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Antimicrobial Agents and Chemotherapy, December 2005, p. 5013-5017, Vol. 49, No. 12
0066-4804/05/$08.00+0     doi:10.1128/AAC.49.12.5013-5017.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.

Absolute Bioavailability and Intracellular Pharmacokinetics of Azithromycin in Patients with Cystic Fibrosis

Paul Beringer,1,3* Kitty My Tu Huynh,2 Jane Kriengkauykiat,1 Luke Bi,1 Nils Hoem,4 Stan Louie,1 Emily Han,1 Thao Nguyen,1 Donald Hsu,1 Purush A. Rao,3 Bertrand Shapiro,3 and Mark Gill1

University of Southern California, School of Pharmacy, Los Angeles, California,1 University of Oslo, School of Pharmacy, Oslo, Norway,2 University of Southern California, Keck School of Medicine, Los Angeles, California,3 MDS Pharma Services, Hamburg, Germany4

Received 15 July 2005/ Returned for modification 17 September 2005/ Accepted 1 October 2005

Chronic pulmonary infections with Pseudomonas aeruginosa are the primary cause of morbidity and mortality in patients with cystic fibrosis (CF). The macrolide antibiotics exhibit immunomodulatory and antivirulence activity. Clinical trials with azithromycin in CF have demonstrated significant improvements in pulmonary function and decreased hospitalizations. The purpose of this study was to compare the pharmacokinetics (PK) of azithromycin in patients with CF and controls. The study was conducted as an open-label, parallel, two-period crossover study involving 12 healthy volunteers and 12 patients with CF. Period 1 examined the serum PK following a single oral and intravenous dose, while period 2 examined the intracellular PK following multiple-dose oral administration. CF subjects differed significantly from controls based on weight (53.1 versus 71.0 kg; P < 0.01) and body mass index (19.7 versus 23.2; P < 0.01), respectively. Ninety-two percent of CF patients were pancreatic insufficient and were receiving pancreatic enzymes. The rate (time to reach maximum serum drug concentration, 3.0 versus 3.0 h; P = 0.78) and extent of absorption (absolute bioavailability, 34.2 versus 42.8%; P = 0.37) were similar in patients with CF and controls, respectively. Distribution to the tissues (rate of drug transfer from the central to the peripheral compartment, 1.22 versus 0.759 h–1; P = 0.03) and elimination (rate of elimination from the central compartment, 0.693 versus 0.492 h–1; P < 0.01) were more rapid in the healthy volunteers than in the CF subjects, respectively. Mononuclear cell concentrations (15.2 ± 6.0 mg/liter) far exceeded the maximum serum drug concentration (~50-fold), demonstrating significant intracellular accumulation. These results indicate no alteration in dosage of azithromycin is necessary in patients with CF taking pancreatic enzymes.

* Corresponding author. Mailing address: University of Southern California, School of Pharmacy, 1985 Zonal Ave., Los Angeles, CA 90033. Phone: (323) 442-1402. Fax: (626) 628-3024. E-mail: beringer{at}usc.edu.

Antimicrobial Agents and Chemotherapy, December 2005, p. 5013-5017, Vol. 49, No. 12
0066-4804/05/$08.00+0     doi:10.1128/AAC.49.12.5013-5017.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.



This article has been cited by other articles:

  • Liu, S., Beringer, P. M., Hidayat, L., Rao, A. P., Louie, S., Burckart, G. J., Shapiro, B. (2008). Probenecid, but Not Cystic Fibrosis, Alters the Total and Renal Clearance of Fexofenadine. J Clin Pharmacol 48: 957-965 [Abstract] [Full Text]  


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