Interethnic differences in pharmacokinetics of antibacterials.
BACKGROUND
Optimal antibacterial dosing is imperative for maximising clinical outcome. Many factors can contribute to changes in the pharmacokinetics of antibacterials to the extent where dose adjustment may be needed. In acute illness, substantial changes in important pharmacokinetic parameters such as volume of distribution and clearance can occur for certain antibacterials. The possibility of interethnic pharmacokinetic differences can further complicate attempts to design an appropriate dosing regimen. Factors of ethnicity, such as genetics, body size and fat distribution, contribute to differences in absorption, distribution, metabolism and elimination of drugs. Despite extensive previous work on the altered pharmacokinetics of antibacterials in some patient groups such as the critically ill, knowledge of interethnic pharmacokinetic differences for antibacterials is limited.


OBJECTIVE
This systematic review aims to describe any pharmacokinetic differences in antibacterials between different ethnic groups, and discuss their probable mechanisms as well as any clinical implications.


METHODS
We performed a structured literature review to identify and describe available data of the interethnic differences in the pharmacokinetics of antibacterials.


RESULTS
We found 50 articles that met our inclusion criteria and only six of these compared antibacterial pharmacokinetics between different ethnicities within the same study. Overall, there was limited evidence available. We found that interethnic pharmacokinetic differences are negligible for carbapenems, most β-lactams, aminoglycosides, glycopeptides, most fluoroquinolones, linezolid and daptomycin, whereas significant difference is likely for ciprofloxacin, macrolides, clindamycin, tinidazole and some cephalosporins. In general, subjects of Asian ethnicity achieve drug exposures up to two to threefold greater than Caucasian counterparts for these antibacterials. This difference is caused by a comparatively lower volume of distribution and/or drug clearance.


CONCLUSIONS
Interethnic pharmacokinetic differences of antibacterials are likely; however, the clinical relevance of these differences is unknown and warrants further research.
Burns, Trauma and Critical Care Research Centre, School of Medicine, The University of Queensland, Level 3, Ned Hanlon Building, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, 4029, Australia.
Danny
D
Tsai
Janattul-Ain
JA
Jamal
Joshua S
JS
Davis
Jeffrey
J
Lipman
Jason A
JA
Roberts
D000273:Adipose Tissue / Q000378:metabolism; D000900:Anti-Bacterial Agents / Q000493:pharmacokinetics*; D005006:Ethnicity; D006801:Humans
D000900:Anti-Bacterial Agents