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For cefditoren and clavulanic acid, no significant differences were found between target free concentrations, those determined in bacteria-free simulations and those in mixed inocula simulations.
This led to pharmacokinetic parameters of amoxicillin significantly lower in mixed inocula simulations, with fT>MIC values different if β-lactamase activity is considered or not.
On the contrary, in tid amoxicillin simulations, the maintenance and even increase in β-lactamase producing strains (fT>MIC 0%) were able to protect not only S. pneumoniae (because a decrease in fT>MIC from 43.2% to 17.7% in bacteria-free vs. mixed inocula simulations) but also S. pyogenes (decrease in fT>MIC from 99.9% to 24.9%) from eradication.
S. pneumoniae decreased only 0.49 log10 and this could be related to the decrease in fT>MIC from 43.2% in bacteria-free simulations to 17.7% in mixed inocula simulations due to β-lactamase production and amoxicillin inactivation as shown in Table 1 (significantly lower amoxicillin concentrations in mixed inocula vs. bacteria-free simulations).
In addition, in order to know the effects of β-lactamase production on antibiotic pharmacokinetics and its consequences on pharmacodynamic parameters predicting antibacterial activity, pharmacokinetic parameters were determined with concentrations measured in bacterial mixed inocula simulations and in bacteria-free simulations.
Finally, in amoxicillin simulations, where clavulanic acid was not present to protect amoxicillin, negligible values were obtained for both β-lactamase producing strains, and fT>MIC decreased when comparing bacteria-free vs. mixed inocula simulations from 43.2% to 17.7% (S. pneumoniae) and from 99.9% to 24.9% (S. pyogenes) in the case of the gram-positive strains.
Similar(53)
Unpaired t test or one-way ANOVA with Tukey post test was used to compare the concentrations measured and the pharmacokinetic parameters calculated in bacteria-free simulations vs. simulations with the mixed inocula for each study drug, and of β-lactamase production between simulations with the different study drugs.
In contrast, for amoxicillin significant differences were found between concentrations determined in simulations carried out with the mixed inocula and those measured in bacteria-free simulations.
Table 1 shows concentrations and pharmacokinetic parameters experimentally measured in the peripheral compartment in bacteria-free simulations and in those simulations performed with the mixed inocula.
The situation was completely different in simulations with the mixed inocula.
β-lactamase activity was measured in antibiotic simulations with the mixed inocula at 0, Tmax, 2, 4, 6, 8, 10, 12 and 24 h using a modification of a previously described method [26], [27].
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