Streptomycin Pharmacokinetics in Malnutrition

Prasad, J S; Krishnaswamy, Kamala

doi:10.1159/000237803

Cited by 9 publications

(7 citation statements)

References 5 publications

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“…Protein deficiency, lipids, micronutrients, and vitamins can all affect hepatic microsomal drug metabolism 24 , 25 . These studies provide some support to the suggestion that the nutritional status of an elderly patient may well cause changes in the pharmacokinetic parameters of several drugs 26–39 . It is reasonable to speculate that if pharmacokinetics are affected by malnutrition, the elderly would be most at risk.…”

Section: Pharmacokinetics and The Elderlysupporting

confidence: 56%

The Elderly, Undernutrition, and Pharmacokinetics

Lamy

1983

J American Geriatrics Society

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Section: Pharmacokinetics and The Elderlysupporting

confidence: 56%

The Elderly, Undernutrition, and Pharmacokinetics

Lamy

1983

J American Geriatrics Society

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“…In undernourished patients, in vitro binding is 61.9 ± 3.87% and in vivo 47.3 ± 6.86%. Only 50% of the protein bound streptomycin is accounted for by binding to albumin; the rest is bound to globulins (Prasad and Krishnaswamy, 1978). Other recent studies have indicated in vitro binding of 35% in normal serum and 19% in patients with kwashiorkor (Buchanan, 1977;Buchanan and van der Walt, 1977).…”

Section: Streptomycinmentioning

confidence: 98%

“…Concentrations of 10 j.lgjml are considered adequate for treatment; however, levels as low as 0.4 ILgjml may inhibit growth of M. tuberculosis (Bobrowitz, 1970(Bobrowitz, , 1974Prasad and Krishnaswamy, 1978). Earlier reports indicate that intravenous, intramuscular or subcutaneous injections yield approximately the same serum concentrations within 2 hours (Adcock and Hettig, 1946;Anderson and Jewell, 1945;Buggs et aI., 1946).…”

Section: Streptomycinmentioning

confidence: 99%

“…Ethambutol is distributed in most body tissues, including the lung, and is localised within pulmonary alveolar and axillary lymph node macro- Weber and Hein (1979) Buchanan and van der Walt (1977); Acocella (1978); Kenny and Strates (1981) Gundert-Remy et al (1913); Buchanan and van der Walt (1977); Lee et al (1918) Buchanan and van der Walt (1977) Buchanan (1977); Buchanan and van der Walt (1977); Prasad and Krishnaswamy (1978) Orme and Cutler (1969); Kirby et al (1976) Buchanan and van der Walt (1977) phages (Liss et al, 1981). At 2 to 5 hours after administration, lung levels were markedly elevated over plasma levels in squirrel monkeys.…”

Section: Ethambutolmentioning

confidence: 99%

“…Streptomycin has a Vd of 66.3 ± 7.4L in malnourished patients (n = 6) [Prasad and Krishnaswamy, 1978]. Almost all of a streptomycin dose is present in the plasma or distributed in extracellular fluids; little enters the erythrocytes.…”

Section: Streptomycinmentioning

confidence: 99%

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Clinical Pharmacokinetics of the Antituberculosis Drugs

Holdiness

1984

Clinical Pharmacokinetics

189

106

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The quantitative aspects of the disposition in man of 12 antituberculosis drugs [isoniazid, rifampicin, (rifampin), ethambutol, para-aminosalicylic acid, pyrazinamide, streptomycin, kanamycin, ethionamide, cycloserine, capreomycin, viomycin and thiacetazone] are reviewed. Isoniazid appears to be the only agent for which plasma concentrations and clearance are related to hereditary differences in acetylator status and for which there is an appreciable 'first-pass' effect. Recent data cast doubt on the suggestion that isoniazid may be more hepatotoxic for rapid as opposed to slow acetylators. Continuous administration of rifampicin leads to induction of enzymes in the liver with a concomitant decrease in maximum plasma concentrations, the time required to achieve this level, elimination half-life, and area under the plasma concentration-time curve (AUC). Coadministration of para-aminosalicylic acid leads to increases in the serum concentrations and elimination half-life of isoniazid. With a few exceptions, the metabolites of the antituberculosis drugs are devoid of antimicrobial activity; the exceptions are 25-desacetylrifampicin which accounts for approximately 80% of the drug's antimicrobial activity in human bile, the acetylated and glycylated metabolites of para-aminosalicylic acid, and the sulphoxide metabolites of ethionamide. The effect of renal impairment is relatively unimportant for the excretion of isoniazid, rifampicin and para-aminosalicylic acid, but the elimination half-life of streptomycin increases to 100 hours when the blood urea nitrogen level is greater than 100mg/100ml, and ototoxicity is strikingly more frequent. In states of malnutrition, such as kwashiorkor, the protein binding of para-aminosalicylic acid decreases from 15% to essentially zero and in the case of ethionamide and streptomycin binding decreases by 6% and 16% respectively. Of the data concerning age-related effects, most notable are the prolonged elimination half-life of isoniazid in neonates (up to 19.8 hours), and the lower peak serum concentrations of rifampicin in children of one-third to one-tenth those of adults following a similar dose on a weight basis. For kanamycin, the maximum plasma concentration varies inversely with age but is not influenced by birthweight; however, the clearance is directly dependent upon birthweight and postnatal age. For the elderly, age is an insignificant factor for the elimination of isoniazid when compared with young adults of similar acetylator status, and the metabolism of rifampicin may be considered globally unaltered in this age group.(ABSTRACT TRUNCATED AT 400 WORDS)

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Pharmacokinetics of streptomycin in Ethiopian children with tuberculosis and of different nutritional status

Bolme

Eriksson

Habte

et al. 1988

Eur J Clin Pharmacol

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Fifty-six malnourished Ethiopian children with tuberculosis classified in four nutritional groups (normal, underweight, marasmus and kwashiorkor), were given streptomycin 20 or 30 mg.kg-1 i.m. The plasma concentration-time data revealed an increased apparent volume of distribution in children with kwashiorkor compared to normals. The total plasma clearance was low and did not differ between the nutritional groups. Thus, the half-life was prolonged only in kwashiorkor. The results could be explained by decreased protein binding in plasma and decreased renal clearance by glomerular filtration.

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Streptomycin Pharmacokinetics in Malnutrition

Cited by 9 publications

References 5 publications

The Elderly, Undernutrition, and Pharmacokinetics

The Elderly, Undernutrition, and Pharmacokinetics

Clinical Pharmacokinetics of the Antituberculosis Drugs

Pharmacokinetics of streptomycin in Ethiopian children with tuberculosis and of different nutritional status

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