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Home > Impact of Omeprazole, Rosuvastatin and Clopidogrel on the Pharmacokinetics of Cefixime in Healthy Adult Human Subjects

Impact of Omeprazole, Rosuvastatin and Clopidogrel on the Pharmacokinetics of Cefixime in Healthy Adult Human Subjects

Thesis Info

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Author

Khan, Abbas

Program

PhD

Institute

University of Peshawar

City

Peshawar

Province

KPK

Country

Pakistan

Thesis Completing Year

2012

Thesis Completion Status

Completed

Subject

Applied Sciences

Language

English

Link

http://prr.hec.gov.pk/jspui/bitstream/123456789/2694/1/2679S.pdf

Added

2021-02-17 19:49:13

Modified

2024-03-24 20:25:49

ARI ID

1676726421370

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The aim of the present study is to evaluate the pharmacokinetics (PK) parameters of the cefixime in the local healthy human volunteers and to study the influence of its PK on the co-administration with omeprazole; rosuvastatin and clopidogrel on the pharmacokinetic of cefixime. The study was designed in three stages. In first stage of study, reverse phase high performance liquid chromatography (RP-HPLC-UV) method for the analysis of cefixime was developed and validated. In the second stage PK of cefixime was established in local healthy human volunteers while in the third stage potential drug-drug interaction of cefixime with concurrent administration of omeprazole, rosuvastatin and clopidogrel was investigated. A novel isocratic, simple, economic, precise, selective, and reproducible RP-HPLC-UV method of determination of cefixime and cefdinir (I.S) in human plasma was developed and validated. The cefixime was separated on a Supelco Discovery HS C 18 (150 x 4.6 mm, 5 μm) analytical column, fixed with Perkin Elmer C 18 (30 x 4.6 mm, 10 μm) guard cartridge. The methanol/acetonitrile (50/50 v/v):0.05% trifluoroacetic acid (19:81 v/v) was used as mobile phase. The flow rate was adjusted at 2.0 ml.min -1 . The temperature of the column was fixed at 50̊C and sample was injected using 20 μl loop and the eluents were monitored at a 285 nm. Sample preparation was based on a simple extraction procedure consisting of deproteination and extraction with 3 parts of 6% TCA solution (aqueous) followed by volume make up with the mobile phase. Separation of cefixime and cefdinir were achieved within 4 min. The present method demonstrated good values for specificity/selectivity, linearity (0.004-5.0 μg mL -1 ; r 2 >0.999 f), recovery I Abstract (>96% for cefixime), precision (%RSD <2.2 for cefixime), sensitivity (limit of detection: 1 ng mL -1 and lower limit of quantification: 4 ng mL -1 , stability of solutions, and robustness. The method was efficiently applied to a pharmacokinetic study in healthy adult volunteers. The PK study of cefixime in healthy human volunteers (n = 20) was conducted using single dose, open label study design. A strict inclusion and exclusion criterion was adopted. The physical, biochemical and hematological examination of every individual were conducted. Each individual volunteer was orally administered cefixime capsule (400 mg) with full glass of water (Ca ᴝ 250 ml) and blood samples were collected at preset time intervals and analyzed using HPLC. The plasma drug concentration was calculated and various PK parameters were calculated using PK summit ® a PK software. The mean ± SD of C max , T max AUC , AUC and AUMC of cefixime was 3.54 ± 0.55mg.ml -1 , 32.54 ± 5.81μg-hml -1 , 32.49 ± 5.99 μg-hml -1 and 246.67 ± 58.57 μg-h*h ml - 1 respectively. While the mean ± SD of Cl, Vd and MRT were 192.71 ± 31.46 ml/h/kg, 1200.13 ± 364.47 ml/kg and 7.23 ± 0.85h . The Pharmacokinetic analysis using non- compartment model for cefixime was also studied and the mean ± SD AUC , MRT, Cl and Vd were 33.492 ± 5.99 mg.ml -1 , 7.320 ± 0.853 h, 12270.252± 1958.550 ml/h/kg and 76485.611 ± 23318.799 ml, respectively. The present data reveal that most of the PK parameters of cefixime found in study are not significantly different from reported values in other nations and no need to adjust the dose under normal conditions. II Abstract The PK drug-drug interaction studies were carried out with same group of volunteers (n = 20) which participated in PK study with a wash out period of 3 weeks. Same protocol was adopted for inclusion and exclusion of volunteers. The single dose, two periods, two sequences, open labeled with wash out period of one week between the two interaction studies was designed. The plasma drug concentrations of cefixime following oral administration of cefixime (400 mg) alone and with simultaneous administration of omeprazole (40 mg) were investigated. The concentration of cefixime in plasma samples following simultaneous administration of cefixime (400 mg) and omeprazole (40 mg) capsule were calculated. The different PK parameters were determined to investigate interaction between cefixime and omeprazole. The C max of cefixime was significantly decreased from 3.545 ± 0.552 μg.ml -1 to 2.648 ± 0.356 mg.ml -1 whereas t max was non-significantly increase to 3.964 ± 0.118 to 4.00 ± 00 h. The decrease in AUC AUC ∞ and were also observed from 37.67 ± 3.77 μg-h ml -1 to 27.25 ± 5.94 μg-h ml - 1, 34.03 ± 5.496 μg-h ml -1 to 22.629 ± 5.99 μg-h ml - 1 and 435.415 ± 48.37, to 234.32 ± 52.43 μg-h*h/ml, respectively. The mean ± SD of Cl and Vd were reduced and MRT was increased from 192.71 ± 31.46 ml/h/kg to 188.70 ± 36.62, 1200.13 ± 364.47 to 1756.439 ± 900.81 ml/kg and 7.46 ± 4.55 h to 11.444 ± 5.42. The Pharmacokinetic analysis using non-compartment model for cefixime with simultaneous administration of omeprazole was also studied that also showed similar alteration in PK of cefixime following simultaneous administration of cefixime and III Abstract omeprazole. The alteration in drug plasma profile by changes in bound and un-bound fraction mainly affects the changes in the Cl and Vd. The change in the Cl and Vd will also alter the Vss and AUC. Similar protocol was adopted to study the PK drug drug interaction between the cefixime and rosuvastatin. Single oral dose of cefixime capsule (400 mg) alone and in combination with rosuvastatin (40 mg) were administered in healthy human volunteers (n = 20) using two periods, two sequence, open labeled, cross over design with washout period of 7 days between two treatments. Concurrent administration of cefixime with rosuvastatin significantly decreased C max , AUC and AUC ∞ of cefixime from 3.79 ± 0.69 mg.ml -1 to 2.88 ± 0.33 mg.ml -1 , 33.79 ± 6.22 μg.h ml -1 to 27.89 ± 3.80 μg.h ml -1 and from 29.06 ± 4.99 μg.h ml -1 to 25.01 ± 6.15 μg.h ml -1 , respectively. Similarly the Cl, MRT, and Vd also decreased significantly from 194.67 ± 54.23 to ± 42.48 ml/h/kg, 9.80 ± 5.22 to 8.65 ± 4.59 h and from 1435.24 ± 398.26 to 1246.21 ± 500.38 ml/h/kg, respectively. The non-compartment model analysis of the data for cefixime with co-administration with rosuvastatin showed significant decrease in AUC , and Cl from 33.49 ± 5.99 to 31.37 ± 3.89 mg.ml -1 , 12653.44 ± 7246.82 to 11893.69 ± 2761.52 ml/h/kg, respectively. while the MRT and Vd were also significantly decreased from 9.21 ± 1.21 to 8.49 ± 2.36 h and 97221.61 ± 33215.21 to 82341.41 ± 29368.67 ml. The decrease in the parameters may be due to the use of same class of transporter (SLC) both cefixime and rosuvastatin may either compete for same transporter or rosuvastatin may inhibit the transporter responsible for the transport of the cefixime across the G.I.T. membrane. IV Abstract The PK drug-drug interaction study of cefixime (400 mg) with clopidogrel (150 mg) was carried out with in healthy human volunteers (n= 20) using two period, two sequence, open labeled, cross over design with one week washout time between treatment periods. Various PK parameters like C max , T max , AUC, AUMC, MRT, t 1⁄2 β, Cl, Vd and t 1/2 β etc were calculated for cefixime single oral dose of cefixime following single oral dose of cefixime (400 mg capsule) alone and concurrent administration with clopidogrel (150 mg tablet). The data showed the decrease in the C max of cefixime from 3.35 ± 0.538 mg.ml -1 to 3.13 ± 1.13 mg.ml -1 . Whereas AUC , AUC and MRT of cefixime were also decreased from 37.67 ± 21.97 μg-h ml -1 to 32.97 ± 6.44 μg-h ml -1 , 34.04 ± 22.65 to 30.974 ± 3.664 and from 7.462 ± 5.22 h to 7.213 ± 3.198h, respectively. Moreover, non- compartment PK model was applied for cefixime with co-administration with clopidogrel was studied and the mean ± SD AUC , and Cl were decreased 41.27 ± 23.67 to 35.42 ± 6.90 mg.ml -1 , 12653.44 ± 7246.46 to 11627.21 ± 1930.77 ml/h/kg, respectively. While the MRT and Vd was decreased from 7.33 ± 0.86 to 6.96 ± 1.49 h and 76485.61± 23318.79 to 97295.95 ± 21281.29 ml, respectively. The t 1/2 β of cefixime changed from 3.64 ± 1.88 h to 6.96 ± 1.49 h with simultaneous administration of clopidogrel. The reason of alteration may be due to that; clopidogrel may competitively displace cefixime from protein and re-distribution of cefixime that may result in changes of PK parameters. The oral concurrent administration of the clopidogrel and cefixime is considered to be safe. The drug-drug interaction between the cefixime and clopidogrel may be classified as moderate type of drug-drug interaction." xml:lang="en_US
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جنہوں ہاہ نہیں بھرنی اوندی

جینوں ہاہ نہیں بھرنی اوندی
نہیں محبت کرنی اوندی
حسن اوہدے دا رعب اولّا
مینوں گل نہیں کرنی اوندی
ناانصافی جتھے ہووے
مینوں تے نہیں جرنی اوندی
کنڈیاں نال پھلاں دا پہلو
اینویں نہیں باس نکھرنی اوندی
اوہی عشق دی بازی جتے
جنھوں بازی ہرنی اوندی
چمکن بن بن چن تے تارے
جنھاں روشنی کرنی اوندی
سن کے سخن حقیقت دا یارو
حاسداں نوں پئی مرنی اوندی

Untamed Subjectivity upon Blasphemy: Comparative Subjectivity of the National and International English and National Urdu Print Media upon Reporting a Blasphemy Case in Pakistan

Objectivity of news have always been a debate, even the trusted source of information, the newspapers are not ‘clean’ so to say. Contrary to the codes of neat journalism, news reports are often found reflecting ideological, economic, regional, religious and pre-determined viewpoints. In the current study the researcher has purposely picked the blasphemy case of Aasiya Bibi from year 2010 involving Salman Taseer (late), then the Governor of Punjab and Mumtaz Qadri (late) the member of elite police force who shot Mr. Taseer and was later hanged in 2016. The researcher analyzed level of subjectivity in the news stories and editorial of two international and three national newspapers, The Guardian, The New York Time and The Dawn, Daily Jang and the Daily Express respectively. Through the scientific method of analyzing the content it is observed that in such cases, even the pioneers of print medium and the self-proclaimed champions of the codes of journalism are found overwhelmingly subjective.

In Vitro and in Vivo Evaluation of Traditional Herbs for the Control of Staphylococcus Aureus, a Causative Agent of Sore Throat

Staphylococcus aureus normally colonizes about 30 percent healthy population asymptomatically, but it has the potential to causes deep-seated infections. Life threatening diseases like septicemia, Pneumonia and endocarditis. S. aureus is also involved in many toxicoses like food poisoning. Moreover, it is considered as one of the most common causes of nosocomial infection worldwide and its increasing resistance to antibiotic makes it difficult to control spread within the community. The aims of this work was (a) to increase the knowledge about virulence and pathogenesis of S. aureus isolated from sore throat patients (b) validation of traditional herbs as an effective antibacterial remedy that can be used against methicillin resistantS. aureus (c) the effectiveness of these herbs in in vivosetting and finally (d) the toxicological assessment of active herbs. The first part of this thesis comprised of identification and characterization of S. aureus. Isolated from a sore throat patients. The strains were identified using conventional microbiological and molecular methods. The agar disc diffusion method was used to evaluate the antibiotic susceptibility profiling. Virulence-associated genes were detected using PCR while Logistic regression was used to test the likelihood of strains carrying combinations of genes involved in toxin production and/or host immune evasion. Highest resistance was observed against beta-lactam group followed by cephalosporin, lincosamide, tetracycline, macrolides and aminoglycosides. No resistance was observed against vancomycin and linezolid. Among genes involved in host immune evasion, Staphylococcus protein A (spa) was identified most frequently (81%) and proportions of capsular polysaccharides (CP8), clumping factor A (clfA) and intracellular adhesion A (ica A) were 78%, 68.5% and 40% respectively. Intracellular adhesion D (ica D) and capsular polysaccharide 5 (CP5) could not be amplified from any isolate. Toxin genes were present in 43.5% isolates. Staphylococcus enterotoxins genes (SEs) (69 %) were most frequently detected among toxin gene containing isolates, followed by enterotoxin (ETs) (24.09 %) and toxic shock syndrome toxin (TSST-1) (15 %). More than one toxin genes were present in the 32.53% isolates. Host immune evasion and toxin genes were not associated with each other. Coaand spa gene polymorphism and band association analysis revealed that spa negative isolates possess Coa 1200 and 900bp, whereas spa positive isolates contain coa of 650bp and 750bp. The spa, CP8 and sea may be considered molecular targets in designing treatment and control strategies. In the second part in vitro, antibacterial activities of 29 traditional medicinal plants used in respiratory ailments were assessed on multidrug-resistant Gram-positive and Gram-negative bacteria isolated from the sore throat patients and two reference strains. The methanolic, n-hexane and aqueous extracts were screened by the agar well diffusion assay. Bioactive fractions of effective extracts were identified on TLC coupled with bio-autography, while their toxicity was determined using hemolytic assay against human erythrocytes. Qualitative and quantitative phytochemical analysis of effective extracts was also performed. Methanolic extract of 18 plants showed antimicrobial activity against test strains. Adhatoda vasica (ZI = 17–21 mm, MIC: 7.12–62.5 ?g/ml), Althaea officinalis (ZI = 16–20 mm, MIC: 15.62–31.25 ?g/ml), Cordia latifolia (ZI = 16– 20 mm, MIC: 12.62–62.5 ?g/ml), Origanum vulgare(ZI = 20–22 mm, MIC: 3–15.62 ?g/ml), Thymus vulgaris (ZI = 21–25 mm, MIC: 7.81–31.25 ?g/ml) and Ziziphus jujuba (ZI = 14–20 mm, MIC: 7.81–31.25 ?g/ml) showed significant antibacterial activity. Alkaloid fractions of Adhatoda vasica, Cordia latifolia and Origanum vulgare and flavonoid fraction of the Althaea officinalis, Origanum vulgare, Thymus vulgaris and Ziziphus jujuba exhibited antimicrobial activity. Effective plant extracts show 0.93–4.1 % erythrocyte haemolysis. The results obtained from this study provide a scientific rationale for the traditional use of these herbs and emphasized on the in vivo validation of in vitro evaluation. The third part of study comprised of experiments on in vivo validation of in vitro finding. Six plants extract having MIC ≤ 100 μg/ml were selected for their in vivo validation against anti-MRSA activity in an animal model. Efficacy of plant extracts on the course of sore throat was checked by analyzing selected parameters and general health. Two experiments were conducted in this regard. A pilot study was conducted to determine the dose of clinical isolate required to induce clinical infection in mice. The dose at which infection established was used for the main experiment to check the effect of treatments on the progress of infections. In the main trial, after the establishment of infection treatment with plant extracts was given up to 7th-day after wards. Re-isolation, gross lesion scoring and bacterial load in tissues were measured. In addition, hematological parameters were recorded. The quantitative evaluation of bacterial load and blood parameters proved A. vasica and O. vulgare to be the best active plant even in in vivo setting. The fourth part of study comprises of the toxicological assessment of the A. vasica and O. vulgarea recommended dose in human (200 mg/ml/Kg) and double the recommended dose (400 mg/ml/Kg). Extracts were forcibly fed to the Mus musculus for 07 days consecutively and on 08 day blood sample was drawn serum were analyzed for known markers of toxicity including (ALT, AST, ALP, T. bilirubin), (Urea and Creatinine) test. Liver and kidney section were also studied through histology for any toxic effect of both extracts. High dose of both plants induced toxicity which was also supported by histological findings. It is concluded that A. vasica and O. vulgare plants showed and used to isolate broad spectrum antimicrobial compounds that will serve as a novel agent for controlling resistant and highly virulent strains of S. aureus. The plant contains a lot of secondary metabolites that can be explored for the treatment infections condition in place of antibiotics. It may prevent the development of resistance to life saving drugs.