Ertapenem's therapeutic potential for Mycobacterium avium lung disease in the hollow fibre model.
Int J Antimicrob Agents
; 64(3): 107204, 2024 Sep.
Article
in En
| MEDLINE
| ID: mdl-38754528
ABSTRACT
INTRODUCTION:
Guideline-based therapy for Mycobacterium avium complex (MAC) pulmonary disease achieves sustained sputum conversion rates in only 43-53% of patients. Repurposing of ß-lactam antibiotics such as ertapenem could expedite design of more efficacious regimens, compared to developing new drugs.METHODS:
We performed an ertapenem exposure-response study in the hollow fibre system model of intracellular MAC (HFS-MAC). We recapitulated human-like intrapulmonary concentration-time profiles of eight once-daily intravenous doses of ertapenem over 28 days and performed repetitive sampling for drug concentration-time profiles and MAC burden. The % of time concentration persisted above MIC (%TMIC) mediating either 50% or 80% of maximal effect (E50, EC80) were identified. The EC80 was used as target exposure in a 10 000 subject Monte Carlo experiments for ertapenem doses of 1G, 2G, or 4G administered once versus twice daily.RESULTS:
The ertapenem MIC ranged from 0.5 to 2 mg/L on three occasions. Ertapenem achieved a half-life of 4.04 ± 0.80 h in the HFS-MAC and killed a maximum of 2.17 log10 CFU/mL below day 0. The EC50 was %TMIC of 75.9% (95% confidence interval 68.43%-86.54%) and the EC80 was %TMIC of 100%. Target attainment probability was >90% for 1G twice daily up to an MIC of 2 mg/L, while for 2G twice daily the susceptibility MIC breakpoint was 4-8 mg/L.CONCLUSIONS:
Ertapenem microbial kill below day 0 burden was better than guideline-based therapy drugs in the HFS-MAC in the past. Ertapenem is a promising drug for novel combination therapies for MAC lung disease.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Mycobacterium avium Complex
/
Mycobacterium avium-intracellulare Infection
/
Microbial Sensitivity Tests
/
Ertapenem
/
Anti-Bacterial Agents
Limits:
Humans
Language:
En
Journal:
Int J Antimicrob Agents
/
Int. j. antimicrob. agents
/
International journal of antimicrobial agents
Year:
2024
Document type:
Article
Affiliation country:
Estados Unidos
Country of publication:
Países Bajos