Journal of Antimicrobial Chemotherapy (1990) 26, Suppl. C, 83-87
The pharmacokinetics of cefodizime in children A. Boccazzi, G. Fnsi, A. M. Mezzopane, M. Maretti and P. Careddu First Pediatric Department, Milan University, Via Commenda 9, 20122 Milan, Italy
Introduction Cefodizime (HR221) is an aminothiazolyl cephalosporin with a broad antibacterial spectrum similar to that possessed by cefotaxime. In particular, it is active against Gram-positive cocci and, among Gram-negative bacteria, Haemophilus influenzae, Neisseria spp. and Proteus mirabilis. Its activity against H. influenzae is particularly marked, with a geometric mean MIC of 0031 mg/1. Furthermore, cefodizime is relatively stable to /Mactamases and presents interesting immunological properties. We investigated the pharmacokinetics of cefodizime in children before undertaking a wider clinical study of its efficacy.
Materials and methods Ten hospitalized children were included in the study (Table 1). All had lower respiratory tract infections (bronchopneumonia, pneumonia), presented normal renal and hepatic function tests and had no clinical history of allergic reactions to antibacterial agents. Informed consent was obtained from the relatives of the children. Cefodizime, 25 mg/kg was administered iv every 12 h for 11 days in four subjects and im in the remaining six subjects and the pharmacokinetic study was confined to the first dose. Timed blood samples were obtained after the first iv or im administration at 15, 30, 60 and 90 min and at 2, 3, 4, 6, 8 and 12 h. Samples were then immediately centrifuged and stored at -20°C. Timed urine samples were collected at 0-1, 1-2, 2-4, 4-8 and 8-12h intervals after iv administration. O3O5-7453/9O/26CO83 + O5 J02.00/0
83 © 1990 The British Society for Antimicrobial Chemotherapy
Downloaded from http://jac.oxfordjournals.org/ at Boston University on June 28, 2015
The single-dose pharmacokinetics of cefodizime were studied in ten hospitalized children aged between two and 15 years and weighing 12-5-26-2 kg. Six subjects received the drug (25 mg/kg) im and four received it iv. Cefodizime concentrations in blood and urine (iv dosage only) sampled up to 12 h post dose were measured by microbiological assay and pharmacokinetic parameters were derived on the basis of a two-compartment open model. Peak serum concentrations were 131 ±22-7 mg/1 (15min post iv dose) and 54-8 ± 17-8 mg/1 (60min post im dose). Mean Tv were l-9±0-13 h (iv) and l-88±0-25 h (im). Mean AUCs were 217-2±37-9mg.h/l (Iv) and 15085 ± 22-98 mg.h/1 (im). Mean volumes of distribution were 7-6 ±2-51 (iv) and 7-9 ±1-41 (im). Twelve hours after the iv administration the cumulative urinary excretion was 78-87% of the dose. The pharmaqokinetic behaviour of cefodizime in children is thus similar to that of other compounds in this class.
84
A. Boccazzi et al. Table I. Demographic characteristics of the ten children Weight (kg)
15 3,4 3 10,2 7,6 6,8 2 8,5 6,7 7,2
26-2 14 15-8 34 21 21 12-5 30 16-8 15-4
Cefodizime concentrations in serum and urine samples were determined within one week of collection by an agar disc diffusion method employing Morganella morganii 557/CR ATCC as the indicator organism. The limit of detection of the assay was 0-05 mg/1. A two-compartment, open model was used to describe serum concentrationtime curves. Pharmacokinetic parameters were estimated for each patient using Siphar and Non-Lin software. Results
Figures 1 and 2 illustrate the mean (± s.D.) serum antibiotic concentrations following iv and im administration of cefodizime 25 mg/kg, respectively. Fifteen minutes after iv injection, the serum concentration was 131 ( ± S . D . 22-7)mg/1, after 8 and 12h cefodizime was still detectable and the serum concentrations were 3-2 ( ± S . D . 0-9) mg/1 and 11 200 -
0 0-2 0-5
I 1-5 2
3
4
5
6
7
8
9
10 II 12
Figure 1. Mean (±SJ>.) «crum concentrations of cefodizime following 25 mg/kg iv.
Downloaded from http://jac.oxfordjournals.org/ at Boston University on June 28, 2015
Age (years, months)
85
PharmacokinerJcs in children
I 1-5 2
3
4 5 6 Time (h)
8
9
10
12
Figure 2. Mean (±s.D.) serum concentrations of cefodizime following 25mg/kg im.
07)mg/l, respectively. Following im administration, peak serum concentrations of 54-8 (±S.D. 17-8)mg/l were reached after 60min. The subsequent decline of the serum concentration-time profile was similar to that observed after iv administration with a 12 h trough level of 0-9 (s.D.±0-4)mg/l. Urinary excretion was rapid and elevated urinary concentrations were achieved. Within 2 h of administration, a mean of 65-5% (range 55-72) of the administered dose was excreted in the urine, while 82-5% (range 78-87) was excreted within 12 h. Table II shows the renal excretion data for cefodizime while the cumulative renal excretion data are reported in Table III. Pharmacokinetic details following iv and im administration are summarized in Tables IV and V, respectively. After im administration, a mean elimination half-life of (±S.D.
Table II. Renal excretion data for cefodizime. Mean (s.D.) Mean (s.D.) urinary concentration (mg/1) 0-1 h 1-2 h 2^*h 4-8 h 8-12 h
3049-5 (660) 2168 (457-7) 468-8 (1908) 190-8 (22-4) 26-9 (22-4)
Excreted (nig) 197-5 (100-9) 125-3 (50-3) 54-3 (18-8) 20-1 (11-6)
5-3 ()
Downloaded from http://jac.oxfordjournals.org/ at Boston University on June 28, 2015
0-2 0-5
86
A. Boccazd et al. Table HI. Cumulative renal excretion of cefodizime during the five time intervals (%
Patient no.
0-1 h
1-2 h
2-4 h
4-8h
8-12 h
1 2 3 4 Mean
32 39 46 42 39-9
55 64 72 71 65-5
70 74 80 84 77
77 79 83 86 81-3
78 81 83-8 87 82-5
Patient 2
AUQ-. (mg.h/1)
186-8
206-8
024 20 9-5
Tii (h) V (1)
3
Mean ± S.D.
272-5
036 1-8 4-7
202-6
02 1-9 9-9
217-2 ±37-9 O24±O108 l-9±O13 7-6 ±2-5
017 1-7 6-3
Table V. Pharmacokinetic parameters of cefodizime following administration of 25 mg/kg im Patient
1 T(h)
km AUCo_12 (mg.h/1) AUCo.,, (mg.h/1)
2 203
3
1-83 2-58 137-2 138-6
2-87 181-7 184-5
1-57 3-22 128-2 1291
60
8-4
8-9
4
5
219
204
2-45 159-8
1-42 124-1 126-7
164 9-6
6-5
6
Mean ± s.D.
1-6
1-88 ± 0 2 5 2-83 ± 1 0 148-65 ±22-45 15085 ±22-98 7-9±14
4-46
161 162-2
8-2
(Tif) 1-88 (s.D. 0-25) h was measured, a mean AUQ, of 150-85 (s.D. 22-98) mg.h/1 and a mean volume of distribution of 7-9 (s.D. 1-4) 1. Following iv administration, a mean distribution half-life (T^ of 0-24 (s.D. 0-08) h and a mean elimination half-life (T^ of 1-9 (s.D. 0-13) h was measured. A mean AUQ.^ of 217 (s.D. 37-9) mg.h/1 and a mean volume of distribution of 7-6 (s.D. 2-5) 1 were also observed. Discussion Cefodizime has a pharmacokinetic profile similar to that described for cefotaxime. After im administration, peak concentrations are reached rapidly, indicating a favourable passage from the site of injection to the bloodstream; high and effective antibacterial concentrations are thus reached soon after the first administration of the compound. In this study the elimination half-life was estimated in the dosing interval 0-12h.
Downloaded from http://jac.oxfordjournals.org/ at Boston University on June 28, 2015
Table IV. Pharmacokinetic parameters of cefodizime following administration of 25 mg/kg iv
Pharmacokinetks in children
87
Following iv injection, cefodizime is eliminated from the circulation bicxponentially with a terminal half-life of about 2 h after a short distribution phase with a half-life of about 15min. Trough levels still exceeding the MIC values of the most common pathogens responsible for infections in the paediatric age group are detectable after both iv and im administration of cefodizime. With regard to the kinetic profile described in adults between 0 and 36 h it is clear that the half-life represents the 0-phase rather than the terminal (y-)phase which is observed between 12 and 36 h (Bryskier et al., 1990; Nilsen et al., 1990). To complete the pharmacokinetic profile of cefodizime between 0 and 36 h, a study should be carried out in hospitalized children.
Bryskier, A., Procyk, T.., Tremblay, D., Lenfant, B. & Fourtillan, J. B. (1990). Pharmacokinetics of ccfodizime administered intravenously as a single dose (1-0 g and 20 g) to healthy adult volunteers. Journal of Antimicrobial Chemotherapy 26, Suppl. C, 65-70. Nilsen, O. G., Rennemo, F., Rennemo, R. & Lenfant, B. (1990). Pharmacokinetics of cefodizime in the elderly following single and repeated intravenous administration of 1 g. Journal of Antimicrobial Chemotherapy 26, Suppl. C, 71-75.
Downloaded from http://jac.oxfordjournals.org/ at Boston University on June 28, 2015
References
The pharmacokinetics of cefodizime in children A. Boccazzi, G. Fnsi, A. M. Mezzopane, M. Maretti and P. Careddu First Pediatric Department, Milan University, Via Commenda 9, 20122 Milan, Italy
Introduction Cefodizime (HR221) is an aminothiazolyl cephalosporin with a broad antibacterial spectrum similar to that possessed by cefotaxime. In particular, it is active against Gram-positive cocci and, among Gram-negative bacteria, Haemophilus influenzae, Neisseria spp. and Proteus mirabilis. Its activity against H. influenzae is particularly marked, with a geometric mean MIC of 0031 mg/1. Furthermore, cefodizime is relatively stable to /Mactamases and presents interesting immunological properties. We investigated the pharmacokinetics of cefodizime in children before undertaking a wider clinical study of its efficacy.
Materials and methods Ten hospitalized children were included in the study (Table 1). All had lower respiratory tract infections (bronchopneumonia, pneumonia), presented normal renal and hepatic function tests and had no clinical history of allergic reactions to antibacterial agents. Informed consent was obtained from the relatives of the children. Cefodizime, 25 mg/kg was administered iv every 12 h for 11 days in four subjects and im in the remaining six subjects and the pharmacokinetic study was confined to the first dose. Timed blood samples were obtained after the first iv or im administration at 15, 30, 60 and 90 min and at 2, 3, 4, 6, 8 and 12 h. Samples were then immediately centrifuged and stored at -20°C. Timed urine samples were collected at 0-1, 1-2, 2-4, 4-8 and 8-12h intervals after iv administration. O3O5-7453/9O/26CO83 + O5 J02.00/0
83 © 1990 The British Society for Antimicrobial Chemotherapy
Downloaded from http://jac.oxfordjournals.org/ at Boston University on June 28, 2015
The single-dose pharmacokinetics of cefodizime were studied in ten hospitalized children aged between two and 15 years and weighing 12-5-26-2 kg. Six subjects received the drug (25 mg/kg) im and four received it iv. Cefodizime concentrations in blood and urine (iv dosage only) sampled up to 12 h post dose were measured by microbiological assay and pharmacokinetic parameters were derived on the basis of a two-compartment open model. Peak serum concentrations were 131 ±22-7 mg/1 (15min post iv dose) and 54-8 ± 17-8 mg/1 (60min post im dose). Mean Tv were l-9±0-13 h (iv) and l-88±0-25 h (im). Mean AUCs were 217-2±37-9mg.h/l (Iv) and 15085 ± 22-98 mg.h/1 (im). Mean volumes of distribution were 7-6 ±2-51 (iv) and 7-9 ±1-41 (im). Twelve hours after the iv administration the cumulative urinary excretion was 78-87% of the dose. The pharmaqokinetic behaviour of cefodizime in children is thus similar to that of other compounds in this class.
84
A. Boccazzi et al. Table I. Demographic characteristics of the ten children Weight (kg)
15 3,4 3 10,2 7,6 6,8 2 8,5 6,7 7,2
26-2 14 15-8 34 21 21 12-5 30 16-8 15-4
Cefodizime concentrations in serum and urine samples were determined within one week of collection by an agar disc diffusion method employing Morganella morganii 557/CR ATCC as the indicator organism. The limit of detection of the assay was 0-05 mg/1. A two-compartment, open model was used to describe serum concentrationtime curves. Pharmacokinetic parameters were estimated for each patient using Siphar and Non-Lin software. Results
Figures 1 and 2 illustrate the mean (± s.D.) serum antibiotic concentrations following iv and im administration of cefodizime 25 mg/kg, respectively. Fifteen minutes after iv injection, the serum concentration was 131 ( ± S . D . 22-7)mg/1, after 8 and 12h cefodizime was still detectable and the serum concentrations were 3-2 ( ± S . D . 0-9) mg/1 and 11 200 -
0 0-2 0-5
I 1-5 2
3
4
5
6
7
8
9
10 II 12
Figure 1. Mean (±SJ>.) «crum concentrations of cefodizime following 25 mg/kg iv.
Downloaded from http://jac.oxfordjournals.org/ at Boston University on June 28, 2015
Age (years, months)
85
PharmacokinerJcs in children
I 1-5 2
3
4 5 6 Time (h)
8
9
10
12
Figure 2. Mean (±s.D.) serum concentrations of cefodizime following 25mg/kg im.
07)mg/l, respectively. Following im administration, peak serum concentrations of 54-8 (±S.D. 17-8)mg/l were reached after 60min. The subsequent decline of the serum concentration-time profile was similar to that observed after iv administration with a 12 h trough level of 0-9 (s.D.±0-4)mg/l. Urinary excretion was rapid and elevated urinary concentrations were achieved. Within 2 h of administration, a mean of 65-5% (range 55-72) of the administered dose was excreted in the urine, while 82-5% (range 78-87) was excreted within 12 h. Table II shows the renal excretion data for cefodizime while the cumulative renal excretion data are reported in Table III. Pharmacokinetic details following iv and im administration are summarized in Tables IV and V, respectively. After im administration, a mean elimination half-life of (±S.D.
Table II. Renal excretion data for cefodizime. Mean (s.D.) Mean (s.D.) urinary concentration (mg/1) 0-1 h 1-2 h 2^*h 4-8 h 8-12 h
3049-5 (660) 2168 (457-7) 468-8 (1908) 190-8 (22-4) 26-9 (22-4)
Excreted (nig) 197-5 (100-9) 125-3 (50-3) 54-3 (18-8) 20-1 (11-6)
5-3 ()
Downloaded from http://jac.oxfordjournals.org/ at Boston University on June 28, 2015
0-2 0-5
86
A. Boccazd et al. Table HI. Cumulative renal excretion of cefodizime during the five time intervals (%
Patient no.
0-1 h
1-2 h
2-4 h
4-8h
8-12 h
1 2 3 4 Mean
32 39 46 42 39-9
55 64 72 71 65-5
70 74 80 84 77
77 79 83 86 81-3
78 81 83-8 87 82-5
Patient 2
AUQ-. (mg.h/1)
186-8
206-8
024 20 9-5
Tii (h) V (1)
3
Mean ± S.D.
272-5
036 1-8 4-7
202-6
02 1-9 9-9
217-2 ±37-9 O24±O108 l-9±O13 7-6 ±2-5
017 1-7 6-3
Table V. Pharmacokinetic parameters of cefodizime following administration of 25 mg/kg im Patient
1 T(h)
km AUCo_12 (mg.h/1) AUCo.,, (mg.h/1)
2 203
3
1-83 2-58 137-2 138-6
2-87 181-7 184-5
1-57 3-22 128-2 1291
60
8-4
8-9
4
5
219
204
2-45 159-8
1-42 124-1 126-7
164 9-6
6-5
6
Mean ± s.D.
1-6
1-88 ± 0 2 5 2-83 ± 1 0 148-65 ±22-45 15085 ±22-98 7-9±14
4-46
161 162-2
8-2
(Tif) 1-88 (s.D. 0-25) h was measured, a mean AUQ, of 150-85 (s.D. 22-98) mg.h/1 and a mean volume of distribution of 7-9 (s.D. 1-4) 1. Following iv administration, a mean distribution half-life (T^ of 0-24 (s.D. 0-08) h and a mean elimination half-life (T^ of 1-9 (s.D. 0-13) h was measured. A mean AUQ.^ of 217 (s.D. 37-9) mg.h/1 and a mean volume of distribution of 7-6 (s.D. 2-5) 1 were also observed. Discussion Cefodizime has a pharmacokinetic profile similar to that described for cefotaxime. After im administration, peak concentrations are reached rapidly, indicating a favourable passage from the site of injection to the bloodstream; high and effective antibacterial concentrations are thus reached soon after the first administration of the compound. In this study the elimination half-life was estimated in the dosing interval 0-12h.
Downloaded from http://jac.oxfordjournals.org/ at Boston University on June 28, 2015
Table IV. Pharmacokinetic parameters of cefodizime following administration of 25 mg/kg iv
Pharmacokinetks in children
87
Following iv injection, cefodizime is eliminated from the circulation bicxponentially with a terminal half-life of about 2 h after a short distribution phase with a half-life of about 15min. Trough levels still exceeding the MIC values of the most common pathogens responsible for infections in the paediatric age group are detectable after both iv and im administration of cefodizime. With regard to the kinetic profile described in adults between 0 and 36 h it is clear that the half-life represents the 0-phase rather than the terminal (y-)phase which is observed between 12 and 36 h (Bryskier et al., 1990; Nilsen et al., 1990). To complete the pharmacokinetic profile of cefodizime between 0 and 36 h, a study should be carried out in hospitalized children.
Bryskier, A., Procyk, T.., Tremblay, D., Lenfant, B. & Fourtillan, J. B. (1990). Pharmacokinetics of ccfodizime administered intravenously as a single dose (1-0 g and 20 g) to healthy adult volunteers. Journal of Antimicrobial Chemotherapy 26, Suppl. C, 65-70. Nilsen, O. G., Rennemo, F., Rennemo, R. & Lenfant, B. (1990). Pharmacokinetics of cefodizime in the elderly following single and repeated intravenous administration of 1 g. Journal of Antimicrobial Chemotherapy 26, Suppl. C, 71-75.
Downloaded from http://jac.oxfordjournals.org/ at Boston University on June 28, 2015
References
