title: Pharmacodynamic studies of amoxicillin against Streptococcus pneumoniae: comparison of a new pharmacokinetically enhanced formulation (2000 mg twice daily) with standard dosage regimens.
abstract: OBJECTIVE
  To compare the pharmacodynamic effects of a pharmacokinetically enhanced formulation of amoxicillin 2000 mg twice daily, with amoxicillin 875 mg twice daily, 875 mg three times daily and 500 mg three times daily against Streptococcus pneumoniae with different susceptibility to amoxicillin in an in vitro kinetic model.
  
  
  METHODS
  Strains of S. pneumoniae with amoxicillin MICs of 1, 2, 4 and 8 mg/L at an initial inoculum of approximately 10(5) cfu/mL were exposed to amoxicillin in an in vitro kinetic model simulating the human serum concentration-time profile of the pharmacokinetically enhanced formulation twice daily (C(max) 17 mg/L after 1.5 h). All isolates were also exposed to amoxicillin with concentration-time profiles correlating to the human dosage of 875 mg twice daily (C(max) 15 mg/L after 1 h), 875 mg three times daily and 500 mg (C(max) 8 mg/L after 1 h) three times daily with simulated half-life of 1 h. Repeated samples were taken regularly during 24 h and viable counts were carried out.
  
  
  RESULTS
  Overall, the pharmacokinetically enhanced formulation was more effective at reducing bacterial counts than any of the other formulations evaluated. Eradication was achieved with the enhanced formulation for strains with a MIC of < or =2 mg/L, however, regrowth occurred with the other dosing regimens. In the experiments with the strain with a MIC of 4 mg/L, the enhanced formulation kept the bacterial counts < or =10(2) cfu/mL for at least 14 out of 24 h tested. In contrast, none of the other formulations reduced the bacterial counts down to < or =10(2) cfu/mL at any point. None of the regimens was able to eradicate the strain with an MIC of 8 mg/L, even though an initial substantial kill was noted with the enhanced formulation after both doses. The least effective dosage regimen for all strains was 875 mg twice daily.
authors.affiliation: Antibiotic Research Unit, Department of Medical Sciences, Infectious Diseases and Clinical Bacteriology, Uppsala University, 20502 Malmö, Sweden. inga.odenholt@inf.mas.lu.se
authors.forename: Inga
authors.initials: I
authors.lastname: Odenholt
authors.forename: Otto
authors.initials: O
authors.lastname: Cars
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Löwdin
mesh_terms: D000658:Amoxicillin / Q000493:pharmacokinetics* / Q000494:pharmacology*; D000900:Anti-Bacterial Agents / Q000493:pharmacokinetics* / Q000494:pharmacology*; D002626:Chemistry, Pharmaceutical; D019818:Clavulanic Acid / Q000493:pharmacokinetics* / Q000494:pharmacology*; D015169:Colony Count, Microbial; D003198:Computer Simulation; D004305:Dose-Response Relationship, Drug; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination / Q000493:pharmacokinetics / Q000494:pharmacology; D006801:Humans; D008826:Microbial Sensitivity Tests; D008954:Models, Biological; D010599:Pharmacokinetics; D013296:Streptococcus pneumoniae / Q000187:drug effects* / Q000254:growth & development
chemical_list: D000900:Anti-Bacterial Agents; D019818:Clavulanic Acid; D000658:Amoxicillin