Development of a Population Pharmacokinetic Model To Describe Azithromycin Whole-Blood and Plasma Concentrations over Time in Healthy Subjects

ABSTRACT Azithromycin (AZI), a broad-spectrum antibiotic, accumulates in polymorphonuclear cells and peripheral blood mononuclear cells. The distribution of AZI in proinflammatory cells may be important to the anti-inflammatory properties. Previous studies have described plasma AZI pharmacokinetics. The objective of this study was to describe the pharmacokinetics of AZI in whole blood (concentration in whole blood [ C b ]) and plasma (concentration in plasma [ C p ]) of healthy subjects. In this study, 12 subjects received AZI (500 mg once a day for 3 days). AZI C b and C p were quantified in serial samples collected up to 3 weeks after the last dose and analyzed using noncompartmental and compartmental methods. After the last dose, C b was greater than C p . Importantly, C b , but not C p , was quantifiable in all but one subject at 3 weeks. The blood area under the curve during a 24-h dosing interval (AUC 24 ) was ∼2-fold greater than the plasma AUC 24 , but simulations suggested that C b was not at steady state by day 3. Upon exploration of numerous models, an empirical 3-compartment model adequately described C p and C b , but C p was somewhat underestimated. Intercompartmental clearance (CL; likely representing cells) was lower than apparent oral CL (18 versus 118 liters/h). Plasma, peripheral, and cell compartmental volumes were 439 liters, 2,980 liters, and 3,084 liters, respectively. Interindividual variability in CL was low (26.2%), while the volume of distribution variability was high (107%). This is the first report to describe AZI C b in healthy subjects, the distribution parameters between C p and C b , and AZI retention in blood for up to 3 weeks following 3 daily doses. The model can be used to predict C b from C p for AZI under various dosing regimens. (This study has been registered at ClinicalTrials.gov under registration no. NCT01026064.