Selecting antibiotics based on pharmacokinetic and pharmacodynamic principles.
Key pharmacokinetic and pharmacodynamic parameters influencing antimicrobial selection include the area under the curve (AUC) and minimum inhibitory concentration (MIC). These concepts can be integrated to describe the unique triangular relationship between the antibiotic, infecting organism, and patient. Antibiotic pharmacodynamics have been described as the ratio of AUC/MIC, maximum concentration to MIC, and time above MIC. These relationships can help define whether an antibiotic class kills by concentration-dependent or concentration-independent mechanisms. For example, aminoglycosides and fluoroquinolones have concentration-dependent killing while beta-lactams are concentration-dependent. This killing is also reflected in the post-antibiotic effect (PAE) that describes the prolonged activity even when the antibiotic levels are undetectable. These principles allow antibiotic classes to be selected and dosed via new strategies such as once daily aminoglycosides and continuous infusion beta-lactams.
Klutman
N E
NE
School of Pharmacy, University of Kansas, Lawrence, KS 66045, USA.
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents / Q000493:pharmacokinetics* / Q000592:standards / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000493:pharmacokinetics / Q000592:standards / Q000627:therapeutic use; D019540:Area Under Curve; D001424:Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology; D004305:Dose-Response Relationship, Drug; D004358:Drug Therapy / Q000592:standards*; D024841:Fluoroquinolones; D006801:Humans; D007769:Lactams; D014481:United States / Q000453:epidemiology