação (LIQ) de 0,20 &#181;g/mL, linearidade na faixa compreendida 0,2 &#181;g/mL a 200 &#181;g/mL e 4,37% e 2,95% para precisão intra- e inter-dias, respectivamente. Boa exatidão (98,75%) e alta seletividade foram registradas para o método. Através de um protocolo de estudo para antibioticoprofilaxia das infecções cirúrgicas investigaram-se dez pacientes com indicação de cirurgia eletiva de revascularização do miocárdio com circulação extracorpórea. Realizou-se o monitoramento das concentrações plasmáticas após a dose de ataque de 1,5 g, seguido da manutenção realizada através de bolus em tres doses de 0,75 g 6/6 horas. Uma vez que as concentrações plasmáticas de cefuroxima obtidas na sexta hora (vale) foram inferiores à recomendada 16 &#181;g/mL (4x MIC), recomenda-se o aumento de 0,75 g 6/6 horas para 1,5 g mantendo-se o intervalo entre doses de forma a atingir aquela requerida na antibioticoprofilaxia das cirurugias cardíacas. / The objective of the study was to validate na analytical method to determine cefuroxime in plasma by high performance liquid chromatography (HPLC - UV) for clinical purposes in surgical patients submitted to elective cardiac surgery of myocardial revascularization with cardiopulmonary bypass after drug administration as IV boluses. Retention times for the analite and its internal standard (guaifenesin) were 5.3 and 8.7 minutes, respectively; run time was 15 minutes, using a reversed phase colunm C18 (250X4.6 mm, 5 micron) and a binary mobile phase of ammonium acetate/trietilamine 0.025 M pH 4.2 and acetonitrile (80:20, v/v), flow rate 1 mL/min, ultraviolet detector, &#955;=274nm isocratic elution system. Validation of confidence limits presented 0.1 &#181;g/mL sensitivity (LD) and lower limit of quantification (LLOQ) of 0.20 &#181;g/mL, linearity in the range 0.2 &#181;g/mL to 200 &#181;g/mL and 4.37% e 2.95% for intra- / interday precisions, respectively. Good accuracy (98.75%) and high selectivity were obtained. The study protocol for antibiotic prophylaxis of surgical infections was designed for ten patients with indication of elective cardiac surgery of myocardial revascularization with cardiopulmonary bypass. Loading dose of 1.5 g followed by maintenance dose of 0.75 g every six hours by IV boluses were applied and plasma drug monitoring was done. Based on data obtained cefuroxime plasma concentrations at time dose interval were lower than 16 &#181;g/mL (4x MIC) at the trough, consequently it is recommended to increase the maintainance dose from 0.75 g 6/6 h up to 1.5 g 6/6h, to reach the minimum required for the antibiotic prophylaxis of cardiac surgeries.