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New Formulations of Amoxicillin/Clavulanic AcidA Pharmacokinetic and Pharmacodynamic Review

 

作者: Amparo Sánchez Navarro,  

 

期刊: Clinical Pharmacokinetics  (ADIS Available online 2005)
卷期: Volume 44, issue 11  

页码: 1097-1115

 

ISSN:0312-5963

 

年代: 2005

 

出版商: ADIS

 

关键词: Amoxicillin/clavulanic acid, pharmacodynamics;Amoxicillin/clavulanic acid, pharmacokinetics;Antibacterials, pharmacodynamics;Antibacterials, pharmacokinetics;Bacterial infections;Beta lactamase inhibitors, pharmacodynamics;Beta lactamase inhibitors, pharm

 

数据来源: ADIS

 

摘要:

The pharmacokinetic properties of amoxicillin and clavulanic acid when used alone or in combination are extensively reviewed and discussed in this article. The reported data support a nonlinear absorption process for amoxicillin. Saturable transport mechanisms, limited solubility and the existence of an absorption window are possibly involved in the gastrointestinal absorption of this antibacterial, all leading to a decrease in the peak plasma concentration (Cmax)/dose ratio, a prolongation of the time to reach Cmax, and broad variability for high doses of amoxicillin. Data available in the literature also suggest a possible interaction between amoxicillin and clavulanic acid that might decrease the absolute bioavailability of clavulanic acid. In the present review the intrinsic pharmacodynamics of each drug, together with the synergism produced by the amoxicillin/clavulanic acid association, are also reviewed and analysed. Not only β-lactamase-producing strains, but alsoStreptococcus pneumoniaestrains, seem to be more efficiently eradicated by the association of amoxicillin and clavulanic acid, and a relevant post-antibacterial effect and post-β-lactamase inhibitor effect are likely to operate when amoxicillin is administered together with clavulanic acid.The principles of pharmacokinetic/pharmacodynamic analysis applied to amoxicillin are reviewed, with special emphasis being placed on the results obtained fromin vitrostudies and animal models regarding the new pharmacokinetically enhanced formulation. Theoretical considerations concerning the efficacy of this formulation provided by the application of pharmacokinetic/pharmacodynamic analysis to the scarce pharmacokinetic data available are also included. The broad pharmacokinetic variability of both amoxicillin and clavulanic acid, particularly when administered together and at high doses of amoxicillin, is highlighted and the interest in considering this aspect to improve predictions based on pharmacokinetic/pharmacodynamic analyses for the new formulations is indicated. Methodological recommendations such as the Monte Carlo simulation are proposed in order to obtain more realistic predictions in clinical practice.

 

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