Effect of posture on ampicillin pharmacokinetics, glomerular filtration rate and renal plasma flow in resting subjects.

Breiby, M; Aarbakke, Jarle; Sundsfjord, Johan; Goussius, G; Pape, Joy

doi:10.1111/j.1365-2125.1983.tb02242.x

Cited by 6 publications

(6 citation statements)

References 14 publications

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“…Several studies failed to show any relevant postural effect on metabolism or elimination of the drugs administered intravenously [44][45][46][47]. As there is no absorption phase after intravenous application, the effects of posture on gastric emptying are not relevant.…”

Section: Posture and Route Of Administrationmentioning

confidence: 99%

Influence of posture on pharmacokinetics

Queckenberg

Fuhr

2008

Eur J Clin Pharmacol

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Introduction Body position may influence physiological characteristics, such as perfusion, gastrointestinal function and plasma volume. These characteristics may interact with key factors determining the pharmacokinetics of drugs (dissolution, absorption, distribution, metabolism, excretion). Objectives Based on a systematic literature search, current data on the effect of posture on physiological characteristics and/or pharmacokinetics are summarized, and the relevance of possible effects, such as those presenting in clinical practice and clinical pharmacokinetic studies, is assessed. Results Postures which favour rapid gastric emptying (sitting, standing, recumbent right) accelerate the absorption of orally administered drugs. Consequently, these postures favour a shorter time to reach peak plasma drug concentration (t max ) and a higher maximum plasma drug concentration (C max ) and-in the case of transient saturation of first-pass metabolism-total exposure (area under the concentration-time curve, AUC) in comparison to recumbent left and supine positions (e.g. nifedipine: AUC 30 and 38% higher in standing and right lateral position vs. left lateral position; C max 149 and 80% higher, respectively). The magnitude of these postural effects depends strongly on the nature and amount of liquids and food ingested before drug administration and is most pronounced in the fasting state and after administration with a nonnutrient liquid. Changes in splanchnic-hepatic blood flow (e.g. reduction of estimated hepatic perfusion by 37% in standing vs. supine position) may substantially affect the metabolism of orally administered drugs, especially of those with a high/saturable first-pass metabolism. For highly protein-bound drugs (e.g. phenytoin, imipramine), the total plasma concentration has been found to be approximately 10% higher in standing than lying subjects due to changes in plasma volume. Conclusions Positioning of a patient may be an effective method of enhancing or retarding absorption of some drugs in appropriate clinical situations (e.g. toxic ingestions, bedridden patients). In clinical pharmacokinetic trials, such as bioequivalence studies, defining and maintaining posture precisely is a useful approach for reducing within-and between-subject variability.Keywords Absorption . Gastric emptying . Pharmacokinetics . Posture IntroductionThe influence of body position on physiological characteristics and pharmacokinetics has been investigated for several decades. The first study on this topic (effects of posture on gastric emptying) was reported to have been performed as early as 1918 [1] when it was observed that barium was emptied faster when subjects lay on the right side compared to other positions. Since then, a multitude of studies has addressed various aspects of postural effects, especially those on gastrointestinal motility, haematological parameters/perfusion and the pharmacokinetics of orally administered drugs.

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Section: Posture and Route Of Administrationmentioning

confidence: 99%

Influence of posture on pharmacokinetics

Queckenberg

Fuhr

2008

Eur J Clin Pharmacol

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“…Since no significant differences in the key pharmacokinetic parameters were observed for the 2 treatments administered during the day, it is reasonable to conclude that posture did not have a significant effect on the rate of absorption of cefprozil, volume of distribution and AUC of this cephalosporin. Unlike cefprozil, the effect of sitting vs standing posture on the volume of distribution of ampicillin has been reported (Breiby et al 1983). …”

Section: Discussionmentioning

confidence: 98%

“…These phenomena are caused by changes in absorption (Adir & Barr 1977;Davenport 1966), distribution (Breiby et al 1983), metabolism (DiSanto & Wagner 1972;Jori et al 1973;Patel et al 1977;Radzialowski & Bousquet 1968;Roberts & Turnbull et al 1970), and elimination (Beckett & Rowland 1964;Koike et al 1984;Roberts & Denton 1980). Several antibacterial drugs such as amoxicillin (Roberts & Denton 1980), ampicillin (Breiby et al 1983), tetracycline (Adir & Barr 1977) and cinoxacin (Koike et al 1984) have demonstrated pharmacokinetic changes due to time of administration or posture.…”

mentioning

confidence: 96%

Effects of Time of Administration and Posture on the Pharmacokinetics of Cefprozil

Shyu

Gleason

Barbhaiya

1993

Clinical Pharmacokinetics

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The effects of time of administration, sleep and posture on the pharmacokinetics of cefprozil were evaluated in a single-dose 3-way crossover study. After a 6-hour fast, 12 healthy male volunteers received oral cefprozil 250mg at 1200h (treatment A), 1200h (treatment B) and 2400h (treatment C) with a 7-day washout interval between each treatment. During the study period, volunteers receiving treatment A remained in a sitting/standing position or were ambulatory, those receiving treatment B were in the supine position, and those receiving treatment C were sleeping. Blood samples were taken over an 8-hour period and the plasma samples were analysed for the concentrations of cefprozil by a high performance liquid chromatography-ultraviolet method. Plasma concentration vs time data were analysed using noncompartmental analysis methods. Mean peak plasma concentrations (Cmax) were 4.51, 5.02 and 4.91 mg/L for treatments A, B and C, respectively. Corresponding mean values of the area under the plasma concentration-time curve (AUC(0-infinity)) were 12.6, 12.6 and 14.2 mg/L.h, respectively. The mean half-life (t1/2) values were 1.30, 1.23 and 1.50 hours for treatments A, B and C, respectively. Mean AUC(0-infinity), Cmax and t1/2 values following treatment B were not significantly different from those of treatment A. However, the mean AUC(0-infinity) and t1/2 values of cefprozil following treatment C were significantly greater than those of either treatment A or B. The mean Cmax value following treatment C was not significantly different than that of either treatments A or B. From these results, it was concluded that posture has no effect on the pharmacokinetics of cefprozil.(ABSTRACT TRUNCATED AT 250 WORDS)

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“…The primary weaknesses of OAT are inter-individual variability in the clinical outcomes and AMR owing to inter-individual variability in pharmacokinetics [25,29,30,[96][97][98] and hepatobiliary vs. renal clearance [20] delaying the achievement of the minimum inhibitory concentration (MIC) in urine [23,87]. The oral bioavailability of OAT differs with race [32,99], food intake [97], inter-individual variability in the gastric emptying time [100], posture (supine or ambulatory) [101,102], and the general health status of the patient [103]. MIC is the lowest antimicrobial concentration required to prevent the visible growth of the test strain of a microbe after a definite incubation period under strictly controlled in vitro conditions [104].…”

Section: Swots Of Oral Antimicrobial Therapy (Oat) For Cystitismentioning

confidence: 99%

“…Opportunities-predictable oral bioavailability [30,101,102,109] could reduce the delay in achieving urinary MIC [28,105], and informed clinical practices [110,111] could counter the emergence of AMR.…”

Section: Volume Of Distribution (Vd) and Clearance Of Oatmentioning

confidence: 99%

SWOT and Root Cause Analyses of Antimicrobial Resistance to Oral Antimicrobial Treatment of Cystitis

Tyagi,

Stewart

et al. 2024

Antibiotics

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Nearly 150 million cases of urinary tract infections (UTIs) are reported each year, of which uncomplicated cystitis triggers > 25% of outpatient prescriptions of oral antimicrobial treatment (OAT). OAT aids immune cells infiltrating the urothelium in eliminating uropathogens capable of invading the urothelium and surviving hyperosmotic urine. This self-evident adaptability of uropathogens and the short interval between the introduction of Penicillin and the first report of antimicrobial resistance (AMR) implicate AMR as an evolutionary conserved heritable trait of mutant strains selected by the Darwinian principle to survive environmental threats through exponential proliferation. Therefore, AMR can only be countered by antimicrobial stewardship (AMS) following the principle of the five Ds—drug, dose, duration, drug route, and de-escalation. While convenient to administer, the onset of the minimum inhibitory concentration (MIC) for OAT in urine leaves a window of opportunity for uropathogens to survive the first contact with an antimicrobial and arm their descendant colonies with AMR for surviving subsequent higher urine antimicrobial levels. Meanwhile, the initial dose of intravesical antimicrobial treatment (IAT) may be well above the MIC. Therefore, the widespread clinical use of OAT for cystitis warrants an analysis of the strengths, weaknesses, opportunity, and threats (SWOTs) and a root cause analysis of the AMR associated with OAT and IAT.

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Effect of posture on ampicillin pharmacokinetics, glomerular filtration rate and renal plasma flow in resting subjects.

Cited by 6 publications

References 14 publications

Influence of posture on pharmacokinetics

Influence of posture on pharmacokinetics

Effects of Time of Administration and Posture on the Pharmacokinetics of Cefprozil

SWOT and Root Cause Analyses of Antimicrobial Resistance to Oral Antimicrobial Treatment of Cystitis

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