Mechanism-Based Pharmacokinetic/Pharmacodynamic Modeling of Aerosolized Colistin in a Mouse Lung Infection Model.

Abstract

Optimized dosage regimens of aerosolized colistin (as colistin methanesulfonate [CMS]) are urgently required to maximize bacterial killing against multidrug-resistant Gram-negative bacteria while minimizing toxicity. This study aimed to develop a mechanism-based pharmacokinetic (PK)/pharmacodynamic (PD) model (MBM) for aerosolized colistin based upon PK/PD data in neutropenic infected mice and to perform a deterministic simulation with the PK of aerosolized colistin (as CMS) in critically ill patients. In vivo time-kill experiments were carried out with three different strains of Pseudomonas aeruginosa An MBM was developed in S-ADAPT and evaluated by assessing its ability to predict the PK/PD index associated with efficacy in mice. A deterministic simulation with human PK data was undertaken to predict the efficacy of current dosage regimens of aerosolized colistin in critically ill patients. In the final MBM, the total bacterial population for each isolate consisted of colistin-susceptible and -resistant subpopulations. The antimicrobial efficacy of aerosolized colistin was best described by a sigmoidal Emax model whereby colistin enhanced the rate of bacterial death. Deterministic simulation with human PK data predicted that an inhalational dosage regimen of 60 mg colistin base activity (CBA) every 12 h is needed to achieve a ≥2-log10 bacterial reduction (as the number of CFU per lung) in critically ill patients at 24 h after commencement of inhaled therapy. In conclusion, the developed MBM is a useful tool for optimizing inhalational dosage regimens of colistin. Clinical studies are warranted to validate and refine our MBM for aerosolized colistin.

• Authors: Yu-Wei Lin, Qi Tony Zhou, Mei-Ling Han, Nikolas J Onufrak, Ke Chen, Jiping Wang, Alan Forrest, Hak-Kim Chan, Jian Li
• Journal: Antimicrobial agents and chemotherapy (Antimicrob Agents Chemother) Vol. 62 Issue 3 (03 2018) ISSN: 1098-6596 [Electronic] United States
• PMID: 29263069 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2018 American Society for Microbiology.

Chemical References

• Anti-Bacterial Agents
• Colistin

Topics

• Administration, Inhalation
• Animals
• Anti-Bacterial Agents (administration & dosage, pharmacokinetics, therapeutic use)
• Colistin (administration & dosage, pharmacokinetics, therapeutic use)
• Disease Models, Animal
• Female
• Mice
• Microbial Sensitivity Tests
• Pseudomonas Infections (drug therapy, metabolism)
• Pseudomonas aeruginosa (drug effects, pathogenicity)
• Respiratory Tract Infections (drug therapy, metabolism)