P. Lees

Antibiotic treatment for animals: effect on bacterial population and dosage regimen optimisation.

Concern regarding antimicrobial resistance has led to proposals for the prudent use of antimicrobial agents. Whilst this is appropriate, it is not sufficient. This article proposes that dosage schedules should be developed to provide a basis for the rational use of antimicrobial drugs. This requires knowledge of resistance mechanisms and transfer, the biochemistry and structure of microorganisms and both the pharmacodynamics and pharmacokinetics of antimicrobial drugs. Dosage schedules should maintain concentrations at the site of infection in excess of MIC(90) for bacteriostatic drugs and bactericidal drugs acting primarily by time-dependent mechanisms whilst they should provide high AUIC and C(max)/minimum inhibitory concentration (MIC) values for agents acting mainly by concentration-dependent mechanisms. It is proposed that pharmacodynamic and population pharmacokinetic data should be integrated through use of the sigmoidal E(max) equation, together with mathematical modelling and appropriate statistical analyses, to take account of the natural variation in drug pharmacodynamics and pharmacokinetics.

Early neutrophil but not eosinophil or platelet recruitment to the lungs of allergic horses following antigen exposure

Previous studies have shown that bronchoalveolar lavage fluid from horses with allergic respiratory disease and showing clinical symptoms contains increased numbers of neutrophils. In some cases, the eosinophil count is also increased. In this study the time course of changes in lung function and the accumulation of radiolabelled leucocytes and platelets in the lungs of allergic and normal horses has been examined during a 7 hr allergen exposure. Antigen challenge had no effect on pleural pressure or the distribution of radiolabelled neutrophils, eosinophils or platelets in normal horses. In contrast, in 6/8 allergic horses, there was an increase in pleural pressure and neutrophil accumulation in the lungs, both of which were evident after 4–5 hr. However, during the 7 hr challenge period radiolabelled eosinophils were detected in the lungs of only 1/6 horses exhibiting an increase in pleural pressure and in 1/7 horses that failed to show a change in airway function despite a clinical history of allergic respiratory disease. Antigen challenge did not alter the distribution of radiolabelled platelets in the five allergic horses tested. These results demonstrate that increased pleural pressure is not accompanied by eosinophil or platelet accumulation in the lungs of horses with allergic respiratory disease following exposure to antigen. However, changes in airway function can be associated with neutrophil accumulation but can also take place in the absence of this cell recruitment. This raises the possibility that the presence of neutrophils in the lung is not a prerequisite for changes in lung function.

Rational dosing of antimicrobial drugs: animals versus humans.

The rational dosing of antimicrobial drugs depends on knowledge of physiology, anatomy and pathology, including disease condition, and in major respects these differ between animals and humans and between species of animal. These differences lead to species variation in drug pharmacokinetics, which can be profound. This review highlights selected aspects of species differences in pharmacokinetics and considers underlying mechanisms by reference to ruminant and non-ruminant mammals, birds, fish and bees. For all species it is desirable and should be possible to design dosage schedules based on knowledge of drug pharmacokinetics and pharmacodynamics. There have been many attempts to integrate pharmacokinetic and pharmacodynamic data to provide dosage schedules which optimize efficacy and minimize opportunities for the development of antimicrobial resistance in both laboratory animal studies and human clinical trials. However, there have been relatively few studies in animal species of major veterinary interest. This review summarizes recent studies in four ruminant species (calf, sheep, goat and camel) which have used PK-PD integration to determine for the fluoroquinolone, danofloxacin, AUC/MIC ratios producing (a) bacteriostasis (b) bactericidal activity and (c) elimination of bacteria. Future possible developments in dosage schedule design are considered.

Pharmacodynamics and enantioselective pharmacokinetics of carprofen in the cat

The pharmacodynamics and enantioselective pharmacokinetics of the arylpropionic acid non-steroidal anti-inflammatory drug, carprofen, were investigated in cats after administration of the racemic mixture (rac-carprofen) at dose rates ranging from 0.7 to 4.0 mg kg-1 intravenously and subcutaneously. A low dose of rac-carprofen (0.7 mg kg-1) partially inhibited the rise in skin temperature at a site of acute inflammation but had no effect on the ex vivo synthesis of serum thromboxane (Tx) B2. A higher dose (4.0 mg kg-1) inhibited oedematous swelling, although the response was statistically significant at only one time, and also reduced the ex vivo synthesis of serum TxB2 for 12 hours after intravenous injection or 24 hours after subcutaneous injection. The main features of carprofen pharmacokinetics were a low distribution volume, a relatively long elimination half-life, the predominance of the R(-) enantiomer and a bioavailability (after subcutaneous dosing) of 100 per cent and 92 per cent, respectively, after doses of 0.7 and 4.0 mg kg-1. On the basis of these data, it is suggested that a dose of 4.0 mg kg-1 by both intravenous and subcutaneous routes should be evaluated in clinical subjects.

Serum thromboxane in the horse and its inhibition by aspirin, phenylbutazone and flunixin

Abstract A study of the inhibitory actions of non-steroidal anti-inflammatory drugs on serum TXB2 formation was undertaken. Flunixin (1.1 mg/kg) and phenylbutazone (4.4 mg/kg) administered as single intravenous doses to six horses produced a similar degree of reversible inhibition. Values of percentage blockade were 98% and 88% at 4 h, 77% and 76% at 8 h, 63% and 50% at 24 h, and by 48 h inhibition was no longer apparent, although an apparent reversal of the action of phenylbutazone occurred at 96 h. These findings were related to pharmacokinetic parameters of each drug; mean values of t 1 2 β , Vd area and ClB for phenylbutazone and flunixin were 6·11 and 1·94 h, 0·14 and 0·16 l/kg and 16·3 and 57·3 ml/kg/h, respectively. Aspirin (19 mg/kg) produced complete blockade of serum TXB2 formation for seven days and 74% inhibition was still present after 24 days, indicating that aspirin blocks platelet cyclo-oxygenase irreversibly and that this action probably extends to megakaryocytes. Mean t 1 2 β values for aspirin and salicylate were 0·11 and 3·70 h, respectively. These findings suggest that a strategy of inhibiting platelet cyclo-oxygenase, for the prophylaxis or therapy of vascular and thrombo-embolic disorders in the horse, might require therapy with phenylbutazone and flunixin one or more times daily, whereas an aspirin dosage every 10 days or less frequently might also be appropriate.

Pharmacokinetics (PK), Pharmacodynamics (PD), and PK-PD Integration of Danofloxacin in Sheep Biological Fluids

ABSTRACT The fluoroquinolone antimicrobial drug danofloxacin was administered to sheep intravenously (i.v.) and intramuscularly (i.m.) at a dose of 1.25 mg/kg of body weight in a two-period crossover study. The pharmacokinetic properties of danofloxacin in serum, inflamed tissue cage fluid (exudate), and noninflamed tissue cage fluid (transudate) were established by using a tissue cage model. The in vitro and ex vivo activities of danofloxacin in serum, exudate, and transudate against a pathogenic strain of Mannheimia haemolytica were established. Integration of in vivo pharmacokinetic data with the in vitro MIC provided mean values for the area under the curve (AUC)/MIC for serum, exudate, and transudate of 60.5, 85.6, and 45.7 h, respectively, after i.v. dosing and 55.9, 77.9, and 49.1 h, respectively, after i.m. dosing. After i.m. dosing, the maximum concentration/MIC ratios for serum, exudate, and transudate were 10.8, 3.0, and 1.6, respectively. The ex vivo growth inhibition data after i.m. dosing were fitted to the inhibitory sigmoid Emax equation to provide the values of AUC/MIC required to produce bacteriostasis, bactericidal activity, and elimination of bacteria. The respective values for serum were 17.8, 20.2, and 28.7 h, and slightly higher values were obtained for transudate and exudate. It is proposed that use of these data might provide a novel approach to the rational design of dosage schedules.

Pharmacokinetic/pharmacodynamic modelling of NSAIDs in a model of reversible inflammation in the cat

Data on the relationships between plasma concentration and analgesic and anti‐inflammatory effects of NSAIDs are limited because most inflammation models do not permit pharmacokinetic/pharmacodynamic (PK/PD) modelling to be readily performed. In this study, a kaolin‐induced inflammation model in the cat was evaluated for pre‐clinical characterization of the pharmacodynamic profiles of NSAIDs (determination of efficacy, potency, sensitivity (that is the slope of the concentration–effect relationship) and duration of drug response), using meloxicam as a probe article. Indirect response PK/PD models described the time course and magnitude of responses produced by 0.3 mg kg−1 meloxicam administered subcutaneously. For endpoints for which spontaneous recovery from inflammation was superimposed on drug response, a PK/PD model with a time‐dependent Kin was used to allow for the spontaneous changes of the inflammation with time. The selected endpoints were suitable for studying simultaneously the analgesic, anti‐inflammatory and antipyretic effects of meloxicam, allowing comparison of relative potencies for these effects. Mean±s.d. IC50 or EC50 values (ng ml−1) were 777±124 (body temperature), 841±187 (locomotion variable), 883±215 (pain score), 911±189 (lameness score) and 1298±449 (skin temperature difference). Corresponding mean times±s.d. of peak responses (h) were 5.6±1.3, 8.6±3.8, 5.2±5.0, 5.6±3.7 and 4.3±2.4, respectively. As the pharmacokinetic profiles of meloxicam in cats and humans are similar, simulations of several dosage regimens in the cat provided a pre‐clinical basis, illustrating the value of the cat model for predicting a clinical dose regimen for evaluation in man. The predicted loading doses (mg kg−1) of meloxicam in the cat producing 70% of the maximum attainable responses were 0.29 (body temperature), 0.32 (lameness score), 0.33 (overall locomotion variable), 0.36 (pain score) and 0.50 (skin temperature difference). The values are similar to or somewhat greater than the clinically recommended doses both in cats (0.3 mg kg−1) and humans (7.5–15 mg, that is, between 0.1 and 0.3 mg kg−1). These findings indicate the potential value of the cat as a laboratory model, and of a PK/PD modelling approach in assisting NSAID development programs in animals and humans.

Studies of eicosanoid production in the air pouch model of synovial inflammation.

The time course of the inflammatory reaction in the rat air pouch model of synovial inflammation has been investigated at different stages of development of the lining structure using immune (pertussis vaccine) and non-immune (carrageenan) irritants. Exudate volumes and leucocyte numbers were greater with carrageenan than with pertussis vaccine but with both irritants much greater reactions were obtained when the irritant was injected at a time when the air pouch architecture most closely resembled synovium (i.e. 6 days). The time course of fluid accumulation following carrageenan in 6 day pouches was not interrupted when exudate was aspirated from the pouch six days after carrageenan injection. In the 6 day old air pouch PGE2 and 6-oxo-PGF1α concentration peaked at 6 hours and 24 hours respectively. With carrageenan and pertussis vaccine stimulation, LTB4 concentrations were maximal at 3–6 hours with both irritants and low concentrations were still present at 13 days. The presence of a lining structure was found to influence concentrations of PGE2 in the air pouch. Pre-treatment with colchicine or 5-fluorouracil to reduce cell accumulation was not found to effect the modified PGE2 response. Our findings suggest that the presence of a synovial like lining structure may induce changes in composition in respect to cellular content and in putative mediator concentrations. We conclude that it is important in elucidating the mechanisms involved in arthritic inflammation to study injury in a cavity linedby macrophages and fibroblasts.

PHARMACODYNAMICS AND PHARMACOKINETICS OF MILOXICAM IN THE HORSE

The novel non-steroidal anti-inflammatory drug (NSAID) miloxicam was administered intravenously to six New Forest ponies at a dosage rate of 0.6 mg/kg in a two-part cross-over study. In each part, three horses received miloxicam and three were given a placebo preparation. The actions of miloxicam, compared to placebo, were assessed in a carrageenan-sponge model of acute inflammation. The rise in skin temperature over the site of the acute inflammatory reaction was less in treated ponies, but differences were not statistically significant. Concentrations of the enzymes acid phosphatase (AP) and lysozyme in inflammatory exudates harvested at 4, 8, 12 and 24 h were not significantly different in drug-treated animals compared with those receiving placebo. Concentrations of protein and lactate dehydrogenase (LDH) in exudate and exudate leucocyte numbers were significantly reduced in drug-treated horses when data for all sampling times were pooled. The differences were not significant, however, at each sampling time. Exudate concentrations of the eicosanoids, bicyclic-PGE2, 6-keto-PGF1 alpha and TXB2, were reduced significantly by miloxicam at most sampling times, and serum TXB2 was also significantly reduced at 4 and 8 h but not at 12 and 24 h after drug administration. These pharmacodynamic findings correlated with the pharmacokinetic properties of miloxicam. The plasma concentration-time curve was defined by a three-compartment open model in one pony and by a two-compartment model in five ponies. Mean values for pharmacokinetic parameters for the five ponies were: t1/2 alpha 0.40 h; t1/2 beta 2.70 h; Vd area 0.158 l/kg; ClB 41.87 ml/kg/h. Exudate concentrations of miloxicam were initially similar to and eventually greater than concentrations in plasma, and this may explain the more prolonged inhibition of eicosanoid synthesis in exudate than in serum. These findings demonstrate the value of relating, in a single experimental study, drug action on a range of variables to drug fate in the body.

Ketoprofen in the Cat: Pharmacodynamics and Chiral Pharmacokinetics

The non-steroidal anti-inflammatory drug ketoprofen (KTP) was administered as the racemate to cats intravenously (IV) and orally at clinically recommended dose rates of 2 and 1 mg/kg, respectively, to establish its chiral pharmacokinetic and pharmacodynamic properties. After IV dosing, clearance was more than five times greater and elimination half-life and mean residence time were approximately three times shorter for R(-) KTP than for S(+) KTP. Absorption of both S(+) and R(-) enantiomers was rapid after oral dosing and enantioselective pharmacokinetics was demonstrated by the predominance of S(+) KTP, as indicated by plasma AUC of 20.25 (S(+)KTP) and 4.09 (R(-)KTP) microg h/mL after IV and 6.36 (S(+)KTP) and 1.83 (R(-)KTP) microg h/mL after oral dosing. Bioavailability after oral dosing was virtually complete. Reduction in ex vivo serum thromboxane (TX)B(2) concentrations indicated marked inhibition of platelet cyclo-oxygenase (COX)-1 for 24 h after both oral and IV dosing and inhibition was statistically significant for 72 h after IV dosing. Both oral and IV rac-KTP failed to affect wheal volume produced by intradermal injection of the mild irritant carrageenan but wheal skin temperature was significantly inhibited by IV rac-KTP at some recording times. Possible reasons for the disparity between marked COX-1 inhibition and the limited effect on the cardinal signs of inflammation are considered. In a second experiment, the separate enantiomers of KTP were administered IV, each at the dose rate of 1mg/kg. S(+)KTP again predominated in plasma and there was unidirectional chiral inversion of R(-) to S(+)KTP. Administration of both enantiomers again produced marked and prolonged inhibition of platelet COX-1 and, in the case of R(-)KTP, this was probably attributable to S(+)KTP formed by chiral inversion.