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OBJECTIVES: Increased rates of carbapenem-resistant strains of Acinetobacter baumannii have forced clinicians to rely upon last-line agents, such as the polymyxins, or empirical, unoptimized combination therapy. Therefore, the objectives of this study were: (a) to evaluate the in vitro pharmacodynamics of meropenem and polymyxin B (PMB) combinations against A. baumannii; (b) to utilize a mechanism-based mathematical model to quantify bacterial killing; and (c) to develop a genetic algorithm (GA) to define optimal dosing strategies for meropenem and PMB. METHODS: A. baumannii (N16870; MICmeropenem = 16 mg/L, MICPMB = 0.5 mg/L) was studied in the hollow-fibre infection model (initial inoculum 108 cfu/mL) over 14 days against meropenem and PMB combinations. A mechanism-based model of the data and population pharmacokinetics of each drug were used to develop a GA to define the optimal regimen parameters. RESULTS: Monotherapies resulted in regrowth to ~1010 cfu/mL by 24 h, while combination regimens employing high-intensity PMB exposure achieved complete bacterial eradication (0 cfu/mL) by 336 h. The mechanism-based model demonstrated an SC50 (PMB concentration for 50% of maximum synergy on meropenem killing) of 0.0927 mg/L for PMB-susceptible subpopulations versus 3.40 mg/L for PMB-resistant subpopulations. The GA had a preference for meropenem regimens that improved the %T > MIC via longer infusion times and shorter dosing intervals. The GA predicted that treating 90% of simulated subjects harbouring a 108 cfu/mL starting inoculum to a point of 100 cfu/mL would require a regimen of meropenem 19.6 g/day 2 h prolonged infusion (2 hPI) q5h + PMB 5.17 mg/kg/day 2 hPI q6h (where the 0 h meropenem and PMB doses should be 'loaded' with 80.5% and 42.2% of the daily dose, respectively). CONCLUSION: This study provides a methodology leveraging in vitro experimental data, a mathematical pharmacodynamic model, and population pharmacokinetics provide a possible avenue to optimize treatment regimens beyond the use of the 'traditional' indices of antibiotic action.

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Fragmentable electron donors (FEDs) are molecules designed to undergo bond fragmentation after capturing the hole created by photoexposure of silver halide. By design, the radical remaining after fragmentation is a potent reductant expected to be capable of injecting an electron into the conduction band of the silver halide. Thus, the addition of a FED to the AgX surface should allow the creation of two electrons for each photon absorbed by the substrate. Photographic studies have confirmed that the addition of FEDs can increase the photosensitivity of AgX materials. In this work, EPR spectroscopy was employed to study the processes of hole capture, donor fragmentation, and secondary electron injection by FEDs in AgBr dispersions. To do so, we used AgBr microcrystals doped with diamagnetic transition metal complexes that act as deep electron traps. For samples exposed to actinic light at 15 K, secondary electron injection was detected as an increase in the EPR signal from electrons trapped at the dopant upon annealing the samples above 50 K. Organic radical intermediates and self-trapped hole centers were the other paramagnetic species monitored in this study. The results presented here confirm that the FED sensitization mechanisms originally proposed by Gould et al. take place at silver halide surfaces and result in additional electrons in the silver halide conduction band.