Research Article  Open Access
Bioequivalence and Population Pharmacokinetic Modeling of Two Forms of Antibiotic, Cefuroxime Lysine and Cefuroxime Sodium, after Intravenous Infusion in Beagle Dogs
Abstract
To investigate the bioequivalence and the population pharmacokinetics of cefuroxime lysine and cefuroxime sodium in healthy beagle dogs. A randomized 2period crossover design in 18 healthy beagle dogs after receiving 20, 40, and 80 mg/kg of cefuroxime lysine or cefuroxime sodium was conducted. A 3compartment open model was used as the basic model for the population pharmacokinetic study. Both of the antibiotics exhibited doseproportional pharmacokinetics over the dose range of 20–80 mg/kg. The mean relative bioavailability of cefuroxime lysine versus cefuroxime sodium was 1.05 (range, 0.71 to 1.42), with a significant difference between males and females. The estimates of population pharmacokinetic of CL, V_{1}, Q_{2}, V_{2}, Q_{3}, V_{3} were 3.74 mL/h, 1.70 mL, 29.5 mL/min, 3.58 mL, 0.31 mL/min, and 158 mL for cefuroxime lysine and 4.10 mL/h, 1.00 mL, 38.5 mL/min, 4.19 mL, 0.06 mL/min, and 13.6 mL for cefuroxime sodium, respectively. The interindividual variability was determined to be less than 29.1%. A linear pharmacokinetic was revealed for cefuroxime lysine and cefuroxime sodium in dogs after intravenous infusion, and the bioequivalence of these forms of the antibiotic was observed with the significant genderrelated differences in mean relative bioavailability of cefuroxime lysine versus cefuroxime sodium.
1. Introduction
Cefuroxime sodium is a semisynthetic, broadspectrum, and considered as a secondgeneration cephalosporins antibiotic agent for parenteral administration. This antibiotic has been widely used for the treatments for patients having infections of soft tissue, respiratory tract, urinary tract, genital tract, central nervous system, and bone and joint tissues [1–4]. Another new cefuroxime salt, namely, cefuroxime lysine, having the merits of higher water solubility and less irritation to the veins, has also been proposed for clinical application.
In general, cefuroxime sodium, formulated as a lyophilised crystalline powder, is administered by intravenous, intramuscular, or intraperitoneal injection routes. The pharmacokinetic properties of cefuroxime sodium have been determined in several species, including goats, calves, rats, and humans [5–9]. In most cases, a 2compartment open model was considered to be the best model fitting the administration of cefuroxime sodium and which showed the values of to be 1.48 h after the intravenous or intramuscular injection of the antibiotic. Another salt of cefuroxime is cefuroxime lysine, which is a possible alternative of cefuroxime sodium. However, the pharmacokinetic studies on cefuroxime lysine are very limited. The information of cefuroxime lysine regarding its absorption, distribution, metabolism, and excretion is missing. In order to facilitate the research and development of cefuroxime lysine, the current study aimed to determine the pharmacokinetic properties of a 30 min intravenous infusion of cefuroxime lysine, or cefuroxime sodium (serving as a control), in healthy young beagle dogs. The differences in pharmacokinetic parameters between the two chemical forms of the antibiotic were compared. Moreover, we also aimed to explore the pharmacokinetic linearity for both antibiotics, as well as to monitoring the possible tolerability and side effects. Lastly, a population pharmacokinetic model was developed and evaluated.
2. Materials and Methods
2.1. Animals
Eighteen healthy beagle dogs (gender in half, 10.40–14.25 kg, aged 9–14 months) were obtained from the Experimental Animal Research and Development Center of Guangzhou Institute of Pharmaceutical Industry (Guangzhou, China), and they were housed individually in the stainlesssteel cages in a controlled environment. Filtered tap water and a standard animal diet were available ad libitum. Six animals were enrolled in each group. Before the experiment, the dogs were confirmed to be clinically healthy according to a prestudy of a physical and haematological examination. The dogs had no previous exposure to any antibiotic and other drugs during the acclimation or the study periods. The animal study was carried out in accordance with the Guidelines for Animal Experiment of Shenyang Pharmaceutical University (Shenyang, China), and the protocol was approved by Animal Ethics Committee of the Institute.
2.2. Experimental Design
The study design was a randomized 2period crossover using a doubleblind, parallelgroup, ascendingsingledose, and a week washout period between the treatments. Three dosages (containing 20, 40, 80 mg/kg according to cefuroxime) of cefuroxime sodium (purity: 98.0%, GlaxoSmithKline Manufacturing S.p.A., Italy) and cefuroxime lysine (purity: 98.8%, Shandong Luoxin Pharmacy Stock Co., Ltd., Shandong, China) were dissolved in 0.9% NaCl sterile solution. The drugs were infused constantly for 30 min with an infusion pump via the hindlimb vein of the dogs. The dose was selected based on the amount normally administered to human in clinic. The blood samples (1 mL) were withdrawn via the foreleg vein into 1.5 mL heparinized tubes at −0.5 (to serve as a control), −0.42, −0.33, −0.25, 0 (the end of infusion) and 0.25, 0.5, 1, 1.5, 2, 4, 6, 8, 10, 12 h after the end of the infusion. The plasma samples were immediately centrifuged at 3500 g for 10 min and stored at −80°C until analysis.
2.3. Analysis of Blood Samples
A triplequadrupole tandem mass spectrometer (Micromass Quattro micro API mass spectrometer, Waters Corp., Milford, MA, USA) equipped with electrospray ionization (ESI) interface was used for analytical detection [10]. In brief, an ACQUITY bridged ethyl hybrid (BEH) C_{18} column (50 mm × 2.1 mm, 1.7 μm; Waters Corp.), an internal standard (IS) of phenacetin, and a mobile phase consisting of acetonitrile0.1% formic acid in 10 mM ammonium acetate (40 : 60, v/v) were used. The ESI source was operated in positive ionization mode. Quantification was performed using multiple reaction monitoring (MRM) of the transitions of m/z for cefuroxime and m/z for IS, with the scan time of 0.20 s per transition. The optimal MS parameters were as follows: capillary voltage 2.8 kV, cone voltage 14 V for cefuroxime and 20 V for IS, source temperature 110°C, and desolvation temperature 450°C. Nitrogen was used as the desolvation and cone gas with a flow rate of 500 and 30 L/h. Argon was used as the collision gas at a pressure of approximately 0.213 Pa. The optimized collision energy for cefuroxime and IS was 8 and 20 eV, respectively. All data were collected in centroid mode and processed using MassLynx NT 4.1 software with QuanLynx program (Waters Corp.). Ten μl of sample was injected onto an UPLCMS/MS system with the lower limit of quantification of 0.01 μg/mL. The intra and interday precisions in all samples were less than 8.1%, while the accuracy was within ±6.2% of the nominal values.
2.4. Pharmacokinetic Analysis
Pharmacokinetic parameters of cefuroxime lysine and cefuroxime sodium were calculated from plasma concentrationtime curves using WinNonlin 5.2 (Pharsight Corporation, Mountain View, CA, USA) and DRUG AND STATISTICS software (DAS, version 2.1.1, Mathematical Pharmacology Professional Committee of China) by noncompartmental and compartmental modeling approaches. All values were averaged across different individuals and their standard errors were calculated.
2.4.1. Noncompartmental Pharmacokinetic Analysis
For each subject, the maximum plasma concentration and its corresponding time of the antibiotics were determined by visual inspection of the profiles. The apparent terminal elimination rate constant (λ) was calculated by linear regression of the natural logarithms of the terminal plasma concentrations. The terminal half life was derived from 0.693/λ. The area under the curve to the last measured point (AUC_{0–t}) was calculated using the trapezoidal rule. The area under the plasma concentration versus time curve from 0 h to infinite time (AUC_{0–∞}) was calculated as the sum of AUC_{0–t} and , while was the last quantifiable concentration. Total body systemic clearance (CL) was determined as the given dose divided by the AUC, and this value was normalized to the body weight. The total body weightnormalized apparent volume of distribution (V) was calculated as CL/λ/, where was the body weight of the subject. The mean residence time (MRT) was calculated by MRT = AUMC_{0–∞}/AUC_{0–∞}.
2.4.2. Compartmental Pharmacokinetic Analysis
In order to select the basic model for the population pharmacokinetic analysis, WinNonlin and DAS programs were used here to perform classic compartmental pharmacokinetic analysis. One, two, and threecompartment open model were employed to describe the observed data, respectively, and the best one was selected as the basic model of population pharmacokinetics.
2.4.3. Population Pharmacokinetic Modeling
A total of 504 plasma samples were used to establish the population pharmacokinetic model using the nonlinear mixed effects modeling (NONMEM) program (version 7.1, GloboMax LLC, Ellicott City, MD) with the fixed factors of dose, age, body weight, and gender as covariates [11, 12]. All nonmem analyses were determined by the firstorder conditional estimation. The model comparisons were made using the resulting decrease of objective function value (OFV) by nonmem. The critical value used throughout was 0.05 (OFV = 3.84). The addition of one covariate could lead to the changes of the OFV: this change resembled a distribution with a 1 degree of freedom (df). Additional population models were examined with the progressive introduction of any covariates, which were found to contribute to the statistically significant drop in OFV. A recursive backward elimination procedure was then performed to further refine the model, and a covariate would be removed from the model if the increase in OFV was less than 10.84 during the exclusion [13].
2.5. Statistical Analysis
The statistical analyses were performed by using SPSS software (version 16.0; SPSS Inc., Chicago, IL). A oneway analysis of variance (ANOVA) was used to determine the difference in different formulations, dosages, and genders. Bioequivalence of cefuroxime lysine and cefuroxime sodium was assessed by calculating 90% confidence intervals of the geometric mean ratios for , AUC_{0–t}, and AUC_{0–∞}, which should between 80% to 125% [14]. Values for were compared using nonparametric Wilcoxon twosample test. Comparisons of the pharmacokinetic parameters between different gender levels were evaluated by paired test. Descriptive statistics were expressed as arithmetic means ± standard deviation (SD) values. A value of less than 0.05 was considered statistically significant [15].
3. Results
3.1. Subject Characteristics
Each dog was individually weighted at 1 week and 2 week, and the demographic characteristics of the subjects were listed in Table 1. Insignificant difference was found in the age and weight for different dosages and genders of those dogs.
 
^{
a}: The administrated antibiotics (both cefuroxime forms). ^{ b}: M: male, F: female. ^{ c}: Data are listed as means ± SD, where . 
3.2. Noncompartmental Model Results and Statistical Analysis
The pharmacokinetic parameters of cefuroxime lysine, or cefuroxime sodium, were calculated by noncompartment model via WinNonlin and DAS: these results were listed in Tables 2 and 3. The oneway ANOVA test analyzed on the pharmacokinetic parameters obtained by WinNonlin and DAS softwares did not show any statistical difference between the two forms of cefuroxime. Cefuroxime lysine and cefuroxime sodium were rapidly absorbed and eliminated, having overall mean values of at approximately 1.15 h and 1.33 h, respectively. The mean values of and AUC for both antibiotics were significantly higher at the administrated doses of 40 and 80 mg/kg, as compared with the 20 mg/kg dose (, ). There were no significant differences of the main pharmacokinetic parameters (except for , AUC_{0–t}, AUC_{0–∞}) between the three administrated drug dosages. The mean and AUC were increased in proportional to an increased drug dosage. In contrast, the other pharmacokinetic parameters seemed to be exhibited a doseindependent manner. After normalizing the values of and AUC by the administrated dose, there was no significant difference for either 20, or 40, or 80 mg/kg of drug intake. From and AUC of different doses, as listed in Tables 2 and 3, the pharmacokinetic parameters of both antibiotics agreed well with the linear dynamic features, in a range of 20–80 mg/kg of administration, with the correlation coefficient of at least over 0.77 (Figures 1(a) and 1(b)).
 
The denotations are : elimination rate constant; : the drug elimination halflife; : volume of distribution; CL: clearance; MRT_{0∞}: mean residence time from time zero to infinity; : time to reach peak concentration; : peak concentration, AUC_{0∞}: the area under the plasma concentrationtime curve from time zero to infinity; AUMC_{0∞}: area under the first moment curve from time zero to infinity; : adjusted by dose; AUC_{adjusted}: AUC_{0∞} adjusted by dose; the values are expressed by mean ± SD, where . 
 
The denotations are : elimination rate constant; : the drug elimination half life; : volume of distribution; CL: clearance; MRT_{0∞}: mean residence time from time zero to infinity; : time to reach peak concentration; : peak concentration; AUC_{0∞}: the area under the plasma concentrationtime curve from time zero to infinity; AUMC_{0∞}: area under the first moment curve from time zero to infinity; : adjusted by dose; AUC_{adjusted}: AUC_{0∞} adjusted by dose; the values are expressed by mean ± SD, where . 
(a)
(b)
In order to investigate the relative bioavailability and bioequivalence of cefuroxime lysine and cefuroxime sodium, the ratio of dosenormalized AUC (AUC_{0–∞}/dose) between the two antibiotics was considered as the relative bioavailability. The average AUC_{0–∞}/dose for cefuroxime lysine and cefuroxime sodium was 3.28 ± 0.18, 3.27 ± 0.46, 3.24 ± 0.71 h/L and 3.27 ± 0.58, 3.04 ± 0.59, 3.21 ± 0.42 h/L at three different dosages, that are, 20, 40, and 80 mg/kg, respectively (Tables 2 and 3). Thus, there were obviously no statistical differences between the pharmacokinetic parameters of the two antibiotics. In addition, the relative bioavailability of cefuroxime lysine, between male and female, was 1.05 ± 0.18 (0.71~1.42), with a significant difference between males and females (Figure 2).
By the two oneside test and the by Wilcoxon test, the bioequivalence of the two antibiotics was determined on the basis of their , AUC_{0–t}, and AUC_{0–∞}. At the 90% confidence intervals of the cefuroxime lysine versus cefuroxime sodium in the group of 20 mg/kg, the calculated values were 90.2–112.1% for , 96.0–103.0% for AUC_{0–t}, and 96.0–103.0% for AUC_{0–∞}. The other two dose groups (40 and 80 mg/kg) were both fit the bioequivalence criterion for , AUC_{0–t}, and AUC_{0–∞}. In case of , the results showed that there was no significant difference between the two forms of antibiotics. Thus, cefuroxime lysine and cefuroxime sodium were having similar bioequivalence in terms of their rate and extent of absorption. In addition, there was no genderbased difference in the pharmacokinetic data of the two antibiotics (data not shown).
3.3. Population Pharmacokinetic Modelling
In a drug concentrationtime curve, a nonlinear relationship between drug concentration in plasma and time was observed (Figure 3). The changes of drug concentration according to time were similar for both forms of the antibiotic, and the profiles were also similar under different dosages of the antibiotics. A 3compartment open model was determined by an application of Akaike’s Information Criterion (AIC) [16]. Figure 4 illustrates that the observed plasma concentrations, most of them, fall within the standard error bars from the predicted concentrations. The analysis indicated that the predicted versus the observed drug concentrations, as well as the residuals from the predicted pooled model (Figure 4 insert), were exhibiting excellent agreement to the model. On the other hand, the correlation coefficient of the curve deriving from the predicted versus observed drug concentrations was greater than 0.96, which indicated that the 3compartment open model could therefore predict the population concentration of cefuroxime lysine, or cefuroxime sodium, when the dosages were given (Table 4). The results were in consistent with the model fitting by WinNonlin and DAS softwares.

(a)
(b)
(a)
(b)
In addition, the population pharmacokinetic parameters of cefuroxime lysine and cefuroxime sodium were estimated and listed in Table 5. Figure 5(a) showed that the dots were uniformly distributed around the line of identity, which indicated that the values of predicted drug concentration agree with the observed values very well. The individual weighted residual values (IWR, −4~6) for modelpredicted concentration shown in the rectangular distribution were well acceptable (Figure 5(b)). In addition, a drug concentration time could be developed for both the predicted versus the measured concentrations of the antibiotic in plasma (Figure 5(c)), which indeed highly similar in both cases. This calculation therefore indicated that this population 3compartment model was rather reliable to describe the final population pharmacokinetic parameters of cefuroxime lysine and cefuroxime sodium in dogs.
 
The denotations are RSE (%): relative standard error; : residual variability; : central volume of distribution; , : two peripheral volumes of distribution; , : intercompartmental clearances. 
(a)
(b)
(c)
4. Discussion
The present study evaluated the linear pharmacokinetics, genderrelated pharmacokinetic profiles and bioequivalence for βlactam agent, cefuroxime lysine, and cefuroxime sodium, in beagle dogs for the first time. It was reported that the total body water was ranged from 0.556~0.660 L/kg in healthy nonobese dogs, which were similar to the values of V for both forms of the antibiotic [17]. This result suggested the distribution of the drug, most of them might be limited to the extracellular fluid compartment, and which were not extensively distributed to most of the organ tissues. However, a hypothesis was needed to be validated according to the tissue distribution of the antibiotics in future.
The pharmacokinetic properties of cefuroxime sodium have been extensively studied with the most appropriate pharmacokinetic model of a 2compartment model [18]. Here, a 3compartment model was selected in calculating the population pharmacokinetic, the possible reasons of that might be due to the difference in administration method (intravenous infusion) and/or the better accuracy in the chemical analysis.
In summary, this intravenous infusion demonstrated that the pharmacokinetic profiles of both antibiotics were similar. Further studies are required to determine the tissue distribution, as to provide a better understanding of its distribution and elimination in the body. The values of AUC were proportional to dose administrated, except the values of CL and , and thus a linear pharmacokinetic was revealed here. There were not any side effects occurred during the trial, indicating that both forms of the antibiotic showed good tolerability. Moreover, no genderbased difference in the pharmacokinetic data was revealed, thus, the gender as a covariate was not included in the final model.
Abbreviations
:  Terminal elimination half life 
:  Maximum plasma concentration 
:  Time to arrive at the 
:  The apparent volume of distribution at steady state 
:  Central volume of distribution 
, :  Two peripheral volumes of distribution 
, :  Intercompartmental clearances 
CL:  Total body systemic clearance 
MRT:  Mean residence time 
:  Area under the curve to the last measured point 
:  Area under the plasma concentration time curve from 0 h to infinite time 
:  normalized to dose 
AUC_{adjusted}:  normalized to dose 
CV:  Coefficient of variation. 
Acknowledgments
The authors would like to thank Professor Karl Tsim of Hong Kong University of Science and Technology for his comment on this paper. This work was supported by the National Key Scientific Project for New Drug Discovery and Development (no. 2009ZX09301012).
References
 A. Fiocchi, E. Calcinai, G. Beghi, and L. Terracciano, “Paediatric upper respiratory infections: the role of antibiotics,” International Journal of Immunopathology and Pharmacology, vol. 23, no. 1, pp. 56–60, 2010. View at: Google Scholar
 A. Barbour, S. Schmidt, W. R. Rout, K. BenDavid, O. Burkhardt, and H. Derendorf, “Soft tissue penetration of cefuroxime determined by clinical microdialysis in morbidly obese patients undergoing abdominal surgery,” International Journal of Antimicrobial Agents, vol. 34, no. 3, pp. 231–235, 2009. View at: Publisher Site  Google Scholar
 J. C. Vazquez and E. Abalos, “Treatments for symptomatic urinary tract infections during pregnancy,” Cochrane Database of Systematic Reviews, vol. 19, Article ID CD002256, 2011. View at: Google Scholar
 G. M. Salzmann, F. D. Naal, F. von Knoch et al., “Effects of cefuroxime on human osteoblasts in vitro,” Journal of Biomedical Materials Research A, vol. 82, no. 2, pp. 462–468, 2007. View at: Publisher Site  Google Scholar
 K. Abo ElSooud, H. A. ElBanna, M. S. M. Hanafy, and A. Goudah, “Pharmacokinetics and intramuscular bioavailability of cefuroxime sodium in goats,” Research in Veterinary Science, vol. 69, no. 3, pp. 219–224, 2000. View at: Publisher Site  Google Scholar
 G. Benoni, L. Franco, A. Conforti, A. Totorizzo, and G. P. Velo, “Pharmacokinetics of cefuroxim and cefoxitin in experimental pleurisy in the rat,” Giornale Italiano di Chemioterapia, vol. 28, no. 12, pp. 33–39, 1981. View at: Google Scholar
 R. K. Chaudhary, A. K. Srivastava, and S. Rampal, “Modification of the pharmacokinetics and dosage of cefuroxime by endotoxininduced fever in buffalo calves,” Veterinary Research Communications, vol. 23, no. 6, pp. 361–368, 1999. View at: Publisher Site  Google Scholar
 C. A. Knoderer, S. A. Saft, S. G. Walker et al., “Cefuroxime pharmacokinetics in pediatric cardiovascular surgery patients undergoing cardiopulmonary bypass,” Journal of Cardiothoracic and Vascular Anesthesia, vol. 25, no. 3, pp. 425–430, 2011. View at: Publisher Site  Google Scholar
 M. Bischoff, A. Beck, P. Frei, and G. Bischoff, “Pharmacokinetics of cefuroxime in traumatic wound secretion and antibacterial activity under vacuum therapy,” Journal of Chemotherapy, vol. 22, no. 2, pp. 92–97, 2010. View at: Google Scholar
 L. S. Zhao, Y. L. Zhao, Q. Li et al., “A fast, sensitive, and high throughput method for the determination of cefuroxime lysine in dog plasma by UPLCMS/MS,” Talanta, vol. 89, pp. 84–90, 2012. View at: Google Scholar
 J. W. Mandema, D. Verotta, and L. B. Sheiner, “Building population pharmacokineticpharmacodynamic models. I. Models for covariate effects,” Journal of Pharmacokinetics and Biopharmaceutics, vol. 20, no. 5, pp. 511–528, 1992. View at: Publisher Site  Google Scholar
 S. L. Beal, A. J. Boeckman, and L. B. Sheiner, NONMEM: User’s Guides, Universtiy of California at San Friacisco, San Francisco Calif, USA, 1988–1992.
 A. M. Nevill, S. Bate, and R. L. Holder, “Modeling physiological and anthropometric variables known to vary with body size and other confounding variables,” American Journal of Physical Anthropology, vol. 41, pp. 141–153, 2005. View at: Google Scholar
 P. Colucci, J. Turgeon, and M. P. Ducharme, “How critical is the duration of the sampling scheme for the determination of halflife, characterization of exposure and assessment of bioequivalence?” Journal of Pharmacy and Pharmaceutical Sciences, vol. 14, no. 2, pp. 217–226, 2011. View at: Google Scholar
 J. Powers, “Statistical analysis of pharmacokinetics data,” Journal of Veterinary Pharmacology and Therapeutics, vol. 13, pp. 113–120, 1990. View at: Google Scholar
 K. Yamaoka, T. Nakagawa, and T. Uno, “Application of Akaike's information criterion (AIC) in the evaluation of linear pharmacokinetics equations,” Journal of Pharmacokinetics and Biopharmaceutics, vol. 6, no. 2, pp. 165–175, 1978. View at: Google Scholar
 S. Wamberg, N. C. F. Sandgaard, and P. Bie, “Simultaneous determination of total body water and plasma volume in conscious dogs by the indicator dilution principle,” Journal of Nutrition, vol. 132, no. 6, pp. 1711s–1713s, 2002. View at: Google Scholar
 P. Partani, S. Gurule, A. Khuroo, T. Monif, and S. Bhardwaj, “Liquid chromatography/electrospray tandem mass spectrometry method for the determination of cefuroxime in human plasma: application to a pharmacokinetic study,” Journal of Chromatography B, vol. 878, no. 34, pp. 428–434, 2010. View at: Publisher Site  Google Scholar
Copyright
Copyright © 2012 Longshan Zhao et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.