title: Ultra-high performance liquid chromatographic determination of levofloxacin in human plasma and prostate tissue with use of experimental design optimization procedures.
abstract: Fluoroquinolones are considered as gold standard for the prevention of bacterial infections after transrectal ultrasound guided prostate biopsy. However, recent studies reported that fluoroquinolone- resistant bacterial strains are responsible for gradually increasing number of infections after transrectal prostate biopsy. In daily clinical practice, antibacterial efficacy is evaluated only in vitro, by measuring the reaction of bacteria with an antimicrobial agent in culture media (i.e. calculation of minimal inhibitory concentration). Such approach, however, has no relation to the treated tissue characteristics and might be highly misleading. Thus, the objective of this study was to develop, with the use of Design of Experiments approach, a reliable, specific and sensitive ultra-high performance liquid chromatography- diode array detection method for the quantitative analysis of levofloxacin in plasma and prostate tissue samples obtained from patients undergoing prostate biopsy. Moreover, correlation study between concentrations observed in plasma samples vs prostatic tissue samples was performed, resulting in better understanding, evaluation and optimization of the fluoroquinolone-based antimicrobial prophylaxis during transrectal ultrasound guided prostate biopsy. Box-Behnken design was employed to optimize chromatographic conditions of the isocratic elution program in order to obtain desirable retention time, peak symmetry and resolution of levofloxacine and ciprofloxacine (internal standard) peaks. Fractional Factorial design 2(4-1) with four center points was used for screening of significant factors affecting levofloxacin extraction from the prostatic tissue. Due to the limited number of tissue samples the prostatic sample preparation procedure was further optimized using Central Composite design. Design of Experiments approach was also utilized for evaluation of parameter robustness. The method was found linear over the range of 0.030-10μg/mL for human plasma and 0.300-30μg/g for human prostate tissue samples. The intra-day and inter-day variability for levofloxacine from both plasma and prostate samples were less than 10%, with accuracies between 93 and 108% of the nominal values. The limit of detection and the limit of quantification for human plasma were 0.01μg/mL and 0.03μg/mL, respectively. For the prostate tissue, the limit of detection and the limit of quantification were 0.1μg/g and 0.3μg/g, respectively. The average recoveries of levofloxacin were in the range from 99 to 106%. Also, the method fulfills requirements of robustness what was determined and proved by Design of Experiments. The developed method was successfully applied to examine prostate tissue and plasma samples from 140 hospitalized patients enrolled into the clinical study, 12h after oral administration of LVF at a dose of 500mg. The mean (±SD) LVF concentration in prostate was 6.22±3.52μg/g and in plasma 2.54±1.14μg/mL. Due to simplicity of the method and relative small amount of sample needed for the assay, the method can be applied in clinical practice for monitoring of LVF concentrations in plasma and prostate gland.
authors.affiliation: Medical University of Gdańsk, Department of Biopharmacy and Pharmacodynamics, Al. Gen. J. Hallera 107, 80-416 Gdańsk, Poland.
authors.forename: O
authors.initials: O
authors.lastname: Szerkus
authors.affiliation: Medical University of Gdańsk, Department of Biopharmacy and Pharmacodynamics, Al. Gen. J. Hallera 107, 80-416 Gdańsk, Poland.
authors.forename: J
authors.initials: J
authors.lastname: Jacyna
authors.affiliation: Medical University of Gdańsk, Department of Biopharmacy and Pharmacodynamics, Al. Gen. J. Hallera 107, 80-416 Gdańsk, Poland.
authors.forename: P
authors.initials: P
authors.lastname: Wiczling
authors.affiliation: Medical University of Gdańsk, Department of Urology, M. Smoluchowskiego 17, 80-214 Gdańsk, Poland.
authors.forename: A
authors.initials: A
authors.lastname: Gibas
authors.affiliation: Medical University of Gdańsk, Department of Urology, M. Smoluchowskiego 17, 80-214 Gdańsk, Poland.
authors.forename: M
authors.initials: M
authors.lastname: Sieczkowski
authors.affiliation: Medical University of Gdańsk, Department of Biopharmacy and Pharmacodynamics, Al. Gen. J. Hallera 107, 80-416 Gdańsk, Poland.
authors.forename: D
authors.initials: D
authors.lastname: Siluk
authors.affiliation: Medical University of Gdańsk, Department of Urology, M. Smoluchowskiego 17, 80-214 Gdańsk, Poland.
authors.forename: M
authors.initials: M
authors.lastname: Matuszewski
authors.affiliation: Medical University of Gdańsk, Department of Biopharmacy and Pharmacodynamics, Al. Gen. J. Hallera 107, 80-416 Gdańsk, Poland.
authors.forename: R
authors.initials: R
authors.lastname: Kaliszan
authors.affiliation: Medical University of Gdańsk, Department of Biopharmacy and Pharmacodynamics, Al. Gen. J. Hallera 107, 80-416 Gdańsk, Poland. Electronic address: markusz@gumed.edu.pl.
authors.forename: M J
authors.initials: MJ
authors.lastname: Markuszewski
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000097:blood / Q000493:pharmacokinetics*; D001424:Bacterial Infections / Q000209:etiology / Q000517:prevention & control*; D002851:Chromatography, High Pressure Liquid / Q000379:methods*; D019160:Endosonography / Q000009:adverse effects; D006801:Humans; D061705:Image-Guided Biopsy / Q000009:adverse effects; D064704:Levofloxacin / Q000097:blood / Q000493:pharmacokinetics*; D057230:Limit of Detection; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000378:metabolism / Q000382:microbiology / Q000473:pathology*
chemical_list: D000900:Anti-Bacterial Agents; D064704:Levofloxacin
keywords: Design of experiments (DoE); Human plasma; Levofloxacin; Prostate tissue; Transrectal ultrasound guided prostate biopsy (TRUS-Bx); UHPLC-DAD