Pharmacokinetic properties of mezlocillin in ambulatory elderly subjects.

Twelve healthy ambulatory elderly subjects (mean age, 73-78 years) randomly received either a 4-g or 5-g dose of mezlocillin intravenously. One week later the regimen was repeated and patients crossed over to the other dose. Peak serum concentrations were 165 mg/L and 281 mg/L for the 4-g and 5-g doses, respectively. For both doses, differences in t1/2 beta (1.32 hr vs 1.13 hr), AUC (275 mg.hr/L vs 403 mg.hr/L), CL (207 mL/min vs 174 mL/min), CLR (59 mL/min vs 45 mL/min), CLNR (152 mL/min vs 130 mL/min) were not statistically significant. The differences in Varea (22.4L vs 168.8L, P less than or equal to .01) and Cmax (216.6 mg/L vs 317 mg/L, P less than or equal to .05) were statistically significant. Comparison with pharmacokinetic parameters obtained in younger subjects following the 5-g dose reveals that in the elderly the AUC, Varea, and CLNR are higher whereas the CL and CLR are lower. The elderly demonstrated an increase in nonrenal clearance compared with young subjects that is not fully compensatory. The increased AUC in the elderly group suggests that clinical studies examining mezlocillin doses and dose intervals in the treatment of serious infections are warranted in infected elderly patients.

Comparison of the pharmacokinetic and pharmacodynamic activity of piperacillin and mezlocillin.

STUDY OBJECTIVE: To compare serum bactericidal activity over time and pharmacokinetics resulting from single doses of piperacillin (PIP) and a single dose of mezlocillin (MEZ). DESIGN: Open-label, randomized, three-way crossover study. SETTING: Hartford Hospital Clinical Research Center. PATIENTS: Nine healthy volunteers. INTERVENTIONS: Subjects received single doses of PIP 3 and 4 g/70 kg, and a single dose of MEZ 5 g/70 kg. MEASUREMENTS AND MAIN RESULTS: Test organisms were two clinical isolates of Pseudomonas aeruginosa. Pharmacodynamic analysis revealed that PIP 4 g had 2- to 3-fold higher peak serum bactericidal activity at the end of infusion and 4- to 5-fold higher activity at 0.5 hour than did MEZ 5 g, and also provided approximately 1 hour additional activity over MEZ 5 g. Pharmacokinetic analysis revealed that serum concentrations resulting from PIP 4 g remained above the minimum inhibitory concentration of our test strains almost twice as long as MEZ 5 g. CONCLUSION: Since mezlocillin 5 g every 8 hours is currently proving to be effective at many institutions, and since piperacillin 4 g demonstrates superior pharmacokinetic and pharmacodynamic activity, we believe that piperacillin 4 g every 8 hours could be used instead, with resulting cost savings.

Determination of piperacillin and mezlocillin in human serum and urine by high-performance liquid chromatography after derivatisation with 1,2,4-triazole.

High-performance liquid chromatographic methods have been developed for the determination of piperacillin and mezlocillin in human serum and urine samples. The methods involve ultrafiltration of samples followed by reaction with 1.5 M 1, 2, 4-triazole and 0.5 x 10(-3) M mercury (II) chloride in solution (pH 8.50) at 50 degrees C for 15 min. The resulting products were separated on a C18 column following stabilisation in an eluent containing sodium thiosulphate. They were detected at 323 nm for both penicillins. The methods have been applied to assays applied to assays of these penicillins in human serum and urine samples. The procedures, which permit the determination of penicillin concentration down to 0.1 microgram m1-1 in serum and 1 microgram m1-1 in urine samples, are specific to intact penicillins without interference from corresponding penicilloates [see J. Haginaka et al., Anal. Sci. 1 (1985) 73]. At concentrations of 1-500 micrograms ml-1 for each compound, the within- and between-day precisions were 1.8-4.8 and 3.7-6.9, respectively. The accuracy was ca. 100% for all samples assayed.

Human intestinal tissue antibiotic concentrations. Clindamycin, gentamicin, and mezlocillin.

An antibiotic, to be effective for prophylaxis in abdominal trauma, should quickly achieve high concentrations in the intestinal wall and at enough inhibitory levels to kill most aerobic and anaerobic bacteria that are potential contaminants at the site of surgical incision. Therefore, we studied the intestinal tissue levels of clindamycin, gentamicin, and mezlocillin to see whether the tissue levels achieved by these antibiotics in the intestinal tissue were adequate. A single dose of mezlocillin, 4 grams; clindamycin, 600 mg and gentamicin, 80 mg; quickly reached the desired concentrations, i.e., 52.3, 9.69 and 6.1 micrograms/gram of intestinal tissue respectively. These levels were high enough to inhibit the growth of most isolates of E. coli and B. fragilis, common pathogens involved in intra-abdominal abscess.

Antibiotic prophylaxis in gynecological surgery.

A randomized prospective study was undertaken at the Obstetrics and Gynecology Clinic of the Catholic University of Rome in order to evaluate the effectiveness of two wide spectrum antibiotics: mezlocillin and cefotetan. Both drugs were administered 2 g i.v. 15 to 20 minutes preoperatively to allow optimal serum and tissue levels of antibiotic at the moment of bacterial innoculation. 184 patients undergoing elective gynecological surgery for nonmalignant disease were considered eligible for the study (124 pts abdominal hysterectomy, 58 pts vaginal hysterectomy). We found no statistically significant differences between the results obtained with the two drugs.

Therapeutic effect of aspoxicillin on experimental pneumonia with Klebsiella pneumoniae in mice.

The therapeutic effects of aspoxicillin (ASPC) on an experimental pneumonia in mice were compared with those of piperacillin (PIPC) and mezlocillin (MZPC) under various administration schedules. The pneumonia was induced with K. pneumoniae B-54 by the aerosol method. Fifty mg/kg of each penicillin was subcutaneously injected into mice starting from 12 h after infection. At 3- and 6-h interval regimens, ASPC caused the infected mice to survive longer than the other penicillins. The decrease of viable bacterial counts in the lung after a single or repeated injection of ASPC occurred more rapidly than with the other drugs. The concentration of ASPC in the lung after a single injection was higher than that of the other drugs and the concentration was maintained above the MIC for about 2 h. The therapeutic effects of these penicillins on this model reflected well their concentrations in the lung. Among these penicillins, ASPC gave the highest maximum level and persisted longest in the lung, so is shown to have a therapeutic effect superior to PIPC and MZPC on this model of pneumonia. The findings obtained in this experimental pneumonia model were concluded to correlate well with the good clinical efficacy of ASPC compared to PIPC.

Kinetics of penetration and clearance of mezlocillin in the bronchopulmonary tract.

Mezlocillin is an expanded spectrum semisynthetic penicillin for parenteral administration, with a good activity against a wide range of pathogenic bacteria including most anaerobes. The pharmacokinetic parameters of mezlocillin were determined in serum and sputum at the first and the seventh day of treatment with 1 g/im/12 h in patients suffering from bronchopulmonary infections. In a second group of volunteer patients who had to undergo surgery for lung cancer, mezlocillin levels in pulmonary tissue and the corresponding serum levels were determined at different times after drug administration. The data obtained made it possible to obtain information on the penetration and clearance of this drug in the bronchopulmonary tract in comparison with that of the serum. The pharmacokinetic behaviour of mezlocillin ensures an efficient antibacterial action in the respiratory tract.

Effect of dose on pharmacokinetics and serum bactericidal activity of mezlocillin.

Mezlocillin is subject to dose-dependent pharmacokinetics. Previous studies have examined the pharmacokinetic but not the pharmacodynamic aspects of this effect. The pharmacokinetic disposition of mezlocillin was determined in eight healthy volunteers in a randomized, crossover fashion after single infusions of 50 and 80 mg of mezlocillin per kg of body weight. Plasma and urine were assayed with a specific high-pressure liquid chromatography assay and analyzed by noncompartmental methods. Pharmacodynamic (bactericidal) effects were evaluated from serial serum bactericidal titers obtained after each dose by using the area under the bactericidal activity curve method. The mean mezlocillin total body clearance decreased from 203.6 +/- 36.2 ml/min after the 50-mg/kg dose to 171.7 +/- 42.1 ml/min after the 80-mg/kg dose (P, 0.01). The decreased clearance was reflected by a decrease in nonrenal clearance only (108.9 +/- 20.0 to 77.9 +/- 23.5 ml/min, respectively; P, 0.001). Mean areas under the curve for concentration in plasma versus time normalized to the 50-mg/kg dose were 314 +/- 73 and 375 +/- 64 micrograms X h/ml for the low and high doses, respectively (P, 0.01). No significant changes were observed in the steady-state volume of distribution or elimination half-life. Mean areas under the bactericidal activity curve were 100 +/- 77 and 244 +/- 143 for the 50- and 80-mg/kg doses, respectively. The decrease in mezlocillin clearance and the disproportionate increase in the area under the curve for concentration in plasma versus time, coupled with the observed prolonged bactericidal effects of the 80-mg/kg dose, lend support for administration of mezlocillin at a higher dose less frequently (e.g., 5 g every 8 h). Clinical trials with the higher-dose regimen are warranted to validate these observations.

Effect of saturable clearance during high-dose mezlocillin therapy.

As mezlocillin has been shown to display nonlinear pharmacokinetics in single-dose evaluations, we evaluated a crossover trial in patients with renal dysfunction the impact on serum clearance of fixed-dose versus fixed-interval administration of identical daily doses of the drug. In four patients with creatinine clearances of 0.00 to 1.78 liters/h per 1.73 m2, equal serum clearances were observed when the calculated daily total dose of mezlocillin was given either as a fixed dose of 5,000 mg at various intervals or every 4 h at various doses. We found that repetitive large daily doses that are equivalent to 30 g/day in patients with normal renal function can be administered to patients with impaired renal function as a reduced dose every 4 h instead of prolonging the dosing interval, as suggested by Mangione et al. (Antimicrob. Agents Chemother. 21:428-435, 1982). The observed serum clearances were equal for the two schedules, probably owing to the degree of continuing saturation of the nonlinear clearance mechanisms of mezlocillin.

Improved micromethod for mezlocillin quantitation in serum and urine by high-pressure liquid chromatography.

A rapid, sensitive, and specific method of analysis for mezlocillin in serum and urine by high-pressure liquid chromatography is described. A solid-phase extraction column was used to remove interfering substances from samples before chromatography. Quantitation included the use of an internal standard, nafcillin. Mezlocillin was chromatographed with a phosphate buffer-acetonitrile (73:27) mobile phase and a C-18 reverse-phase column and detected at a wavelength of 220 nm. The assay had a sensitivity of 1.6 micrograms/ml and a linearity of up to 600 micrograms/ml and 16 mg/ml in serum and urine, respectively, with only 0.1 ml of sample. The interday and intraday coefficients of variation for replicate analyses of spiked serum and urine specimens were less than 6.5%.

Benzyl alcohol interference from heparin lock flush solutions in a high pressure liquid chromatographic procedure for mezlocillin.

During the course of a pharmacokinetic study of the antibiotic mezlocillin, we observed an interfering peak in the high pressure liquid chromatographic analytical procedure that was identified as benzyl alcohol. The benzyl alcohol interferent was traced to a preservative in heparin and saline solutions used to flush heparin locks and indicated that the heparin lock purge volume was inadequate to clean the flushing solution. The present study uses this as a model to study the amount of dilution and contamination interference observed in a controlled study where the purge volume was varied for two "real situation" concentrations of benzyl alcohol in the flush solution. It was found that only 0.5 ml of purge must be drawn to avoid significant contamination interference if benzyl alcohol-free saline is used for dilutions. Contamination interference from benzyl alcohol can also be avoided by spectroscopic or chromatographic resolution if the interference is identified and the particular analyte in question can be resolved. The results of this study provide valuable information for any study in which heparin locks are used and especially in procedures where benzyl alcohol may interfere with the method of analysis. If saline containing benzyl alcohol is used for the dilution of heparin solutions, 1.0 ml of purge must be drawn.

Pharmacokinetics of mezlocillin in pleural fluid.

Mezlocillin concentrations in the pleural fluid and serum of six patients with malignant pleural effusion were determined following administration of 10 g mezlocillin over 30 minutes as a rapid infusion. Thirty minutes and eight hours after the infusion had been completed, concentrations of the active ingredient in the pleural fluid were 36.44 micrograms/ml and 112 micrograms/ml respectively; in the serum the respective values were 777.89 micrograms/ml and 44.22 micrograms/ml. The concentrations of active ingredient in the pleural fluid exceed the MIC for clinically significant pathogenic germs. The elimination half-life of mezlocillin in malignant pleural effusion is prolonged.

Investigation of mezlocillin disposition with a porcine model.

The suitability of the pig as an animal model for mezlocillin disposition was assessed. Serum, urine, and bile were collected after the administration of 50, 100 and 200 mg kg-1 mezlocillin to pigs and drug pharmacokinetics were characterized. Mezlocillin concentrations in biological fluids were determined by HPLC and free mezlocillin was determined by ultrafiltration. The pharmacokinetics of mezlocillin appeared to be independent of dose over the dosage range studied. Total clearance, renal clearance, and biliary clearance were 0.18 (0.05) 1 h-1 kg-1, 0.13 (0.03) 1 h-1 kg-1, and 0.07 (0.02) 1 h-1 kg-1, respectively. The steady-state volume of distribution was 0.29 (0.08) 1 kg-1. The pharmacokinetic parameters determined in the porcine model are similar to those reported for health human volunteers. Therefore, this model appears suitable for the study of mezlocillin disposition, and may be applied to the study of other agents that are appreciably biliary excreted.

Mezlocillin pharmacokinetics in pediatric oncology patients.

The pharmacokinetics of mezlocillin were studied in 31 children (age, 2 to 19 years) with malignancies and normal renal and hepatic functions. Mezlocillin was administered intravenously over 30 min every 4 h at doses ranging from 12.2 to 125 mg/kg. Blood samples were obtained over one dosage interval at steady state. For all patients, the mean clearance was 0.21 +/- 0.11 liter/h per kg, the mean distribution volume was 0.26 +/- 0.13 liter/kg, and the mean elimination half-life was 0.97 +/- 0.51 h. Trough concentrations were 23.0 +/- 29.9 mg/liter before the dose was administered and 20.4 +/- 27.5 mg/liter at the end of the dosing interval. Peak concentrations averaged 245 +/- 90.4 mg/liter, and average concentrations for the dosing interval were 83.7 +/- 40.4 mg/liter. There were no apparent effects of sex, malignancy, age, or dose on either the kinetic parameters or plasma concentrations. Overall, the disposition parameters for mezlocillin in this patient group were comparable to those reported in adults.

Pharmacokinetics of mezlocillin in patients with hepatobiliary dysfunction.

The pharmacokinetics of mezlocillin were investigated in 26 patients with alcoholic liver disease. Serum concentrations of mezlocillin were measured following intravenous administration of 3 g doses over 30 min. The mean peak serum concentration (+/- standard deviation) of mezlocillin at the end of infusion was 138.8 +/- 55.7 mg/l and the mean terminal half-life (T 1/2 beta) was 2.10 +/- 0.9 h. The 24 h urinary recovery of mezlocillin was 35.4 +/- 12.4% of the administered dose. Serum clearance was found to be inversely correlated with alkaline phosphatase and with total bilirubin. The T 1/2 beta was related to the following clinical measurements: age, SGOT and prothrombin time. This relationship suggests it may be prudent to adjust the dosage and the dosage interval of mezlocillin in patients with hepatobiliary dysfunction.

Pharmacokinetic properties of mezlocillin in newborn infants.

The pharmacokinetic properties of mezlocillin were evaluated in newborn infants. Mean peak and trough concentrations of drug in plasma, after 75 mg of mezlocillin per kg given intravenously, were 252 and 72 micrograms/ml, respectively, in infants who were less than 38 weeks gestation and less than or equal to 7 days old, compared with 139 and 9 micrograms/ml, respectively, in infants greater than or equal to 38 weeks gestation and greater than 7 days old. The mean elimination half-life values were from 4.5 h in preterm infants who were less than or equal to 7 days old to 1.8 h in term infants greater than or equal to 7 days old. Median peak and trough bactericidal titers of drug in plasma from neonates treated with mezlocillin were 1:8 and 1:4, respectively, against a resistant (minimal bactericidal concentration, 512 micrograms/ml) Escherichia coli strain and 1:64 and 1:32, respectively, against a susceptible (minimal bactericidal concentration, 2 micrograms/ml) E. coli strain. We propose a dosage schedule of 75 mg of mezlocillin per kg administered every 12 h to preterm (gestational age less than 38 weeks) infants less than or equal to 7 days old, every 8 h to preterm infants greater than 7 days old or term infants less than or equal to 7 days old, and every 6 h to term infants greater than 7 days old.

High-performance liquid chromatography analysis of mezlocillin, piperacillin, their degradation products, and of ioxitalamic acid in plasma and urine of healthy volunteers.

In plasma and urine of 10 healthy volunteers after intravenous administration of 4 g mezlocillin and piperacillin, respectively, the parent compounds as well as degradation products were assayed by high-performance liquid chromatography. Ioxitalamic acid, a renal contrast medium, was administered simultaneously, in order to measure the glomerular filtration rate, and to control the collection of 24-h urine. As metabolite of mezlocillin the corresponding penicilloic acid only was found, whereas in the case of piperacillin a further degradation product was observed. Half of the doses given was recovered in the urine as unchanged drugs, and in addition 5-10% as metabolites. No differences were found in the pharmacokinetic behaviour of both antibiotics.