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Antimicrobial Agents and Chemotherapy, June 2008, p. 1945-1951, Vol. 52, No. 6
0066-4804/08/$08.00+0     doi:10.1128/AAC.00736-06
Copyright © 2008, American Society for Microbiology. All Rights Reserved.

Use of Population Pharmacokinetic Modeling and Monte Carlo Simulation To Describe the Pharmacodynamic Profile of Cefditoren in Plasma and Epithelial Lining Fluid{triangledown}

Thomas P. Lodise,1,2 Martina Kinzig-Schippers,1 George L. Drusano,3 Ulrich Loos,4 Friedrich Vogel,5 Jürgen Bulitta,1 Markus Hinder,6,{dagger} and Fritz Sörgel1,7*

Institute for Biomedical and Pharmaceutical Research, Nürnberg-Heroldsberg, Germany,1 Albany College of Pharmacy, Albany, New York,2 Ordway Research Institute, Albany, New York,3 Knappschaft Hospital, Recklinghausen, Germany,4 Krankenhaus Hofheim, Hofheim am Taunus, Germany,5 Grünenthal, Aachen, Germany,6 Department of Pharmacology, University of Duisburg—Essen, Essen, Germany7

Received 15 June 2006/ Returned for modification 12 November 2006/ Accepted 27 April 2007

Cefditoren is a broad-spectrum, oral cephalosporin that is highly active against clinically relevant respiratory tract pathogens, including multidrug-resistant Streptococcus pneumoniae. This study described its pharmacodynamic profile in plasma and epithelial lining fluid (ELF). Plasma and ELF pharmacokinetic data were obtained from 24 patients under fasting conditions. Cefditoren and urea concentrations were determined in plasma and bronchoalveolar lavage fluid by liquid chromatography-tandem mass spectrometry. Concentration-time profiles in plasma and ELF were modeled using a model with three disposition compartments and first-order absorption, elimination, and transfer. Pharmacokinetic parameters were identified in a population pharmacokinetic analysis (big nonparametric adaptive grid with adaptive {gamma}). Monte Carlo simulation (9,999 subjects) was performed with the ADAPT II program to estimate the probability of target attainment at which the free-cefditoren plasma concentrations (88%) protein binding and total ELF concentrations exceeded the MIC for 33% of the dosing interval for 400 mg cefditoren given orally every 12 h. After the Bayesian step, the overall fits of the model to the data were good, and plots of predicted versus observed concentrations for plasma and ELF showed slopes and intercepts very close to the ideal values of 1.0 and 0.0, respectively. In the plasma probability of target attainment analysis, the probability of achieving a time for which free, or unbound, plasma concentration exceeds the MIC of the organism for 33% of the dosing interval was <80% for a MIC of >0.06 mg/liter. Similar to plasma, the probability of achieving a time above the MIC of 33% was <80% for MIC of >0.06 mg/liter in ELF. Cefditoren was found to have a low probability of achieving a bacteriostatic effect against MICs of >0.06 mg/liter, which includes most S. pneumoniae isolates with intermediate susceptibility to penicillin, when given in the fasting state in both plasma and ELF.

* Corresponding author. Mailing address: IBMP—Institute for Biomedical and Pharmaceutical Research, Paul-Ehrlich-Str. 19, D-90562 Nürnberg-Heroldsberg, Germany. Phone: 49-911-518290. Fax: 49-911-5182920. E-mail: ibmp{at}osn.de

{triangledown} Published ahead of print on 7 May 2007.

{dagger} Present address: Sanofi-Aventis, Bad Soden, Germany.

Antimicrobial Agents and Chemotherapy, June 2008, p. 1945-1951, Vol. 52, No. 6
0066-4804/08/$08.00+0     doi:10.1128/AAC.00736-06
Copyright © 2008, American Society for Microbiology. All Rights Reserved.



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