Patent Publication Number: US-6991807-B2

Title: Antibiotic composition

Description:
This application is a continuation-in-part of U.S. application Ser. No. 10/093,321, filed Mar. 7, 2002, which is a continuation-in-part of U.S. application Ser. No. 09/791,983, filed Feb. 23, 2001, which claims the priority of U.S. Provisional Application Ser. No. 60/184,545 filed on Feb. 24, 2000, the disclosures of each of which are hereby incorporated by reference in their entireties. 
    
    
     The instant application also claims the priority of International Application PCT/US03/07118, filed Mar. 7, 2003, which application claims the priority of U.S. application Ser. No. 10/093,321, filed Mar. 7, 2002, which is a continuation-in-part of U.S. application Ser. No. 09/791,983, filed Feb. 23, 2001, which claims the priority of U.S. Provisional Application Ser. No. 60/184,545 filed on Feb. 24, 2000. The disclosures of each of the foregoing applications are hereby incorporated by reference in their entireties. 
     This invention relates to antibiotic compositions and the use thereof. More particularly, this invention relates to a composition for the delivery of two or more antibiotics, and the use thereof. 
     In many cases, it is desirable to employ two different antibiotics in the treatment of a bacterial infection, in that such antibiotics may have complementary mechanisms of action that facilitate treatment of the bacterial infection. 
     The present invention is directed to a new and improved product that delivers two antibiotics one of which is a protein synthesis inhibiting antibiotic, and the other of which is a non-protein synthesis inhibiting antibiotic. In one aspect, the present invention relates to a product that delivers Clarithromycin and Amoxicillin. 
     In accordance with an aspect of the present invention, there is provided an antibiotic product for delivering at least two different antibiotics that is comprised of at least three dosage forms each comprised of at least one antibiotic and a pharmaceutically acceptable carrier, with one of the dosage forms including at least one of the at least two antibiotics and at least one dosage form including at least a second antibiotic of the at least two antibiotics, wherein one of the antibiotics is a protein synthesis inhibiting antibiotic such as Clarithromycin, and the other antibiotic is a non-protein synthesis inhibiting antibiotic such as Amoxicillin. 
     Thus, for example, each of the dosage forms may include two or more antibiotics, or one or two of the dosage forms may include only one of the two or more antibiotics and each of the remaining dosage forms may include only one or more of the different antibiotics or two or more of the antibiotics. Thus, in accordance with this aspect of the invention, there is an antibiotic product for delivering at least two different antibiotics wherein the product includes at least three dosage forms wherein each of the at least two antibiotics is present in at least one of the three dosage forms. In each case, one of the antibiotics is a protein synthesis inhibiting antibiotic such as Clarithromycin, and the other antibiotic is a non-protein synthesis inhibiting antibiotic such as Amoxicillin. 
     In accordance with an embodiment of the present invention, there is provided an antibiotic product for delivering at least two different antibiotics that is comprised of at least three dosage forms each comprised of at least one antibiotic and a pharmaceutically acceptable carrier, with one of the dosage forms including at least one of the at least two antibiotics and at least one dosage form including at least a second antibiotic of the at least two antibiotics, wherein one of the least two antibiotics is a protein synthesis inhibiting antibiotic such as Clarithromycin, and the other antibiotic is a non-protein synthesis inhibiting antibiotic such as Amoxicillin. In a preferred embodiment each dosage form includes at least one of such two antibiotics. In a particularly preferred embodiment, each dosage form includes only one of the two antibiotics with each of the two antibiotics being present in at least one of the three dosage forms. 
     In a preferred embodiment each of the dosage forms has a different release profile, with one of the dosage forms being an immediate release dosage form. 
     In another aspect, the present invention is directed to treating a bacterial infection by administering to a host in need thereof an antibiotic product as hereinabove and hereinafter described. 
     Thus, in accordance with an aspect of the present invention, there is provided a single or unitary antibiotic product that has contained therein at least three antibiotic dosage forms, each of which has a different release profile, whereby the antibiotic contained in each of the at least three dosage forms is released at different times, and wherein at least one of the dosage forms includes at least a protein synthesis inhibiting antibiotic such as Clarithromycin, and at least one of the dosage forms includes at least a non-protein synthesis inhibiting antibiotic such as Amoxicillin. One or more of the dosage forms may include both Clarithromycin and Amoxicillin. 
     In accordance with a further aspect of the invention, the antibiotic product may be comprised of at least four different dosage forms, each of which starts to release the antibiotic contained therein at different times after administration of the antibiotic product, with each of the dosage forms including at least one of either a protein synthesis inhibiting antibiotic such as Clarithromycin, or a non-protein synthesis inhibiting antibiotic such as Amoxicillin, such that at least one dosage form contains a protein synthesis inhibiting antibiotic and at least one dosage form contains at least a non-protein synthesis antibiotic. 
     The antibiotic product generally does not include more than five dosage forms with different release times. 
     In accordance with a preferred embodiment, the antibiotic product has an overall release profile such that when administered the maximum serum concentration of the total antibiotic released from the product is reached in less than twelve hours, preferably in less than eleven hours. In an embodiment, the maximum serum concentration of the total antibiotic released from the antibiotic product is achieved no earlier than four hours after administration. 
     In accordance with one preferred embodiment of the invention, one of the at least three dosage forms is an immediate release dosage form whereby initiation of release of antibiotic therefrom is not substantially delayed after administration of the antibiotic product. The second and third of the at least three dosage forms is a delayed dosage form (which may be a pH sensitive or a non-pH sensitive delayed dosage form, depending on the type of antibiotic product), whereby antibiotic released therefrom is delayed until after initiation of release of antibiotic from the immediate release dosage form. More particularly, antibiotic release from the second of the at least two dosage forms achieves a C max  (maximum serum concentration in the serum) at a time after antibiotic released from the first of the at least three dosage forms achieves a C max  in the serum, and antibiotic released from the third dosage form achieves a C max  in the serum after the C max  of antibiotic released from the second dosage form. 
     In one embodiment, the second of the at least two dosage forms initiates release of antibiotic contained therein at least one hour after the first dosage form, with the initiation of the release therefrom generally occurring no more than six hours after initiation of release of antibiotic from the first dosage form of the at least three dosage forms. 
     In general, the immediate release dosage form produces a C max  for antibiotic released therefrom within from about 0.5 to about 2 hours, with the second dosage form of the at least three dosage forms producing a C max  for antibiotic released therefrom in no more than about four hours. In general, the C max  for such second dosage form is achieved no earlier than two hours after administration of the antibiotic product; however, it is possible within the scope of the invention to achieve C max  in a shorter period of time. 
     As hereinabove indicated, the antibiotic product may contain at least three or at least four or more different dosage forms. For example, the antibiotic released from the third dosage form reaches a C max  at a time later than the C max  is achieved for antibiotic released from each of the first and second dosage forms. In a preferred embodiment, release of antibiotic from the third dosage form is started after initiation of release of antibiotic from both the first dosage form and the second dosage form. In one embodiment, C max  for antibiotic release from the third dosage form is achieved within eight hours. 
     In another embodiment, the antibiotic product contains at least four dosage forms, with each of the at least four dosage forms having different release profiles, whereby antibiotic released from each of the at least four different dosage forms achieves a C max  at a different time. 
     As hereinabove indicated, in a preferred embodiment, irrespective of whether the antibiotic contains at least three or at least four different dosage forms each with a different release profile, C max  for all the antibiotic released from the antibiotic product is achieved in less than twelve hours, and more generally is achieved in less than eleven hours. 
     In a preferred embodiment, the antibiotic product is a once a day product, whereby after administration of the antibiotic product, no further product is administered during the day; i.e., the preferred regimen is that the product is administered only once over a twenty-four hour period. Thus, in accordance with the present invention, there is a single administration of an antibiotic product with the antibiotic being released in a manner such that overall antibiotic release is effected with different release profiles in a manner such that the overall C max  for the antibiotic product is reached in less than twelve hours. The term single administration means that the total antibiotic administered over a twenty-four hour period is administered at the same time, which can be a single tablet or capsule or two or more thereof, provided that they are administered at essentially the same time. 
     Thus in accordance with an aspect of the invention, there is provided a single dosage antibiotic product comprised of at least three antibiotic dosage forms each having a different release profile with each of the dosage forms including at least one of either a protein synthesis inhibiting antibiotic such as Clarithromycin, or a non-protein synthesis inhibiting antibiotic such as Amoxicillin, such that at least one dosage form contains a protein synthesis inhibiting antibiotic and at least one dosage form contains at least a non-protein synthesis antibiotic. Each of the dosage forms of antibiotic in a pharmaceutically acceptable carrier may have one or more antibiotics. 
     In one embodiment, the first dosage form contains a first antibiotic which is one of either a protein synthesis inhibiting antibiotic or a non-protein synthesis inhibiting antibiotic and is free of the other antibiotic, and in a preferred embodiment contains only the first antibiotic; the second dosage form contains a second antibiotic which is the other of either a protein synthesis inhibiting antibiotic or a non-protein synthesis inhibiting antibiotic and is free of the first antibiotic, and in a preferred embodiment contains only second antibiotic; and the third dosage form contains the first antibiotic and is free of the second antibiotic, and in a preferred embodiment contains only the first antibiotic; and if a fourth dosage form is used, such fourth dosage form contains the second antibiotic and is free of the first antibiotic; and in a preferred embodiment bacteria are exposed to alternating pulses of the two antibiotics of the hereinabove described first and second antibiotics. In a particularly preferred embodiment the first and second antibiotics are chosen from the group consisting of Clarithromycin and Amoxicillin. 
     It is to be understood that when it is disclosed herein that a dosage form initiates release after another dosage form, such terminology means that the dosage form is designed and is intended to produce such later initiated release. It is known in the art, however, notwithstanding such design and intent, some “leakage” of antibiotic may occur. Such “leakage” is not “release” as used herein. 
     If at least four dosage forms are used, the fourth of the at least four dosage form may be a sustained release dosage form or a delayed release dosage form. If the fourth dosage form is a sustained release dosage form, even though C max  of the fourth dosage form of the at least four dosage forms is reached after the C max  of each of the other dosage forms is reached, antibiotic release from such fourth dosage form may be initiated prior to or after release from the second or third dosage form. 
     In one embodiment of the invention, one of the antibiotics of the antibiotic pairs as hereinabove and hereinafter described is a protein synthesis inhibiting antibiotic and the other antibiotic of the antibiotic pair is a non-protein synthesis inhibiting antibiotic. 
     The terminology “protein synthesis inhibiting antibiotic” means an agent that disrupts the bacterial ribosome cycle through which polypeptide chain initiation and elongation is normally effected. There are multiple points in the ribosome cycle at which this can occur. 
     The terminology “non-protein synthesis inhibiting antibiotic” means antibiotics other than protein synthesis inhibiting antibiotics. 
     As non-limiting representative examples of “protein synthesis inhibiting antibiotics” there may be mentioned: the aminoglycosides such as streptomycin, amikacin, and tobramycin; the macrolides such as erythromycin, clarithromycin, and lincomycin; the tetracyclines such as tetracycline, doxycycline, chlortetracycline, and minocycline; the oxaxolidinones such as linezolid; fusidic acid; and chloramphenicol. 
     As non-limiting representative examples of “non-protein synthesis inhibiting antibiotics” there may be mentioned: the beta-lactam penicillins such as penicillin, amoxicillin, dicloxacillin, and ampicillin; the beta lactam cephalsporins such as cefotaxime, cefuroxime, cefaclor, and ceftriaxone; the beta lactam carbapenems such as imipenem and meropenem; the quinolones such as ciprofloxacin, moxifloxacin, and levofloxacin; the sulfonamides such as sulfanilimide and sulfamethoxazole; metronidazole; rifampin; vancomycin; and nitrofurantoin. 
     In a preferred embodiment such two antibiotics are delivered in alternating pulses. 
     In a particularly preferred embodiment of the present invention, there is provided an antibiotic composition that includes three different dosage forms: the first dosage form providing an initial dosage of a first antibiotic that is a protein synthesis inhibiting antibiotic and wherein the first dosage form is free of antibiotics that are not protein synthesis inhibiting antibiotics and in one preferred embodiment contains only one antibiotic; the second dosage form providing an initial dosage of a second antibiotic that is not a protein synthesis inhibiting antibiotic and wherein the second dosage form is free of antibiotics that are protein synthesis inhibiting antibiotics and in one preferred embodiment contains only one antibiotic; and the third dosage form providing an additional dosage of said first antibiotic that is a protein synthesis inhibiting antibiotic and wherein the third dosage form is free of antibiotics that are not protein synthesis inhibiting antibiotics and in one preferred embodiment contains only one antibiotic. The first dosage form is an immediate release dosage form; and the second and third dosage forms are delayed release dosage forms. 
     In another preferred embodiment of the present invention, there is provided an antibiotic composition that includes four different dosage forms: the first dosage form providing an initial dosage of a first antibiotic that is a protein synthesis inhibiting antibiotic and wherein the first dosage form is free of antibiotics that are not protein synthesis inhibiting antibiotics and in a preferred embodiment contains only one antibiotic; the second dosage form providing an initial dosage of a second antibiotic that is not a protein synthesis inhibiting antibiotic and wherein the second dosage form is free of antibiotics that are protein synthesis inhibiting antibiotics and in a preferred embodiment contains only one antibiotic; the third dosage form providing an additional dosage of said first antibiotic that is a protein synthesis inhibiting antibiotic and wherein the third dosage form is free of antibiotics that are not protein synthesis inhibiting antibiotics and in a preferred embodiment contains only one antibiotic; and the fourth dosage form providing an additional dosage of said second antibiotic that is not a protein synthesis inhibiting antibiotic and wherein the fourth dosage form is free of antibiotics that are protein synthesis inhibiting antibiotics and in a preferred embodiment contains only one antibiotic. The first dosage form is an immediate release dosage form; the second and third dosage forms are delayed release dosage forms; and the fourth dosage form is optionally a delayed release dosage form or a sustained release dosage form, preferably a delayed release dosage form. 
     Particularly advantageous formulations of the immediately preceding embodiments of the present invention are those that comprise Clarithromycin, a protein synthesis inhibiting antibiotic as one of the antibiotics, and Amoxicillin, a non-protein synthesis inhibiting antibiotic as the other antibiotic. In these formulations a first, immediate release dosage form contains an initial dosage of Clarithromycin and is free of any non-protein synthesis inhibiting antibiotics; a second, delayed release dosage form contains an initial dosage of Amoxicillin and is free of any protein synthesis inhibiting antibiotics; and a third, delayed release dosage form provides an additional dosage of Clarithromycin and is free of any non-protein synthesis inhibiting antibiotics. An optional fourth, dosage form provides an additional dosage of Amoxicillin and is free of any protein synthesis inhibiting antibiotics. This fourth dosage form is a delayed release or a sustained release dosage form, preferably a delayed release dosage form. 
     In accordance with an aspect of the present invention, there is provided an antibiotic composition that is a mixture of antibiotic compositions or dosage forms wherein said composition contains a first composition or dosage form comprising a first antibiotic and a pharmaceutically acceptable carrier; a second composition or dosage form comprising the first antibiotic and a pharmaceutically acceptable carrier; a third composition or dosage form comprising a second antibiotic different from the first antibiotic and a pharmaceutically acceptable carrier; and a fourth composition or dosage form comprising the second antibiotic and a pharmaceutically acceptable carrier; wherein the second and third compositions each have a release profile that provides a maximum serum concentration of the first antibiotic released from the second composition and a maximum serum concentration for the second antibiotic released from the third composition at a time after the first antibiotic released from the first composition reaches a maximum serum concentration, and wherein the fourth composition has a release profile that provides for a maximum serum concentration of the second antibiotic released from the fourth composition at a time after the antibiotics released from the second and third compositions reach a maximum serum concentration. The first antibiotic is either a protein synthesis inhibiting antibiotic such as Clarithromycin or a non-protein synthesis inhibiting antibiotic such as Amoxicillin, and the second antibiotic is the other of either a protein synthesis inhibiting antibiotic such as Clarithromycin or a non-protein synthesis inhibiting antibiotic such as Amoxicillin. 
     In one embodiment, the release profiles of the second and third composition are such that the maximum serum concentration of the first antibiotic released from the second composition, and the maximum serum concentration of the second antibiotic released from the third composition are reached at approximately the same time, or where the first antibiotic reaches a maximum serum concentration before or after the second antibiotic reaches a maximum serum concentration. 
     In effect, in accordance with one preferred embodiment of the present invention, there is provided a first pulse in which a first antibiotic reaches a maximum serum concentration, a second pulse wherein a further dosage of the first antibiotic, and an initial dosage of the second antibiotic reach a maximum serum concentration at a time after the first pulse of the first antibiotic reaches a maximum serum concentration, and a third pulse wherein an additional dosage of the second antibiotic reaches a maximum serum concentration at a time after the maximum serum concentration is reached for each of the first and second antibiotic dosages provided in the second pulse. 
     In a preferred embodiment of the present invention, the first dosage of the first antibiotic achieves a maximum serum concentration within four hours after administration of the antibiotic composition; the second dosage of the first antibiotic and the first dosage of the second antibiotic each reach a maximum serum concentration within four to eight hours after administration of the antibiotic composition; and the second dosage of the second antibiotic reaches a maximum serum concentration within twelve hours after administration of the antibiotic composition. 
     Thus, in accordance with an aspect of the present invention, there is provided an antibiotic composition that includes four different dosage forms, with the first dosage form providing an initial dosage of a first antibiotic, the second dosage form providing a further dosage of the first antibiotic; the third dosage form providing an initial dosage of a second antibiotic; and the fourth dosage form providing an additional dosage of the second antibiotic, wherein the antibiotics released from the second and third dosage forms reach a maximum serum concentration at a time after the antibiotic released from the first dosage form reaches a maximum serum concentration, and the antibiotic released from the fourth dosage form reaching a maximum serum concentration at a time after the times at which the antibiotics released from each of the first, second, and third dosage forms reach a maximum serum concentration. 
     In one embodiment of the invention, the first dosage form provides for immediate release, the second and third dosage forms provide for a delayed release (pH or non pH dependent, with the second dosage form preferably being a pH dependent release), and the fourth dosage form provides for pH dependent or non pH dependent release preferably non pH dependent release. 
     In formulating the antibiotic composition of the present invention, which contains four different dosage forms, as hereinabove described, the first and second dosage forms each generally contain from about 30 percent to about 80 percent of either a protein synthesis inhibiting antibiotic such as Clarithromycin or a non-protein synthesis inhibiting antibiotic such as Amoxicillin; the third and fourth dosage forms each contain from about 30 percent to about 80 percent of the other of either a protein synthesis inhibiting antibiotic such as Clarithromycin or a non-protein synthesis inhibiting antibiotic such as Amoxicillin. In formulating a composition comprised of such four dosage forms or units, each unit or dosage form is present in an amount of at least 20 percent by weight, with each dosage form or unit being present in the overall composition in an amount that generally does not exceed 60 percent by weight. 
     Each of the first and second dosage forms include from 20% to 80% of the total dosage of the first antibiotic to be provided by the composition, and each of the first and second dosage forms may include the same or different dosages of the first antibiotic. 
     Each of the third and fourth dosage forms include from 20% to 80% of the total dosage of the second antibiotic to be delivered by the composition, and each of the third and fourth units may have the same or different dosages of the antibiotic. 
     In another embodiment the product as hereinabove described may also be formulated in a manner such that the product contains at least three dosage forms wherein each of the three dosage forms is a delayed release dosage form, with the product being free of an immediate release dosage form. As hereinabove described, the product contains both a protein synthesis inhibiting antibiotic such as Clarithromycin, and a non-protein synthesis inhibiting antibiotic such as Amoxicillin. In this embodiment the overall Cmax is reached within 12 hours after initial release of antibiotic, i.e. Cmax is achieved in less than about twelve hours after initial release of antibiotic. As hereinabove described this product may optionally contain a fourth dosage form. When such product contains a fourth dosage form, such fourth dosage form is preferably a delayed release dosage form, but may otherwise be a sustained release dosage form. As hereinabove described, in a preferred embodiment, the antibiotic product is a once a day product, whereby after administration of the antibiotic product, no further product is administered during the day; i.e., the preferred regimen is that the product is administered only once over a twenty-four hour period. Thus, in accordance with the present invention, there is a single administration of an antibiotic product with the antibiotic being released in a manner such that overall antibiotic release is effected with different release profiles in a manner such that the overall C max  for the antibiotic product is reached in less than twelve hours from the initial release of antibiotic. The term single administration means that the total antibiotic administered over a twenty-four hour period is administered at the same time, which can be a single tablet or capsule or two or more thereof, provided that they are administered at essentially the same time. 
     In formulating an antibiotic product in accordance with the invention, in one embodiment, the immediate release dosage form of the product generally provides from about 20% to about 50% of the total dosage of antibiotic to be delivered by the product, with such immediate release dosage form generally providing at least 25% of the total dosage of the antibiotic to be delivered by the product. In many cases, the immediate release dosage form provides from about 20% to about 30% of the total dosage of antibiotic to be delivered by the product; however, in some cases it may be desirable to have the immediate release dosage form provide for about 45% to about 50% of the total dosage of antibiotic to be delivered by the product. 
     The remaining dosage forms deliver the remainder of the antibiotic. If more than one delayed release dosage form is used, in one embodiment, each of the delayed release dosage forms may provide about equal amounts of antibiotic; however, they may also be formulated so as to provide different amounts. 
     In one embodiment, where the composition contains one immediate release component and two delayed release components, the immediate release component provides from 20% to 35% (preferably 20% to 30%), by weight, of the total antibiotic; where there is three delayed release components, the immediate release component provides from 15% to 30%, by weight, of the total antibiotic; and where there are four delayed release components, the immediate release component provides from 10% to 25%, by weight, of the total antibiotic. 
     With respect to the delayed release components, where there are two delayed release components, the first delayed release component (the one released earlier in time) provides from 30% to 60%, by weight, of the total antibiotic provided by the two delayed release components with the second delayed release component providing the remainder of the antibiotic. 
     Where there are three delayed release components, the earliest released component provides 20% to 35% by weight of the total antibiotic provided by the three delayed release components, the next in time delayed release component provides from 20% to 40%, by weight, of the antibiotic provided by the three delayed release components and the last in time providing the remainder of the antibiotic provided by the three delayed release components. 
     When there are four delayed release components, the earliest delayed release component provides from 15% to 30%, by weight, the next in time delayed release component provides from 15% to 30%, the next in time delayed release component provides from 20% to 35%, by weight, and the last in time delayed release component provides from 20% to 35%, by weight, in each case of the total antibiotic provided by the four delayed release components. 
     The overall composition includes each of the antibiotics in a therapeutically effective amount. The specific amount(s) is dependant on the antibiotic used, the disease or infection to be treated, and the number of times of day that the composition is to be administered. 
     The antibiotic composition of the present invention may be administered for example, by any one of the following routes of administration: sublingual, transmucosal, transdermal, parenteral, oral, preferably by oral administration. 
     The antibiotic product of the present invention, as hereinabove described, may be formulated for administration by a variety of routes of administration. For example, the antibiotic product may be formulated in a way that is suitable for topical administration; administration in the eye or the ear; rectal or vaginal administration; as nose drops; by inhalation; as an injectable; or for oral administration. In a preferred embodiment, the antibiotic product is formulated in a manner such that it is suitable for oral administration. 
     For example, in formulating the antibiotic product for topical administration, such as by application to the skin, the at least two different dosage forms, each of which contains an antibiotic, may be formulated for topical administration by including such dosage forms in an oil-in-water emulsion, or a water-in-oil emulsion. In such a formulation, the immediate release dosage form is in the continuous phase, and the delayed release dosage form is in a discontinuous phase. The formulation may also be produced in a manner for delivery of three dosage forms as hereinabove described. For example, there may be provided an oil-in-water-in-oil emulsion, with oil being a continuous phase that contains the immediate release component, water dispersed in the oil containing a first delayed release dosage form, and oil dispersed in the water containing a third delayed release dosage form. 
     It is also within the scope of the invention to provide an antibiotic product in the form of a patch, which includes antibiotic dosage forms having different release profiles, as hereinabove described. 
     In addition, the antibiotic product may be formulated for use in the eye or ear or nose, for example, as a liquid emulsion. For example, the dosage form may be coated with a hydrophobic polymer whereby a dosage form is in the oil phase of the emulsion, and a dosage form may be coated with hydrophilic polymer, whereby a dosage form is in the water phase of the emulsion. 
     Furthermore, the antibiotic product with at least three different dosage forms with different release profiles may be formulated for rectal or vaginal administration, as known in the art. This may take the form of a cream or emulsion, or other dissolvable dosage form similar to those used for topical administration. 
     As a further embodiment, the antibiotic product may be formulated for use in inhalation therapy by coating the particles and micronizing the particles for inhalation. 
     In a preferred embodiment, the antibiotic product is formulated in a manner suitable for oral administration. Thus, for example, for oral administration, each of the dosage forms may be used as a pellet or a particle, with a pellet or particle then being formed into a unitary pharmaceutical product, for example, in a capsule, or embedded in a tablet, or suspended in a liquid for oral administration. 
     Alternatively, in formulating an oral delivery system, each of the dosage forms of the product may be formulated as a tablet, with each of the tablets being put into a capsule to produce a unitary antibiotic product. Thus, for example, antibiotic products may include a first dosage form in the form of a tablet that is an immediate release tablet, and may also include two or more additional tablets, each of which provides for a delayed release of the antibiotic, as hereinabove described, whereby the C max  of the antibiotic released from each of the tablets is reached at different times, with the C max  of the total antibiotic released from the antibiotic product being achieved in less than twelve hours. 
     The formulation of an antibiotic product including at least three dosage forms with different release profiles for different routes of administration is deemed to be within the skill of the art from the teachings herein. As known in the art, with respect to delayed release, the time of release can be controlled by the concentration of antibiotics in the coating and/or the thickness of the coating. 
     As hereinabove indicated, the first and second antibiotics employed in the antibiotic composition may be a wide variety of products. In one embodiment, the combination of first and second antibiotics that are used in the composition may be, for example, a penicillin and an aminoglycoside, such as gentamycin, tobramicin, amikacin or vancomycin. Another antibiotic composition that may be employed is a combination of a sulfonamide, such as sulfamethoxasol, which would be combined with trimethoporim. In a preferred embodiment, the first and second, antibiotics are different antibiotics and each is from a different class of antibiotic. 
     The Immediate Release Component 
     The immediate release portion of this system can be a mixture of ingredients that breaks down quickly after administration to release the antibiotic. This can take the form of either a discrete pellet or granule that is mixed in with, or compressed with, the other three components. 
     The materials to be added to the antibiotics for the immediate release component can be, but are not limited to, microcrystalline cellulose, corn starch, pregelatinized starch, potato starch, rice starch, sodium carboxymethyl starch, hydroxypropylcellulose, ydroxypropylmethylcellulose, hydroxyethylcellulose, ethylcellulose, chitosan, hydroxychitosan, hydroxymethylatedchitosan, cross-linked chitosan, cross-linked hydroxymethyl chitosan, maltodextrin, mannitol, sorbitol, dextrose, maltose, fructose, glucose, levulose, sucrose, polyvinylpyrrolidone (PVP), acrylic acid derivatives (Carbopol, Eudragit, etc.), polyethylene glycols, such a low molecular weight PEGs (PEG2000–10000) and high molecular weight PEGs (Polyox) with molecular weights above 20,000 daltons. 
     It may be useful to have these materials present in the range of 1.0 to 60% (W/W). 
     In addition, it may be useful to have other ingredients in this system to aid in the dissolution of the drug, or the breakdown of the component after ingestion or administration. These ingredients can be surfactants, such as sodium lauryl sulfate, sodium monoglycerate, sorbitan monooleate, sorbitan monooleate, polyoxyethylene sorbitan monooleate, glyceryl monostearate, glyceryl monooleate, glyceryl monobutyrate, one of the non-ionic surfactants such as the Pluronic line of surfactants, or any other material with surface active properties, or any combination of the above. 
     These materials may be present in the rate of 0.05–15% (W/W). 
     The Delayed Release Component 
     The components in this composition are the same immediate release unit, but with additional polymers integrated into the composition, or as coatings over the pellet or granule. 
     Materials that can be used to obtain a delay in release suitable for this component of the invention can be, but are not limited to, polyethylene glycol (PEG) with molecular weight above 4,000 daltons (Carbowax, Polyox), waxes such as white wax or bees wax, paraffin, acrylic acid derivatives (Eudragit), propylene glycol, and ethylcellulose. 
     Typically these materials can be present in the range of 0.5–25% (W/W) of this component. 
     The Enteric Release Component 
     The components in this composition are the same as the immediate release component, but with additional polymers integrated into the composition, or as coatings over the pellet or granule. 
     The kind of materials useful for this purpose can be, but are not limited to, cellulose acetate pthalate, Eudragit L, and other pthalate salts of cellulose derivatives. 
     These materials can be present in concentrations from 4–20% (W/W). 
     The invention will be further described with respect to the following examples; however the scope of the invention is not limited thereby. All percentages stated in this specification are by weight, unless otherwise specified. 
    
    
     EXAMPLES 
     Immediate Release Component 
                                             Ingredient   Conc. (% W/W)                          Example 1:               Amoxicillin   65% (W/W)           Microcrystalline cellulose   20           Povidone   10           Croscarmellose sodium    5           Example 2:           Amoxicillin   55% (W/W)           Microcrystalline cellulose   25           Povidone   10           Croscarmellose sodium   10           Example 3:           Amoxicillin   65% (W/W)           Microcrystalline cellulose   20           Hydroxypropylcellulose   10           Croscarmellose sodium    5           Example 4:           Amoxicillin   75% (W/W)           Polyethylene glycol 4000   10           Polyethylene glycol 2000   10           Hydroxypropylcellulose    5           Example 5:           Amoxicillin   75% (W/W)           Polyethylene glycol 8000   20           Polyvinylpyrrolidone    5           Example 6:           Clarithromycin   65% (W/W)           Microcrystalline cellulose   20           Hydroxypropylcellulose   10           Croscarmellose sodium    5           Example 7:           Clarithromycin   75% (W/W)           Microcrystalline cellulose   15           Hydroxypropylcellulose    5           Croscarmellose sodium    5           Example 8:           Clarithromycin   75% (W/W)           Polyethylene glycol 4000   10           Polyethylene glycol 2000   10           Hydroxypropylcellulose    5           Example 9:           Clarithromycin   75% (W/W)           Polyethylene glycol 8000   20           Polyvinylpyrrolidone    5           Example 10:           Ciprofoxacin   65% (W/W)           Microcrystalline cellulose   20           Hydroxypropylcellulose   10           Croscarmellose sodium    5           Example 11:           Ciprofoxacin   75% (W/W)           Microcrystalline cellulose   15           Hydroxypropylcellulose    5           Croscarmellose sodium    5           Example 12:           Ciprofoxacin   75% (W/W)           Polyethylene glycol 4000   10           Polytheylene glycol 2000   10           Hydroxypropylcellulose    5           Example 13:           Cirpofoxacin   75% (W/W)           Polyethylene glycol 8000   20           Polyvinylpyrrolidone    5           Example 14:           Ceftibuten   75% (W/W)           Polyethylene glycol 4000   10           Polyethylene glycol 2000   10           Hydroxypropylcellulose    5           Example 15:           Ceftibuten   75% (W/W)           Polyethylene Glycol 4000   20           Polyvinylpyrrolidone    5                        
Delayed Release Component (Non-pH Dependant)
 
                                             Ingredient   Conc. (% W/W)                          Example 16:               Amoxicillin   65% (W/W)           Microcrystalline cellulose   20           Polyox   10           Croscarmellose sodium    5           Example 17:           Amoxicillin   55% (W/W)           Microcrystalline cellulose   25           Polyox   10           Glyceryl monooleate   10           Example 18:           Amoxicillin   65% (W/W)           Polyox   20           Hydroxypropylcellulose   10           Croscarmellose sodium    5           Example 19:           Clarithromycin   70% (W/W)           Polyox   20           Hydroxypropylcellulose    5           Croscarmellose sodium    5           Example 20:           Gentamicin   20% (W/W)           Sodium lauryl sulfate    2           Sodium monoglycerides   10           Sodium diglycerides   20           Diethyleneglycolmethylether    5           Microcrystalline cellulose   43           Example 21:           Gentamicin   10% (W/W)           Glyvceryl behanate   30           Pluronic   10           Carbopol 94P   30           Microcrystalline cellulose   20           Example 22:           Gentamicin   25% (W/W)           Carbopol 94P   35           Microcrystalline cellulose   20           Vitamin E TPGS   15           Sodium monoglycerate    5           Example 23:           Amikacin   25% (W/W)           Carbopol 94P   10           Sodium monoglycerate   15           Sodium diglycerate   15           Pluronic   10           Lactose   25           Example 24:           Gentamicin   30% (W/W)           Triacetin   15           Capryol 90    5           Poloxamer Synperonic PE/F66   10           Cab-O-Sil    5           Microcrystalline cellulose   35                        
Enteric Release Component
 
                                                Example 25:               Clarithromycin   70% (W/W)           Hydroxypropylcellulose   15           pthalate           Croscarmellose sodium   10           Example 26:           Clarithromycin   75% (W/W)           Polyethylene glycol 2000   10           Eudragit E 30D   15           Example 27:           Clarithromycin   40% (W/W)           Lactose   50           Eudgragit E 30D   10           Example 28:           Ciprofoxacin   65% (W/W)           Microcrystalline Cellulose   20           Eudragit E 30D   10           Example 29:           Ciprofoxacin   75% (W/W)           Microcrystalline Cellulose   15           Hydroxypropylcellulose   10           pthalate           Example 30:           Ciprofoxacin   80% (W/W)           Lactose   10           Eudragit E 30D   10           Example 31:           Ciprofoxacin   70% (W/W)           Polyethylene glycol 4000   20           Cellulose acetate pthalate   10           Example 32:           Ceftibuten   60% (W/W)           Polyethylene glycol 2000   10           Lactose   20           Eudragit E 30D   10           Example 33:           Ceftibuten   70% (W/W)           Microcrystalline cellulose   20           Cellulose acetate pthalate   10           Example 34:           Amoxicillin   65% (W/W)           Microcrystalline cellulose   20           Cellulose Acetate Pthalate   15           Example 35:           Amoxicillin   55% (W/W)           Microcrystalline cellulose   25           Cellulose Acetate Pthalate   10           Hydroxypropylmethylcellulose   10           Example 36:           Amoxicillin   65% (W/W)           Polyox   20           Hydroxypropylcellulose   10           pthalate           Eudragit E 30D    5           Example 37:           Amoxicillin   40% (W/W)           Microcrystalline Cellulose   40           Cellulose Acetate Pthalate   10           Example 38:           Gentamicin   20% (W/W)           Sodium lauryl sulfate    2           Sodium monoglycerides   10           Sodium diglycerides   20           Diethyleneglycolmethylether    5           Microcrystalline cellulose   30           Cellulose acetate pthalate   13           Example 39:           Gentamicin   10% (W/W)           Glyceryl behanate   30           Pluronic   10           Carbopol 94P   10           Microcrystalline cellulose   20           Eudragit E30D   20           Example 40:           Gentamicin   25% (W/W)           Carbopol 94P   15           Microcrystalline cellulose   20           Vitamin E TPGS   15           Sodium Monoglycerate    5           Eudragit E30D   20           Example 41:           Amikacin   25% (W/W)           Carbopol 94p   10           Sodium monoglycerate   15           Sodium diglycerate   15           Pluronic   10           Lactose   15           Cellulose acetate pthalate   10           Example 42:           Gentamicin   30% (W/W)           Triacetin   15           Capryol 90    5           Poloxamer SynperonicPE/F66   10           Cab-O-Sil    5           Microcrystalline cellulose   25           Eudragit E30D   10                        
Three Pulses
 
     Example 43 
     1. Antibiotic Matrix Pellet Formulation and Preparation Procedure (Immediate Release) 
     A. Pellet Formulation 
     The composition of the antibiotic matrix pellets provided in Table 1. 
     
       
         
           
               
             
               
                 TABLE 1 
               
             
            
               
                   
               
               
                 Composition of Antibiotic Pellets 
               
            
           
           
               
               
               
            
               
                   
                 Component 
                 Percentage (%) 
               
               
                   
                   
               
            
           
           
               
               
               
            
               
                   
                 Antibiotic 
                 50 
               
               
                   
                 Avicel PH 101 
                 20 
               
               
                   
                 Lactose 
                 20 
               
               
                   
                 PVP K29/32* 
                 10 
               
               
                   
                 Purified Water 
                   
               
               
                   
                 Total 
                 100 
               
               
                   
                   
               
               
                   
                 *PVP K29/32 was added as a 20% w/w aqueous solution during wet massing. 
               
            
           
         
       
     
     B. Preparation Procedure for Antibiotic Matrix Pellets
         1.2.1 Blend metronidazole and Avicel® PH 101 using a Robot Coupe high shear granulator.   1.2.2 Add 20% Povidone K29/32 binder solution slowly into the powder blend under continuous mixing.   1.2.3 Extrude the wet mass using an LCI Bench Top Granulator. The diameter of the screen of the Bench Top Granulator was 1.0 mm.   1.2.4 Spheronize the extrudate using a Model SPH20 Caleva Spheronizer.   1.2.5 Dry the spheronized pellets at 50° C. overnight.   1.2.6 Pellets between 16 and 30 Mesh were collected for further processing.       

     The above procedure is used to make pellets of a first antibiotic and pellets of a second different antibiotic. 
     1.3 Preparation of an Eudragit® L 30 D-55 Aqueous Coating Dispersion 
     A. Dispersion Formulation 
     The composition of the aqueous Eudragit L30D-55 dispersion applied to the antibiotic matrix pellets is provided below in Table 2. 
     
       
         
           
               
             
               
                 TABLE 2 
               
             
            
               
                   
               
               
                 Eudragit ® L 30 D-55 Aqueous Coating Dispersion 
               
            
           
           
               
               
               
            
               
                   
                 Component 
                 Percentage (%) 
               
               
                   
                   
               
            
           
           
               
               
               
            
               
                   
                 Eudragit ® L 30 D-55 
                 55.0 
               
               
                   
                 Triethyl Citrate 
                 1.6 
               
               
                   
                 Talc 
                 8.0 
               
               
                   
                 Purified Water 
                 37.4 
               
               
                   
                 Solids Content 
                 25.5 
               
               
                   
                 Polymer Content 
                 15.9 
               
               
                   
                   
               
            
           
         
       
     
     B. Preparation Procedure for an Eudragit® L 30 D-55 Aqueous Dispersion
         1.3.1 Suspend triethyl citrate and talc in deionized water.   1.3.2 The TEC/talc suspension is then homogenized using a PowerGen 700 high shear mixer.   1.3.3 Add the TEC/talc suspension slowly to the Eudragit® L 30 D-55 latex dispersion while stirring.   1.3.4 Allow the coating dispersion to stir for one hour prior to application onto the antibiotic matrix pellets.
 
1.4 Preparation of an Eudragit® S 100 Aqueous Coating Dispersion
       

     A. Dispersion Formulation 
     The composition of the aqueous Eudragit® S 100 dispersion applied to the antibiotic matrix pellets is provided below in Table 3. 
     
       
         
           
               
             
               
                 TABLE 3 
               
             
            
               
                   
               
               
                 Eudragit ® S 100 Aqueous Coating Dispersion 
               
            
           
           
               
               
               
            
               
                   
                 Component 
                 Percentage (%) 
               
               
                   
                   
               
            
           
           
               
               
               
            
               
                   
                 Part A 
                   
               
               
                   
                 Eudragit ® S 100 
                 12.0 
               
               
                   
                 1 N Ammonium Hydroxide 
                 6.1 
               
               
                   
                 Triethyl Citrate 
                 6.0 
               
               
                   
                 Purified Water 
                 65.9 
               
               
                   
                 Part B 
               
               
                   
                 Talc 
                 2.0 
               
               
                   
                 Purified Water 
                 8.0 
               
               
                   
                 Solid Content 
                 20.0 
               
               
                   
                 Polymer Content 
                 12.0 
               
               
                   
                   
               
            
           
         
       
     
     B. Preparation Procedure for an Eudragit® S 100 Aqueous Dispersion 
     Part I:
         (i) Dispense Eudragit® S 100 powder in deionized water with stirring.   (ii) Add ammonium hydroxide solution drop-wise into the dispersion with stirring.   (iii) Allow the partially neutralized dispersion to stir for 60 minutes.   (iv) Add triethyl citrate drop-wise into the dispersion with stirring. Stir for about 2 hours prior to the addition of Part B.       

     Part II:
         (i) Disperse talc in the required amount of water   (ii) Homogenize the dispersion using a PowerGen 700D high shear mixer.   (iii) Part B is then added slowly to the polymer dispersion in Part A with a mild stirring.
 
1.5 Coating Conditions for the Application of Aqueous Coating Dispersions
       

     The following coating parameters are used to coat matrix pellets with each of the Eudragit® L 30 D-55 and Eudragit® S 100 aqueous film coating. 
     
       
         
           
               
               
               
             
               
                   
                   
               
             
            
               
                   
                 Coating Equipment 
                 STREA 1 ™ Table Top 
               
               
                   
                   
                 Laboratory Fluid Bed Coater 
               
               
                   
                 Spray nozzle diameter 
                 1.0 mm 
               
               
                   
                 Material Charge 
                 300 gram 
               
               
                   
                 Inlet Air Temperature 
                 40 to 45° C. 
               
               
                   
                 Outlet Air Temperature 
                 30 to 33° C. 
               
               
                   
                 Atomization Air Pressure 
                 1.8 Bar 
               
               
                   
                 Pump Rate 
                 2 gram per minute 
               
               
                   
                   
               
            
           
         
       
         
         
           
             (i) Coat matrix pellets with L30 D-55 dispersion such that you apply 12% coat weight gain to the pellets. 
             (ii) Coat matrix pellets with S100 dispersion such that you apply 20% coat weight gain to the pellets.
 
1.6 Encapsulation of the Antibiotic Pellets
 
           
         
       
    
     Pellets are filled into size 00 hard gelatin capsules at a ratio of 30%: 30%: 40%: Immediate-release matrix pellets uncoated, L30 D-55 coated pellets and S100 coated pellets respectively. 
     The capsule is filled with the three different pellets to achieve a the desire dosage. 
     The immediate release matrix pellets include the first antibiotic, the L30 D-55 coated pellets are made by coating matrix pellets that contain the second antibiotic and the S100 coated pellets are made by coating matrix pellets that contain the first antibiotic. 
     Three Pulses 
     Example 44 
     Antibiotic Pellet Formulation and Preparation Procedure 
     44.1 Pellet Formulations for Subsequent Coating 
     The composition of the Antibiotictrihydrate matrix pellets provided in Table 4. 
                     TABLE 4                  Composition of AntibioticMatrix Pellets                             Component   Percentage (%)                                         AntibioticTrihydrate powder   92           Avicel PH 101   7.0           Hydroxypropyl methylcellulose, NF*   1.0           Total   100                       *Hydroxypropyl methylcellulose was added as a 2.9% w/w aqueous solution during wet massing.            
44.2 Preparation Procedure for Antibiotic Matrix Pellets
         44.2.1 Blend Antibioticand Avicel® PH 101 using a low shear blender.   44.2.2 Add the hydroxypropyl methylcellulose binder solution slowly into the powder blend under continuous mixing.   44.2.3 Extrude the wet mass using an LCI Bench Top Granulator. The diameter of the screen of the Bench Top Granulator is 0.8 mm.   44.2.4 Spheronize the extrudate using a QJ-230.5 pheronizer using a small cross section plate.   44.2.5Dry the spheronized pellets at 60° C. using a fluid bed dryer until the exhaust temperature reaches 40° C.   44.2.6 Pellets between 20 and 40 Mesh were collected for further processing.   44.2.7 The above procedure is used to produce pellets that contain a first antibiotic and pellets that contain a second and different antibiotic.
 
44.3 Preparation of an Eudragit® L 30 D-55 Aqueous Coating Dispersion
   44.3.1 Dispersion Formulation       
     The composition of the aqueous Eudragit L30D-55 dispersion applied to the Antibioticmatrix pellets is provided below in Table 5. 
                     TABLE 5                  Eudragit ® L 30 D-55 Aqueous Coating Dispersion                             Component   Percentage (%)                                         Eudragit ® L 30 D-55   41.6           Triethyl Citrate   2.5           Talc   5.0           Purified Water   50.9           Solids Content   20.0           Polymer Content   12.5                        
44.4 Preparation Procedure for an Eudragit® L 30 D-55 Aqueous Dispersion
         44.4.1 Suspend triethyl citrate and talc in deionized water.   44.4.2 The TEC/talc suspension is mixed using laboratory mixer.   44.4.3 Add the TEC/talc suspension from slowly to the Eudragit® L 30 D-55 latex dispersion while stirring.   44.4.4 Allow the coating dispersion to stir for one hour prior to application onto the Antibioticmatrix pellets.
 
44.5 Preparation of an Eudragit® S 100 Aqueous Coating Dispersion
   44.5.1 Dispersion Formulation       
     The composition of the aqueous Eudragit® S 100 dispersion applied to the Antibioticmatrix pellets is provided below in Table 6. 
                     TABLE 6                  Eudragit ® S 100 Aqueous Coating Dispersion                             Component   Percentage (%)                                         Part A               Eudragit ® S 100   10.0           1 N Ammonium Hydroxide   5.1           Triethyl Citrate   5.0           Water   64.9           Part B           Talc   5.0           Water   10.0           Solid Content   25.0           Polymer Content   10.0                        
44.6 Preparation Procedure for an Eudragit® S 100 Aqueous Dispersion
 
     Part A:
         44.6.1 Dispense Eudragit® S 100 powder in deionized water with stirring.   44.6.2 Add ammonium hydroxide solution drop-wise into the dispersion with stirring.   44.6.3 Allow the partially neutralized dispersion to stir for 60 minutes.   44.6.4 Add triethyl citrate drop-wise into the dispersion with stirring and let stir overnight prior to the addition of Part B.       

     Part B:
         44.6.5 Disperse talc in the required amount of water   44.6.6 Stir the dispersion using an overhead laboratory mixer.   44.6.7 Part B is then added slowly to the polymer dispersion in Part A with a mild stirring.
 
44.7 Coating Conditions for the Application of Aqueous Coating Dispersions
       

     The following coating parameters are used for both the Eudragit® L 30 D-55 and Eudragit® S 100 aqueous film coating processes. 
     
       
         
           
               
               
               
             
               
                   
                   
               
             
            
               
                   
                 Coating Equipment 
                 STREA 1 ™ Table Top 
               
               
                   
                   
                 Laboratory Fluid Bed Coater 
               
               
                   
                 Spray nozzle diameter 
                 1.0 mm 
               
               
                   
                 Material Charge 
                 300 gram 
               
               
                   
                 Inlet Air Temperature 
                 40 to 45° C. 
               
               
                   
                 Outlet Air Temperature 
                 30 to 33° C. 
               
               
                   
                 Atomization Air Pressure 
                 1.8 Bar 
               
               
                   
                 Pump Rate 
                 2–6 gram per minute 
               
               
                   
                   
               
            
           
         
       
         
         
           
             44.7.1 Coat matrix pellets with L30 D-55 dispersion such that you apply 20% coat weight gain to the pellets. 
             44.7.2 Coat matrix pellets with S100 dispersion such that you apply 37% coat weight gain to the pellets.
 
44.8 Preparation of AntibioticGranulation (Immediate Release Component) for tabletting
 
           
         
       
    
     
       
         
           
               
             
               
                 TABLE 7 
               
             
            
               
                   
               
               
                 Composition of AntibioticGranulation 
               
            
           
           
               
               
               
            
               
                   
                 Component 
                 Percentage (%) 
               
               
                   
                   
               
            
           
           
               
               
               
            
               
                   
                 AntibioticTrihydrate powder 
                 92 
               
               
                   
                 Avicel PH 101 
                 7.0 
               
               
                   
                 Hydroxypropyl methylcellulose, NF* 
                 1.0 
               
               
                   
                 Total 
                 100 
               
               
                   
                   
               
               
                   
                 *Hydroxypropyl methylcellulose was added as a 2.9% w/w aqueous solution during wet massing. 
               
            
           
         
       
         
         
           
             44.8.1 Blend Antibioticand Avicel® PH 101 using a low shear blender. 
             44.8.2 Add the hydroxypropyl methylcellulose binder solution slowly into the powder blend under continuous mixing. 
             44.8.3 Dry the granulation at 60° C. using a fluid bed dryer until the exhaust temperature reaches 40° C. 
             44.8.4 Granules between 20 and 40 Mesh are collected for further processing.
 
44.9 Tabletting of the AntibioticPellets
 
           
         
       
    
     
       
         
           
               
             
               
                 TABLE 8 
               
             
            
               
                   
               
               
                 Composition of AntibioticTablets 
               
            
           
           
               
               
               
            
               
                   
                 Component 
                 Percentage (%) 
               
               
                   
                   
               
            
           
           
               
               
               
            
               
                   
                 First antibiotiogranules 
                 32.5 
               
               
                   
                 Avicel PH 200 
                 5.0 
               
               
                   
                 Second antibioticL30D-55 coated pellets 
                 30 
               
               
                   
                 First antibioticS100 coated pellets 
                 30 
               
               
                   
                 Colloidal silicon dioxide 
                 1.5 
               
               
                   
                 Magnesium stearate 
                 1.0 
               
               
                   
                 Total 
                 100 
               
               
                   
                   
               
            
           
         
       
         
         
           
             44.9.1 Blend the Antibioticgranules, Avicel PH-200, Antibioticpellets and colloidal silicon dioxide for 15 minutes in a tumble blender. 
             44.9.2 Add the magnesium stearate to the blender, and blend for 5 minutes. 
             44.9.3 Compress the blend on a rotary tablet press. 
             44.9.4 The fill weight should be adjusted to achieve the desired dosage.
 
Four Pulses
 
           
         
       
    
     Example 45 
     1 Antibiotic Matrix Pellet Formulation and Preparation Procedure 
     45.1 Pellet Formulation 
     The composition of the antibiotic matrix pellets provided in Table 9. 
                     TABLE 9                  Composition of Antibiotic Pellets                             Component   Percentage (%)                                         Antibiotic   50           Avicel PH 101   20           Lactose   20           PVP K29/32*   10           Purified Water               Total   100                       *PVP K29/32 was added as a 20% w/w aqueous solution during wet massing.            
45.2 Preparation Procedure for Antibiotic Matrix Pellets
         45.2.1 Blend antibiotic and Avicel® PH 101 using a Robot Coupe high shear granulator.   45.2.2 Add 20% Povidone K29/32 binder solution slowly into the powder blend under continuous mixing.   45.2.3 Extrude the wet mass using an LCI Bench Top Granulator. The diameter of the screen of the Bench Top Granulator was 1.0 mm.   45.2.4 Spheronize the extrudate using a Model SPH20 Caleva Spheronizer.   45.2.5 Dry the spheronized pellets at 50° C. overnight.   45.2.6 Pellets between 16 and 30 Mesh were collected for further processing.   45.2.7 The above procedure is used to prepare pellets that contain a first antibiotic and pellets that contain a second antibiotic.
 
45.3 Preparation of an Eudragit® L 30 D-55 Aqueous Coating Dispersion
   45.3.1 Dispersion Formulation       
     The composition of the aqueous Eudragit L30D-55 dispersion applied to the antibiotic matrix pellets is provided below in Table 10. 
                     TABLE 10                  Eudragit ® L 30 D-55 Aqueous Coating Dispersion                             Component   Percentage (%)                                         Eudragit ® L 30 D-55   55.0           Triethyl Citrate   1.6           Talc   8.0           Purified Water   37.4           Solids Content   25.5           Polymer Content   15.9                        
45.4 Preparation Procedure for an Eudragit® L 30 D-55 Aqueous Dispersion
         45.4.1 Suspend triethyl citrate and talc in deionized water.   45.4.2 The TEC/talc suspension is then homogenized using a PowerGen 700 high shear mixer.   45.4.3 Add the TEC/talc suspension slowly to the Eudragit® L 30 D-55 latex dispersion while stirring.   45.4.4 Allow the coating dispersion to stir for one hour prior to application onto the antibiotic matrix pellets.
 
45.5 Preparation of an Eudragit® S 100 Aqueous Coating Dispersion
   45.5.1 Dispersion Formulation       
     The composition of the aqueous Eudragit® S 100 dispersion applied to the antibiotic matrix pellets is provided below in Table 11. 
                     TABLE 11                  Eudragit ® S 100 Aqueous Coating Dispersion                             Component   Percentage (%)                                         Part A               Eudragit ® S 100   12.0           1 N Ammonium Hydroxide   6.1           Triethyl Citrate   6.0           Purified Water   65.9           Part B           Talc   2.0           Purified Water   8.0           Solid Content   20.0           Polymer Content   12.0                        
45.6 Preparation Procedure for an Eudragit® S 100 Aqueous Dispersion
 
     Part A:
         45.6.1 Dispense Eudragit® S 100 powder in deionized water with stirring.   45.6.2 Add ammonium hydroxide solution drop-wise into the dispersion with stirring.   45.6.3 Allow the partially neutralized dispersion to stir for 60 minutes.   45.6.4 Add triethyl citrate drop-wise into the dispersion with stirring. Stir for about 2 hours prior to the addition of Part B.       

     Part B:
         45.6.5 Disperse talc in the required amount of water   45.6.6 Homogenize the dispersion using a PowerGen 700D high shear mixer.   45.6.7 Part B is then added slowly to the polymer dispersion in Part A with a mild stirring.
 
45.7 Coating Conditions for the Application of Aqueous Coating Dispersions
       

     The following coating parameters are used for coating with each of the Eudragit® L 30 D-55 and Eudragit® S 100 aqueous film coatings. 
     
       
         
           
               
               
               
             
               
                   
                   
               
             
            
               
                   
                 Coating Equipment 
                 STREA 1 ™ Table Top 
               
               
                   
                   
                 Laboratory Fluid Bed Coater 
               
               
                   
                 Spray nozzle diameter 
                 1.0 mm 
               
               
                   
                 Material Charge 
                 300 gram 
               
               
                   
                 Inlet Air Temperature 
                 40 to 45° C. 
               
               
                   
                 Outlet Air Temperature 
                 30 to 33° C. 
               
               
                   
                 Atomization Air Pressure 
                 1.8 Bar 
               
               
                   
                 Pump Rate 
                 2 gram per minute 
               
               
                   
                   
               
            
           
         
       
         
         
           
             45.7.1 Coat matrix pellets with L30 D-55 dispersion such that you apply 12% coat weight gain to the pellets. 
             45.7.2 Coat matrix pellets with L30 D-55 dispersion such that you apply 30% coat weight gain to the pellets. 
             45.7.3 Coat matrix pellets with S100 dispersion such that you apply 20% coat weight gain to the pellets.
 
45.8 Encapsulation of the Antibiotic Pellets
 
           
         
       
    
     Pellets are filled into size 00 hard gelatin capsules at a ratio of 20%: 30%: 20%: 30% Immediate-release matrix pellets (uncoated), L30 D-55 coated pellets 12% weight gain, L30D-55 coated pellets 30% weight gain and S100 coated pellets respectively. The capsule is filled with the four different pellets to achieve the desired dosage. 
     The immediate release pellets contain the first antibiotic; the L30 D-55 12% weight gain coated pellets containe the second antibiotic; the L30 D-55 30% weight gain coated pellets contain the first antibiotic and the S100 coated pellets contain the second antibiotic. 
     Example 46 
     Amoxicillin Pellet Formulation and Preparation Procedure 
     Pellet Formulations 
     The composition of the Amoxicillin trihydrate pellets provided in Table 12. 
                     TABLE 12                  Composition of Amoxicillin Pellets                             Component   Percentage (%)                                         Amoxicillin Trihydrate powder   92           Avicel PH 101   6.0           Polyoxyl 35 Castor Oil*   1.0           Hydroxypropyl methylcellulose, NF*   1.0           Purified Water   **           Total   100                       *Hydroxypropyl methylcellulose and Cremaphor EL were added as a 2.9% w/w aqueous solution during wet massing.           **Removed during processing            
Preparation Procedure for Amoxicillin Pellets
         Blend Amoxicillin and Avicel® PH 101 using a low shear blender.   Add the hydroxypropyl methylcellulose and Polyoxyl 35 Castor Oil binder solution slowly into the powder blend under continuous mixing.   Extrude the wet mass using an LCI Bench Top Granulator. The diameter of the screen of the Bench Top Granulator is 0.8 mm.   Spheronize the extrudate using a QJ-230 Spheronizer using a small cross section plate.   Dry the spheronized pellets at 60° C. using a fluid bed dryer until the exhaust temperature reaches 40° C.   Pellets between 20 and 40 Mesh were collected for further processing.
 
Amoxicillin Enteric-Release Pellet Formulation and Preparation Procedure
 
Preparation of an Eudragit® L 30 D-55/Eudragit NE 30D Aqueous Coating Dispersion
 
Dispersion Formulation
       
     The composition of the aqueous Eudragit L30D-55/Eudragit NE 30D aqueous coating dispersion applied to the amoxicillin pellets is provided below in Table 13. 
                     TABLE 13                  Eudragit ® L 30 D-55/Eudragit NE 30D Aqueous Coating Dispersion                             Component   Percentage (%)                                         Eudragit ® L 30D-55   44.4           Eudragit NE 30D   14.8           Triethyl Citrate   1.3           Imwitor 900   0.9           Purified Water*   38.6           Solid Content   20.6           Polymer Content   16.4                       *Removed during processing            
Preparation Procedure for an Eudragit® L 30D-55/Eudragit NE 30D Aqueous Dispersion
         Heat purified water to 75–80° C. and then add triethyl citrate (TEC) and Imwitor 900. Homogenize dispersion until temperature is less than 55° C.   The TEC/Imwitor 900 dispersion is then stirred until the temperature is less than 35° C.   Add the TEC/Imwitor 900 dispersion to Eudragit L30D-55 latex dispersion and stir for at least 30 minutes.   Add Eudragit NE 30D to the Eudragit L30DTEC/Imwitor 900 dispersion and stir for at least 10 minutes.   Screen the dispersion through a No. 60 mesh sieve prior to coating.   Continue to stir the dispersion until the coating process is complete.
 
Coating Conditions for the Application of Eudragit L30D-55/Eudragit NE 30DAqueous Coating Dispersion
       
     The following coating parameters were used for coating of the Eudragit® L 30 D-55/Eudragit NE30D film coating dispersion. 
     
       
         
           
               
               
               
             
               
                   
                   
               
             
            
               
                   
                 Coating Equipment 
                 STREA 1 ™ Table Top 
               
               
                   
                   
                 Laboratory Fluid Bed Coater 
               
               
                   
                 Spray nozzle diameter 
                 1.0 mm 
               
               
                   
                 Material Charge 
                 300 gram 
               
               
                   
                 Inlet Air Temperature 
                 45° C. 
               
               
                   
                 Outlet Air Temperature 
                 32 to 35° C. 
               
               
                   
                 Atomization Air Pressure 
                 1.6 Bar 
               
               
                   
                 Pump Rate 
                 3–4 gram per minute 
               
               
                   
                   
               
            
           
         
       
     
     Coat Amoxicillin pellets with Eudragit L30 D-55/Eudragit NE 30D film coating dispersion such that you apply 20% coat weight gain to the pellets. 
     Amoxicillin Delayed Enteric-Release Pellets Formulation and Preparation Procedure 
     Preparation of an AQOAT AS-HF Aqueous Coating Dispersion 
     Dispersion Formulation 
     The composition of the aqueous AQOAT AS-HF aqueous coating dispersion applied to the amoxicillin pellets is provided below in Table 14. 
                     TABLE 14                  AQOAT AS-HF Aqueous Coating Dispersion                             Component   Percentage (%)                                         AQOAT AS-HF   7.0           Triethyl Citrate   2.0           Talc   2.1           Sodium lauryl sulfate   0.2           Purified Water*   88.7           Solid Content   11.3           Polymer Content   7.0                       *Removed during processing            
Preparation Procedure for an AQOAT AS-HF Aqueous Dispersion
         Add triethyl citrate (TEC) to the purified water with stirring.   Add the sodium lauryl sulfate (SLS) to the TEC dispersion with stirring and completely until completely dissolved.   Add the AQOAT to the TEC/SLS dispersion and stir for at least 30 minutes.   Add the talc to the AQOAT dispersion and until completely mixed and for at least 30 minutes.   Screen the dispersion through a No. 60 mesh sieve prior to coating.   Continue to stir the dispersion until the coating process is complete.
 
Coating Conditions for the Application of AQOAT AS-HF Aqueous Coating Dispersion
       
     The following coating parameters were used for coating of the AQOAT AS-HF film coating dispersion. 
     
       
         
           
               
               
               
             
               
                   
                   
               
             
            
               
                   
                 Coating Equipment 
                 STREA 1 ™ Table Top 
               
               
                   
                   
                 Laboratory Fluid Bed Coater 
               
               
                   
                 Spray nozzle diameter 
                 1.0 mm 
               
               
                   
                 Material Charge 
                 300 gram 
               
               
                   
                 Inlet Air Temperature 
                 48° C. 
               
               
                   
                 Outlet Air Temperature 
                 27° C. 
               
               
                   
                 Atomization Air Pressure 
                 1.6 Bar 
               
               
                   
                 Pump Rate 
                 3–4 gram per minute 
               
               
                   
                   
               
            
           
         
       
     
     Coat amoxicillin pellets with AQOAT AS-HF film coating dispersion such that you apply 30–35% coat weight gain to the pellets. 
     Amoxicillin Colonic-Release Pellet Formulation and Preparation Procedure 
     Preparation of an Eudragit® FS 30D Aqueous Coating Dispersion 
     Dispersion Formulation 
     The composition of the aqueous Eudragit® FS 30D dispersion applied to the Amoxicillin pellets is provided below in Table 15. 
                     TABLE 15                  Eudragit ® FS 30D Aqueous Coating Dispersion                             Component   Percentage (%)                                         Eudragit ® FS 30D   54.8           Triethyl Citrate   0.9           Talc   3.3           Purified Water*   41.0           Solid Content   20.6           Polymer Content   16.4                       *Removed during processing            
Preparation Procedure for an Eudragit® FS 30D Aqueous Dispersion
         Disperse triethyl citrate (TEC) in the purified water.   Add the talc in the triethyl citrate dispersion.   Homogenize the dispersion using a homogenizer.   Add slowly the Eudragit® FS 30D dispersion to the talc/TEC dispersion with stirring.       
     Continue to stir the coating dispersion until the coating process is complete. 
     Coating Conditions for the Application of Eudragit FS30D Aqueous Coating Dispersion 
     The following coating parameters were used for coating with each of the Eudragit® FS 30 D aqueous film coating. 
     
       
         
           
               
               
               
             
               
                   
                   
               
             
            
               
                   
                 Coating Equipment 
                 STREA 1 ™ Table Top 
               
               
                   
                   
                 Laboratory Fluid Bed Coater 
               
               
                   
                 Spray nozzle diameter 
                 1.2 mm 
               
               
                   
                 Material Charge 
                 300 gram 
               
               
                   
                 Inlet Air Temperature 
                 38° C. 
               
               
                   
                 Outlet Air Temperature 
                 22° C. 
               
               
                   
                 Atomization Air Pressure 
                 1.6 Bar 
               
               
                   
                 Pump Rate 
                 6 gram per minute 
               
               
                   
                   
               
            
           
         
       
     
     Coat pellets with Eudragit FS 30D coating dispersion dispersion such that you apply 30% coat weight gain to the pellets. 
     Clarithromycin Pellet Formulation and Preparation Procedure 
     Pellet Formulation 
     The composition of the clarithromycin pellets provided in Table 16. 
                     TABLE 16                  Composition of Clarithromycin Pellets                             Component   Percentage (%)                                         Clarithromycin   77.0           Lactose monohydrate, spray dried   11.0           Croscarmellose sodium   5.0           Polyoxyl 35 Castor Oil*   5.0           Hydroxypropyl methylcellulose*   2.0           Purified water   *           Total   100                       *Removed during processing            
Preparation Procedure for Clarithromycin Pellets
         Prepare the binder solution by adding the Polyoxyl to the purified water while stirring. After that is mixed, slowly add the hydroxypropyl methylcellulose and continue to stir until a solution is achieved.   Blend clarithromycin, lactose monohydrate, and croscarmellose sodium using a Robot Coupe high shear granulator.   Add binder solution slowly into the powder blend under continuous mixing.   Granulate the powders in the high shear granulator with the binder solution.   Extrude the wet mass using an LCI Bench Top Granulator. The diameter of the screen of the Bench Top Granulator was 1.0 mm.   Spheronize the extrudate using a Model SPH20 Caleva Spheronizer.   Dry the spheronized pellets at 50° C. until the moisture level is &gt;3%.   Pellets between 16 and 30 Mesh were collected for further processing.
 
Clarithromycin Enteric-Release Pellet Formulation and Preparation Procedure
 
Preparation of an Eudragit® L 30 D-55/Eudragit NE 30D Aqueous Coating Dispersion
 
Dispersion Formulation
       
     The composition of the aqueous Eudragit L30D-55/Eudragit NE 30D aqueous coating dispersion applied to the clarithromycin pellets is provided below in Table 17. 
                     TABLE 17                  Eudragit ® L 30 D-55/Eudragit NE 30D Aqueous Coating Dispersion                             Component   Percentage (%)                                         Eudragit ® L 30D-55   44.4           Eudragit NE 30D   14.8           Triethyl Citrate   1.3           Imwitor 900   0.9           Purified Water*   38.6           Solid Content   20.6           Polymer Content   16.4                       *Removed during processing            
Preparation Procedure for an Eudragit® L 30D-55/Eudragit NE 30D Aqueous Dispersion
         Heat purified water to 75–80° C. and then add triethyl citrate (TEC) and Imwitor 900. Homogenize dispersion until temperature is less than 55° C.   The TEC/Imwitor 900 dispersion is then stirred until the temperature is less than 35° C.   Add the TEC/Imwitor 900 dispersion to Eudragit L30D-55 latex dispersion and stir for at least 30 minutes.   Add Eudragit NE 30D to the Eudragit L30D/TEC/Imwitor 900 dispersion and stir for at least 10 minutes.   Screen the dispersion through a No. 60 mesh sieve prior to coating.   Continue to stir the dispersion until the coating process is complete.
 
Coating Conditions for the Application of Eudragit L30D-55/Eudragit NE 30DAqueous Coating Dispersion
       
     The following coating parameters were used for coating of the Eudragit® L 30 D-55/Eudragit NE30D film coating dispersion. 
     
       
         
           
               
               
               
             
               
                   
                   
               
             
            
               
                   
                 Coating Equipment 
                 STREA 1 ™ Table Top 
               
               
                   
                   
                 Laboratory Fluid Bed Coater 
               
               
                   
                 Spray nozzle diameter 
                 1.0 mm 
               
               
                   
                 Material Charge 
                 300 gram 
               
               
                   
                 Inlet Air Temperature 
                 45° C. 
               
               
                   
                 Outlet Air Temperature 
                 32 to 35° C. 
               
               
                   
                 Atomization Air Pressure 
                 1.6 Bar 
               
               
                   
                 Pump Rate 
                 3–4 gram per minute 
               
               
                   
                   
               
            
           
         
       
     
     Coat clarithromycin pellets with Eudragit L30 D-55/Eudragit NE 30D film coating dispersion such that you apply 20% coat weight gain to the pellets. 
     Clarithromycin Delayed Enteric-Release Pellets Formulation and Preparation Procedure 
     Preparation of an AQOAT AS-HF Aqueous Coating Dispersion 
     Dispersion Formulation 
     The composition of the aqueous AQOAT AS-HF aqueous coating dispersion applied to the clarithromycin pellets is provided below in Table 18. 
                     TABLE 18                  AQOAT AS-HF Aqueous Coating Dispersion                             Component   Percentage (%)                                         AQOAT AS-HF   7.0           Triethyl Citrate   2.0           Talc   2.1           Sodium lauryl sulfate   0.2           Purified Water*   88.7           Solid Content   11.3           Polymer Content   7.0                       *Removed during processing            
Preparation Procedure for an AQOAT AS-HF Aqueous Dispersion
         Add triethyl citrate (TEC) to the purified water with stirring.   Add the sodium lauryl sulfate (SLS) to the TEC dispersion with stirring and completely until completely dissolved.   Add the AQOAT to the TEC/SLS dispersion and stir for at least 30 minutes.   Add the talc to the AQOAT dispersion and until completely mixed and for at least 30 minutes.   Screen the dispersion through a No. 60 mesh sieve prior to coating.   Continue to stir the dispersion until the coating process is complete.
 
Coating Conditions for the Application of AQOAT AS-HF Aqueous Coating Dispersion
       
     The following coating parameters were used for coating of the AQOAT AS-HF film coating dispersion. 
     
       
         
           
               
               
               
             
               
                   
                   
               
             
            
               
                   
                 Coating Equipment 
                 STREA 1 ™ Table Top 
               
               
                   
                   
                 Laboratory Fluid Bed Coater 
               
               
                   
                 Spray nozzle diameter 
                 1.0 mm 
               
               
                   
                 Material Charge 
                 300 gram 
               
               
                   
                 Inlet Air Temperature 
                 48° C. 
               
               
                   
                 Outlet Air Temperature 
                 27° C. 
               
               
                   
                 Atomization Air Pressure 
                 1.6 Bar 
               
               
                   
                 Pump Rate 
                 3–4 gram per minute 
               
               
                   
                   
               
            
           
         
       
     
     Coat clarithromycin pellets with AQOAT AS-HF film coating dispersion such that you apply 30–35% coat weight gain to the pellets. 
     Clarithromycin Colonic-Release Pellets Formulation and Preparation Procedure 
     Preparation of an Eudragit® FS30D Aqueous Coating Dispersion 
     Dispersion Formulation 
     The composition of the aqueous Eudragit® FS 30D dispersion applied to the clarithromycin pellets is provided below in Table 19. 
                     TABLE 19                  Eudragit ® FS 30D Aqueous Coating Dispersion                             Component   Percentage (%)                                         Eudragit ® FS 30D   54.8           Triethyl Citrate   0.9           Talc   3.3           Purified Water*   41.0           Solid Content   20.6           Polymer Content   16.4                       *Removed during processing            
Preparation Procedure for an Eudragit® FS 30D Aqueous Dispersion
         Disperse triethyl citrate (TEC) in the purified water.   Add the talc in the triethyl citrate dispersion.   Homogenize the dispersion using a homogenizer.   Add slowly the Eudragit® FS 30D dispersion to the talc/TEC dispersion with stirring.   Continue to stir the coating dispersion until the coating process is complete.
 
Coating Conditions for the Application of Eudragit FS30D Aqueous Coating Dispersion
       
     The following coating parameters were used for coating with each of the Eudragit® FS 30 D aqueous film coating. 
     
       
         
           
               
               
               
             
               
                   
                   
               
             
            
               
                   
                 Coating Equipment 
                 STREA 1 ™ Table Top 
               
               
                   
                   
                 Laboratory Fluid Bed Coater 
               
               
                   
                 Spray nozzle diameter 
                 1.2 mm 
               
               
                   
                 Material Charge 
                 300 gram 
               
               
                   
                 Inlet Air Temperature 
                 38° C. 
               
               
                   
                 Outlet Air Temperature 
                 22° C. 
               
               
                   
                 Atomization Air Pressure 
                 1.6 Bar 
               
               
                   
                 Pump Rate 
                 6 gram per minute 
               
               
                   
                   
               
            
           
         
       
     
     Coat pellets with Eudragit FS 30D coating dispersion dispersion such that you apply 30% coat weight gain to the pellets. 
     Amoxicillin and Clarithromycin Tablets 
     Preparation of Amoxicillin and Clarithromycin Granulation for Tableting 
     
       
         
           
               
             
               
                 TABLE 20 
               
             
            
               
                   
               
               
                 Composition of Amoxicillin and Clarithromycin Granulation 
               
               
                 (Immediate Release) 
               
            
           
           
               
               
               
            
               
                   
                 Component 
                 Percentage (%) 
               
               
                   
                   
               
            
           
           
               
               
               
            
               
                   
                 Amoxicillin Trihydrate powder 
                 22.0 
               
               
                   
                 Clarithromycin 
                 22.0 
               
               
                   
                 Lactose monohydrate, spray dried 
                 45.0 
               
               
                   
                 Avicel PH 101 
                 10.0 
               
               
                   
                 Hydroxypropyl methylcellulose, NF* 
                 1.0 
               
               
                   
                 Total 
                 100 
               
               
                   
                   
               
               
                   
                 *Hydroxypropyl methylcellulose was added as a 2.9% w/w aqueous solution during wet massing. 
               
            
           
         
       
         
         
           
             Blend Amoxicillin, Clarithromycin, lactose, and Avicel® PH 101 using a high shear mixer. 
             Add the hydroxypropyl methylcellulose binder solution slowly into the powder blend under continuous mixing. 
             Dry the granulation at 60° C. using a fluid bed dryer until the exhaust temperature reaches 40° C. 
             Granules between 20 and 40 Mesh are collected for further processing.
 
Tableting of the Amoxicillin and Clarithromycin
 
           
         
       
    
     
       
         
           
               
             
               
                 TABLE 21 
               
             
            
               
                   
               
               
                 Composition of Amoxicillin and Clarithromycin Tablets 
               
            
           
           
               
               
            
               
                 Component 
                 Percentage (%) 
               
               
                   
               
            
           
           
               
               
            
               
                 Amoxicillin/Clarithromycin granules 
                 45.0 
               
               
                 Avicel PH 200 
                 7.5 
               
               
                 Eudragit L30D-55/NE 30D coated Amoxicillin Pellets 
                 6.4 
               
               
                 Eudragit L30D-55/NE 30D coated Clarithromycin Pellets 
                 7.6 
               
               
                 AQOAT coated Amoxicillin Pellets 
                 7.2 
               
               
                 AQOAT coated Clarithromycin Pellets 
                 8.6 
               
               
                 Eudragit FS 30D coated Amoxicillin Pellets 
                 6.9 
               
               
                 Eudragit FS 30D coated Clarithromycin Pellets 
                 8.3 
               
               
                 Colloidal silicon dioxide 
                 1.5 
               
               
                 Magnesium stearate 
                 1.0 
               
               
                 Total 
                 100 
               
               
                   
               
            
           
         
       
         
         
           
             Blend the Amoxicillin/Clarithromycin granules, Avicel PH-200, Amoxicillin coated pellets, Clarithromycin coated pellets and colloidal silicon dioxide for 15 minutes in a tumble blender. 
             Add the magnesium stearate to the blender, and blend for 5 minutes. 
             Compress the blend on a rotary tablet press. 
             The fill weight should be adjusted to achieve a 500 mg total dose tablet. 
           
         
       
    
     Example 47 
     Amoxicillin Pellet Formulation and Preparation Procedure 
     Pellet Formulations 
     The composition of the Amoxicillin trihydrate pellets provided in Table 22. 
                     TABLE 22                  Composition of Amoxicillin Pellets                             Component   Percentage (%)                                         Amoxicillin Trihydrate powder   92           Avicel PH 101   6.0           Polyoxyl 35 Castor Oil*   1.0           Hydroxypropyl methylcellulose, NF*   1.0           Purified Water   **           Total   100                       *Hydroxypropyl methylcellulose and Cremaphor EL were added as a 2.9% w/w aqueous solution during wet massing.           **Removed during processing            
Preparation Procedure for Amoxicillin Pellets
         Blend Amoxicillin and Avicel® PH 101 using a low shear blender.   Add the hydroxypropyl methylcellulose and Polyoxyl 35 Castor Oil binder solution slowly into the powder blend under continuous mixing.   Extrude the wet mass using an LCI Bench Top Granulator. The diameter of the screen of the Bench Top Granulator is 0.8 mm.   Spheronize the extrudate using a QJ-230 Spheronizer using a small cross section plate.   Dry the spheronized pellets at 60° C. using a fluid bed dryer until the exhaust temperature reaches 40° C.   Pellets between 20 and 40 Mesh were collected for further processing.
 
Amoxicillin Delayed Enteric-Release Pellets Formulation and Preparation Procedure
 
Preparation of an AQOAT AS-HF Aqueous Coating Dispersion
 
Dispersion Formulation
       
     The composition of the aqueous AQOAT AS-HF aqueous coating dispersion applied to the amoxicillin pellets is provided below in Table 23. 
                     TABLE 23                  AQOAT AS-HF Aqueous Coating Dispersion                             Component   Percentage (%)                                         AQOAT AS-HF   7.0           Triethyl Citrate   2.0           Talc   2.1           Sodium lauryl sulfate   0.2           Purified Water*   88.7           Solid Content   11.3           Polymer Content   7.0                       *Removed during processing            
Preparation Procedure for an AQOAT AS-HF Aqueous Dispersion
         Add triethyl citrate (TEC) to the purified water with stirring.   Add the sodium lauryl sulfate (SLS) to the TEC dispersion with stirring and completely until completely dissolved.   Add the AQOAT to the TEC/SLS dispersion and stir for at least 30 minutes.   Add the talc to the AQOAT dispersion and until completely mixed and for at least 30 minutes.   Screen the dispersion through a No. 60 mesh sieve prior to coating.   Continue to stir the dispersion until the coating process is complete.
 
Coating Conditions for the Application of AQOAT AS-HF Aqueous Coating Dispersion
       
     The following coating parameters were used for coating of the AQOAT AS-HF film coating dispersion. 
     
       
         
           
               
               
               
             
               
                   
                   
               
             
            
               
                   
                 Coating Equipment 
                 STREA 1 ™ Table Top 
               
               
                   
                   
                 Laboratory Fluid Bed Coater 
               
               
                   
                 Spray nozzle diameter 
                 1.0 mm 
               
               
                   
                 Material Charge 
                 300 gram 
               
               
                   
                 Inlet Air Temperature 
                 48° C. 
               
               
                   
                 Outlet Air Temperature 
                 27° C. 
               
               
                   
                 Atomization Air Pressure 
                 1.6 Bar 
               
               
                   
                 Pump Rate 
                 3–4 gram per minute 
               
               
                   
                   
               
            
           
         
       
     
     Coat amoxicillin pellets with AQOAT AS-HF film coating dispersion such that you apply 30–35% coat weight gain to the pellets. 
     Clarithromycin Pellet Formulation and Preparation Procedure 
     Pellet Formulation 
     The composition of the clarithromycin pellets provided in Table 24. 
                     TABLE 24                  Composition of Clarithromycin Pellets                             Component   Percentage (%)                                         Clarithromycin   77.0           Lactose monohydrate, spray dried   11.0           Croscarmellose sodium   5.0           Polyoxyl 35 Castor Oil*   5.0           Hydroxypropyl methylcellulose*   2.0           Purified water   *           Total   100                       *Removed during processing            
Preparation Procedure for Clarithromycin Pellets
         Prepare the binder solution by adding the Polyoxyl to the purified water while stirring. After that is mixed, slowly add the hydroxypropyl methylcellulose and continue to stir until a solution is achieved.   Blend clarithromycin, lactose monohydrate, and croscarmellose sodium using a Robot Coupe high shear granulator.   Add binder solution slowly into the powder blend under continuous mixing.   Granulate the powders in the high shear granulator with the binder solution.   Extrude the wet mass using an LCI Bench Top Granulator. The diameter of the screen of the Bench Top Granulator was 1.0 mm.   Spheronize the extrudate using a Model SPH20 Caleva Spheronizer.   Dry the spheronized pellets at 50° C. until the moisture level is &gt;3%.   Pellets between 16 and 30 Mesh were collected for further processing.
 
Clarithromycin Enteric-Release Pellet Formulation and Preparation Procedure
 
Preparation of an Eudragit® L 30 D-55/Eudragit NE 30D Aqueous Coating Dispersion
 
Dispersion Formulation
       
     The composition of the aqueous Eudragit L30D-55/Eudragit NE 30D aqueous coating dispersion applied to the clarithromycin pellets is provided below in Table 25. 
                     TABLE 25                  Eudragit ® L 30 D-55/Eudragit NE 30D Aqueous Coating Dispersion                             Component   Percentage (%)                                         Eudragit ® L 30D-55   44.4           Eudragit NE 30D   14.8           Triethyl Citrate   1.3           Imwitor 900   0.9           Purified Water*   38.6           Solid Content   20.6           Polymer Content   16.4                       *Removed during processing            
Preparation Procedure for an Eudragit® L 30D-55/Eudragit NE 30D Aqueous Dispersion
         Heat purified water to 75–80° C. and then add triethyl citrate (TEC) and Imwitor 900. Homogenize dispersion until temperature is less than 55° C.   The TEC/Imwitor 900 dispersion is then stirred until the temperature is less than 35° C.   Add the TEC/Imwitor 900 dispersion to Eudragit L30D-55 latex dispersion and stir for at least 30 minutes.   Add Eudragit NE 30D to the Eudragit L30D/TEC/Imwitor 900 dispersion and stir for at least 10 minutes.   Screen the dispersion through a No. 60 mesh sieve prior to coating.   Continue to stir the dispersion until the coating process is complete.
 
Coating Conditions for the Application of Eudragit L30D-55/Eudragit NE 30DAqueous Coating Dispersion
       
     The following coating parameters were used for coating of the Eudragit® L 30 D-55/Eudragit NE30D film coating dispersion. 
     
       
         
           
               
               
               
             
               
                   
                   
               
             
            
               
                   
                 Coating Equipment 
                 STREA 1 ™ Table Top 
               
               
                   
                   
                 Laboratory Fluid Bed Coater 
               
               
                   
                 Spray nozzle diameter 
                 1.0 mm 
               
               
                   
                 Material Charge 
                 300 gram 
               
               
                   
                 Inlet Air Temperature 
                 45° C. 
               
               
                   
                 Outlet Air Temperature 
                 32 to 35° C. 
               
               
                   
                 Atomization Air Pressure 
                 1.6 Bar 
               
               
                   
                 Pump Rate 
                 3–4 gram per minute 
               
               
                   
                   
               
            
           
         
       
     
     Coat clarithromycin pellets with Eudragit L30 D-55/Eudragit NE 30D film coating dispersion such that you apply 20% coat weight gain to the pellets. 
     Clarithromycin Colonic-Release Pellets Formulation and Preparation Procedure 
     Preparation of an Eudragit® FS30D Aqueous Coating Dispersion 
     Dispersion Formulation 
     The composition of the aqueous Eudragit® FS 30D dispersion applied to the clarithromycin pellets is provided below in Table 26. 
                     TABLE 26                  Eudragit ® FS 30D Aqueous Coating Dispersion                             Component   Percentage (%)                                         Eudragit ® FS 30D   54.8           Triethyl Citrate   0.9           Talc   3.3           Purified Water*   41.0           Solid Content   20.6           Polymer Content   16.4                       *Removed during processing            
Preparation Procedure for an Eudragit® FS 30D Aqueous Dispersion
         Disperse triethyl citrate (TEC) in the purified water.   Add the talc in the triethyl citrate dispersion.   Homogenize the dispersion using a homogenizer.   Add slowly the Eudragit® FS 30D dispersion to the talc/TEC dispersion with stirring.   Continue to stir the coating dispersion until the coating process is complete.
 
Coating Conditions for the Application of Eudragit FS30D Aqueous Coating Dispersion
       
     The following coating parameters were used for coating with each of the Eudragit® FS 30 D aqueous film coating. 
     
       
         
           
               
               
               
             
               
                   
                   
               
             
            
               
                   
                 Coating Equipment 
                 STREA 1 ™ Table Top 
               
               
                   
                   
                 Laboratory Fluid Bed Coater 
               
               
                   
                 Spray nozzle diameter 
                 1.2 mm 
               
               
                   
                 Material Charge 
                 300 gram 
               
               
                   
                 Inlet Air Temperature 
                 38° C. 
               
               
                   
                 Outlet Air Temperature 
                 22° C. 
               
               
                   
                 Atomization Air Pressure 
                 1.6 Bar 
               
               
                   
                 Pump Rate 
                 6 gram per minute 
               
               
                   
                   
               
            
           
         
       
     
     Coat pellets with Eudragit FS 30D coating dispersion dispersion such that you apply 30% coat weight gain to the pellets. 
     Amoxicillin and Clarithromycin Tablets 
     Preparation of Amoxicillin Granulation for Tableting 
     
       
         
           
               
             
               
                 TABLE 27 
               
             
            
               
                   
               
               
                 Composition of Amoxicillin Granulation (Immediate Release) 
               
            
           
           
               
               
               
            
               
                   
                 Component 
                 Percentage (%) 
               
               
                   
                   
               
            
           
           
               
               
               
            
               
                   
                 Amoxicillin Trihydrate powder 
                 22.0 
               
               
                   
                 Lactose monohydrate, spray dried 
                 57.0 
               
               
                   
                 Avicel PH 101 
                 20.0 
               
               
                   
                 Hydroxypropyl methylcellulose, NF* 
                 1.0 
               
               
                   
                 Total 
                 100 
               
               
                   
                   
               
               
                   
                 *Hydroxypropyl methylcellulose was added as a 2.9% w/w aqueous solution during wet massing. 
               
            
           
         
       
         
         
           
             Blend Amoxicillin, lactose, and Avicel® PH 101 using a high shear mixer. 
             Add the hydroxypropyl methylcellulose binder solution slowly into the powder blend under continuous mixing. 
             Dry the granulation at 60° C. using a fluid bed dryer until the exhaust temperature reaches 40° C. 
             Granules between 20 and 40 Mesh are collected for further processing.
 
Tableting of the Amoxicillin and Clarithromycin
 
           
         
       
    
     
       
         
           
               
             
               
                 TABLE 28 
               
             
            
               
                   
               
               
                 Composition of Amoxicillin and Clarithromycin Tablets 
               
            
           
           
               
               
            
               
                 Component 
                 Percentage (%) 
               
               
                   
               
            
           
           
               
               
            
               
                 Amoxicillin granules 
                 45.0 
               
               
                 Avicel PH 200 
                 7.5 
               
               
                 Eudragit L30D-55/NE 30D coated Clarithromycin Pellets 
                 14.9 
               
               
                 AQOAT coated Amoxicillin Pellets 
                 14.0 
               
               
                 Eudragit FS 30D coated Clarithromycin Pellets 
                 16.1 
               
               
                 Colloidal silicon dioxide 
                 1.5 
               
               
                 Magnesium stearate 
                 1.0 
               
               
                 Total 
                 100 
               
               
                   
               
            
           
         
       
         
         
           
             Blend the Amoxicillin granules, Avicel PH-200, Amoxicillin coated pellets, Clarithromycin coated pellets and colloidal silicon dioxide for 15 minutes in a tumble blender. 
             Add the magnesium stearate to the blender, and blend for 5 minutes. 
             Compress the blend on a rotary tablet press. 
             The fill weight should be adjusted to achieve a 500 mg total dose tablet.
 
Clarithromycin and Amoxicillin Tablets
 
Preparation of Clarithromycin Granulation for Tableting
 
           
         
       
    
     
       
         
           
               
             
               
                 TABLE 29 
               
             
            
               
                   
               
               
                 Composition of Clarithromycin Granulation (Immediate Release) 
               
            
           
           
               
               
               
            
               
                   
                 Component 
                 Percentage (%) 
               
               
                   
                   
               
            
           
           
               
               
               
            
               
                   
                 Clarithromycin powder 
                 22.0 
               
               
                   
                 Lactose monohydrate, spray dried 
                 57.0 
               
               
                   
                 Avicel PH 101 
                 20.0 
               
               
                   
                 Hydroxypropyl methylcellulose, NF* 
                 1.0 
               
               
                   
                 Total 
                 100 
               
               
                   
                   
               
               
                   
                 *Hydroxypropyl methylcellulose was added as a 2.9% w/w aqueous solution during wet massing. 
               
            
           
         
       
     
     Blend Clarithromycin, lactose, and Avicel® PH 101 using a high shear mixer. 
     Add the hydroxypropyl methylcellulose binder solution slowly into the powder blend under continuous mixing. 
     Dry the granulation at 60° C. using a fluid bed dryer until the exhaust temperature reaches 40° C. 
     Granules between 20 and 40 Mesh are collected for further processing. 
     Tableting of the Amoxicillin and Clarithromycin 
     
       
         
           
               
             
               
                 TABLE 30 
               
             
            
               
                   
               
               
                 Composition of Amoxicillin and Clarithromycin Tablets 
               
            
           
           
               
               
            
               
                 Component 
                 Percentage (%) 
               
               
                   
               
            
           
           
               
               
            
               
                 Clarithromycin granules 
                 45.0 
               
               
                 Avicel PH 200 
                 7.5 
               
               
                 Eudragit L30D-55/NE 30D coated Amoxicillin Pellets 
                 14.9 
               
               
                 AQOAT coated Clarithromycin Pellets 
                 14.0 
               
               
                 Eudragit ES 30D coated Amoxicillin Pellets 
                 16.1 
               
               
                 Colloidal silicon dioxide 
                 1.5 
               
               
                 Magnesium stearate 
                 1.0 
               
               
                 Total 
                 100 
               
               
                   
               
            
           
         
       
         
         
           
             Blend the Clarithromycin granules, Avicel PH-200, Amoxicillin coated pellets, Clarithromycin coated pellets and colloidal silicon dioxide for 15 minutes in a tumble blender. 
             Add the magnesium stearate to the blender, and blend for 5 minutes. 
             Compress the blend on a rotary tablet press. 
           
         
       
    
     The fill weight should be adjusted to achieve a 500 mg total dose tablet. 
     In one embodiment, Amoxicillin will be dosed in an alternate pulse to Clarithromycin. This will alternate the exposure to the bacteria in such a way as to make both antibiotics more effective than if they were co-administered, and thereby competing with each other for sites on the bacterial cell wall receptors, or sites within the bacterial cells. 
     In addition, even when Amoxicillin and Clarithromycin are not delivered in alternate pulses, the dosage forms as hereinabove described provide for improved treatment of infection. 
     Numerous modifications and variations of the present invention are possible in light of the above teachings; therefore, within the scope of the appended claims, the invention may be practiced otherwise than as particularly described.