title: A whole-body physiologically based pharmacokinetic (WB-PBPK) model of ciprofloxacin: a step towards predicting bacterial killing at sites of infection.
abstract: The purpose of this study was to develop a whole-body physiologically based pharmacokinetic (WB-PBPK) model for ciprofloxacin for ICU patients, based on only plasma concentration data. In a next step, tissue and organ concentration time profiles in patients were predicted using the developed model. The WB-PBPK model was built using a non-linear mixed effects approach based on data from 102 adult intensive care unit patients. Tissue to plasma distribution coefficients (Kp) were available from the literature and used as informative priors. The developed WB-PBPK model successfully characterized both the typical trends and variability of the available ciprofloxacin plasma concentration data. The WB-PBPK model was thereafter combined with a pharmacokinetic-pharmacodynamic (PKPD) model, developed based on in vitro time-kill data of ciprofloxacin and Escherichia coli to illustrate the potential of this type of approach to predict the time-course of bacterial killing at different sites of infection. The predicted unbound concentration-time profile in extracellular tissue was driving the bacterial killing in the PKPD model and the rate and extent of take-over of mutant bacteria in different tissues were explored. The bacterial killing was predicted to be most efficient in lung and kidney, which correspond well to ciprofloxacin's indications pneumonia and urinary tract infections. Furthermore, a function based on available information on bacterial killing by the immune system in vivo was incorporated. This work demonstrates the development and application of a WB-PBPK-PD model to compare killing of bacteria with different antibiotic susceptibility, of value for drug development and the optimal use of antibiotics .
authors: Department of Pharmaceutical Biosciences, Uppsala University, Box 591, 75124, Uppsala, Sweden.|CVMD iMED, DMPK, Astrazeneca, Mölndal, Sweden.
authors: Muhammad W
authors: MW
authors: Sadiq
authors: Department of Pharmaceutical Biosciences, Uppsala University, Box 591, 75124, Uppsala, Sweden.
authors: Elisabet I
authors: EI
authors: Nielsen
authors: INRA, Toxalim, Toulouse, France.|Universite de Toulouse, Toulouse, France.
authors: Dalia
authors: D
authors: Khachman
authors: Laboratoire de Pharmacocinetique et Toxicologie Clinique, Hospital Purpan, Institut Federatif de Biologie, Toulouse, France.|Pole d'Anesthesie-Reanimation, Hopital Rangueil, Toulouse, France.
authors: Jean-Marie
authors: JM
authors: Conil
authors: Laboratoire de Pharmacocinetique et Toxicologie Clinique, Hospital Purpan, Institut Federatif de Biologie, Toulouse, France.|Pole d'Anesthesie-Reanimation, Hopital Rangueil, Toulouse, France.
authors: Bernard
authors: B
authors: Georges
authors: Laboratoire de Pharmacocinetique et Toxicologie Clinique, Hospital Purpan, Institut Federatif de Biologie, Toulouse, France.
authors: Georges
authors: G
authors: Houin
authors: INRA, Toxalim, Toulouse, France.|Universite de Toulouse, Toulouse, France.
authors: Celine M
authors: CM
authors: Laffont
authors: Department of Pharmaceutical Biosciences, Uppsala University, Box 591, 75124, Uppsala, Sweden.
authors: Mats O
authors: MO
authors: Karlsson
authors: Department of Pharmaceutical Biosciences, Uppsala University, Box 591, 75124, Uppsala, Sweden. lena.friberg@farmbio.uu.se.
authors: Lena E
authors: http://orcid.org/0000-0002-2979-679X
authors: LE
authors: Friberg
mesh_terms: D000900:Anti-Bacterial Agents / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D019540:Area Under Curve; D002939:Ciprofloxacin / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D003198:Computer Simulation; D004926:Escherichia coli / Q000187:drug effects*; D004927:Escherichia coli Infections / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D014018:Tissue Distribution / Q000502:physiology
chemical_list: D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin
keywords: Antibiotic; Bacterial infection; Fluoroquinolone; Informative priors; Modeling; NONMEM; Pharmacokinetic-pharmacodynamic; Physiologically-based pharmacokinetic