Ideally, the best drug can be determined by comparing the properties of. The three main pharmacodynamic parameters that are used are the 1. The pharmacokinetic and pharmacodynamic profile of antimicrobial agents can be significantly altered in patients with chronic kidney disease. Pharmacodynamic principles of antimicrobial therapy in the prevention of resistance david s. While several limitations affect the universal application of antimicrobial pharmacodynamic principles in clinical practice, recent studies have suggested that these principles may allow optimization of selected. Employing pharmacokinetic and pharmacodynamic principles to optimize antimicrobial treatment in the face of emerging resistance lauro santos filho 1, joseph l. Successful antimicrobial therapy occurs when an effective concentration of drug is delivered to the site of infection for a sufficient period of time. Pharmacodynamic classifications have important implications for the planning of drug regimens. Use of pharmacodynamic principles to inform lactam. For concentrationdependent drugs, peak concentration to minimal inhibitory concentration mic ratios of. Application of pharmacokinetics and pharmacodynamics to antimicrobial therapy of respiratory tract infections david andes, mda, jack anon, mdb, michael r. Pharmacokinetic and pharmacodynamic principles for antibiotic use in bovine respiratory disease lorenzo fraile cresa researcher program iniairta 2. In light of increasing resistance among grampositive and gramnegative bacteria, opportunities exist to optimize antibiotic therapy against these organisms based on the.
Optimizing antimicrobials in the icu using pharmacodynamic. General principles the rational use of antimicrobials is a key element in developing a successful strategy against the development of resistance to antimicrobials. In vitro pharmacodynamic modelling simulating free serum concentrations of fluoroquinolones against multidrug resistant streptococcus. General principles of antimicrobial therapy society for healthcare. The selection of antimicrobial therapy and the timing of its administration are important determinants of death for. Ebert, pharmd, bcps introduction choosing the best antimicrobial agent for a particular patient or infection can be a complicated process. Pharmacokinetic and pharmacodynamic principles oxford. Introduction to antimicrobial therapy christine kubin, pharm.
Pharmacodynamic principles of antimicrobial therapy in the prevention of resistance pdf available in chest 1153 suppl. Abstract dose optimization is one of the key strategies for enhancing antimicrobial stewardship. Role of pharmacodynamics in antimicrobial therapy g. Antimicrobial treatment of ventilatorassociated pneumonia. Because empiric antimicrobial therapy selection is critical to. Today, animal pharmacokineticpharmacodynamic pkpd infection models serve as a cornerstone of the preclinical assessment process for antibacterial agents and dose and dosing. Use of outpatient parenteral antimicrobial therapy is increasing. Pharmacokinetic and pharmacodynamic principles of antimicrobials. Acute otitis media therefore represents a good model in which tostudy the application of pkpd principles to the antimicrobial therapy of rt1s. The success of antibiotic therapy of utis in a population can be estimated by four parameters. For concentrationdependent drugs, peak concentration to minimal inhibitory concentration mic ratios of approximately 10 are associated with clinical success. The physician should establish the need and the reason for therapy, select the appropriate antimicrobial agent, and then decide on the optimum.
Antimicrobial pharmacokinetics and pharmacodynamics. Use of pharmacodynamic principles to inform lactam dosing. Therefore, high drug levels should be the goal of therapy. Pharmacodynamics describes the antimicrobial effect at the site of infection as well as toxic effects in relation to the concentrations of the antimicrobial drug during the course of drug therapy. Ebert, pharmd, bcps introduction choosing the best antimicrobial agent for a. When evaluating the efficacy of antibiotics for the treatment of respiratory tract infections, such as community acquired pneumonia and acute exacerbations of chronic bronchitis, assessment of clinical cure may not be the most relevant parameter, as it may not be related to microbiological eradication or to the minimum inhibitory concentration mic of the infecting pathogen. A set of principles that supports good prescribing practice has evolved specific to infectious disease management. Drug selection is based on knowledge of its antimicrobial spectrum and the known or likely pathogens responsible for a target infection. The uk government has recognised that antimicrobial resistance is a significant health issue and in 20 produced a fiveyear strategy to slow its development and spread healthcare professionals should be. Burgess, pharmd pharmacodynamic properties can be used to divide antibiotics into two major classes based on their mechanism of bactericidal action.
An understanding of the pharmacokinetic pk and pharmacodynamic pd principles that determine response to antimicrobial therapy can provide the clinician with betterinformed dosing regimens. Questions pertinent to choosing antimicrobial therapy appropriately. Pharmacokinetic and pharmacodynamic characteristics are major determinant of efficacy for antimicrobial therapy and is essential for rational determination of clinically relevant susceptibility breakpoints. Therefore, the ability to achieve sufficient concentrations at the site of infection, determines its therapeutic application. A set of principles that supports good prescribing practice has evolved specific to infectious disease. Pdf pharmacodynamic principles of antimicrobial therapy in. Pharmacodynamic parameters integrate the microbiological activity and pharmacokinetics of an antiinfective drug by focusing on its biological effects, in particular growth inhibition and killing of pathogens.
What special pharmacokinetic and pharmacodynamic properties of a. Principles of antimicrobial therapy phrm306 pharmacology ii 2. Pharmacokinetic and pharmacodynamic principles of antiinfective. Antimicrobial pharmacodynamics in theory and clinical practice infectious. Uniquely among drugs, antibiotics target infecting microorganisms which may cause. Achieving bacterial eradication using pharmacokineticl. Strategies for providing optimal antimicrobial therapy basic principles of antimicrobial therapy pertinent to vap definitions classes of antimicrobial drugs, mechanisms of action, and antimicrobial spectra pharmacokinetic and pharmacodynamic principles factors that influence antimicrobial drug activity in the lungs.
The reader is introduced to various aspects of the fundamentals of antimicrobial. Pharmacologic principles of antimicrobial therapy i. Application of pharmacokinetic and pharmacodynamic principles. The terms antimicrobial, antibiotic, and antiinfective encompass a wide variety of pharmaceutical agents that include antibacterial, antifungal, antiviral, and antiparasitic drugs. Using pharmacodynamic and pharmacokinetic surrogate markers. Antimicrobial pharmacokinetics and pharmacodynamics pkpd play a central role in developing dosing regimens that target maximal clinical outcomes and microbiological eradication. Principles of antimicrobial therapy pharmacology 1. Hst151 1 pharmacologic principles of antimicrobial therapy i. Important considerations when prescribing antimicrobial therapy include. The most important pharmacokinetic parameters, useful to determine the significance of extracorporeal removal of a given drug, are molecular weight.
Principles of antimicrobial therapy canterbury scl. Application of pharmacokinetic and pharmacodynamic principles in antimicrobial stewardship. Principles of antibiotic therapy oxford academic journals. Pharmacokineticspharmacodynamics of antimicrobial therapy. Minimum effective concentrations are those needed to inhibit growth. The pharmacokinetic principles of absorption, distribution, metabolism, and elimination determine whether an appropriate dose of medication reaches the intended pathogen. Introduction to antimicrobial therapy columbia university. In light of increasing resistance among grampositive and gramnegative bacteria, opportunities exist to optimize antibiotic therapy against these organisms based on the knowledge of pharmacodynamics, i. Employing pharmacokinetic and pharmacodynamic principles to optimize antimicrobial treatment in the face of emerging resistance lauro santos filho 1, joseph. Antimicrobial pharmacodynamics in theory and clinical practice infectious disease and therapy nightingale, charles h. Pharmacodynamic parameters integrate the microbiological activity and pharmacokinetics of an antiinfective drug by focusing on its biological effects, in particular growth inhibition and killing of.
The continual threat of antimicrobial resistance means that optimizing current antimicrobial therapy is of paramount importance. Achieving bacterial eradication using pharmacokineticl pharmacodynamic principles ron daganl. Pk and pharmacodynamic properties, adverse effects, drug interactions, and cost. Discuss the pathophysiologic changes in critically ill patients that affect pkpd parameters in the context of.
Fundamentals of antimicrobial pharmacokinetics and. Pkpd characteristics of an antimicrobial corresponding author. Pharmacodynamic and pharmacokinetic principles salmaan kanji, bsc. Pharmacodynamic properties can be used to divide antibiotics into two major classes based on their mechanism of bactericidal action. There have been tremendous strides in our understanding of antibiotic exposure. Application of pharmacokinetic and pharmacodynamic. The book will be designed as a reference on the application of pharmacokineticpharmacodynamic principles for the optimization of antimicrobial therapy, namely pharmacotherapy, and infectious. Antimicrobial agents can be categorized on the basis of the pkpd measure that is most predictive of efficacy.
Cox msn, acnpbc, acnpc, fccm penn state hershey medical center neuroscience critical care unit disclosures none obtaining an accurate. Pdf pharmacodynamic principles of antimicrobial therapy. The book will be designed as a reference on the application of pharmacokinetic pharmacodynamic principles for the optimization of antimicrobial therapy, namely pharmacotherapy, and infectious diseases. Important considerations when prescribing antimicrobial therapy include obtaining an accurate diagnosis of infection. Antimicrobial therapy takes advantage of the biochemical differences between microorganisms and humans antimicrobial drugs. General principles of antimicrobial therapy surbhi leekha, mbbs. Applying pharmacokineticpharmacodynamic principles for. Principles of antimicrobial therapy key points early and rapid diagnosis of infection and prompt initiation of appropriate antimicrobial therapy, if warranted, are fundamental to reducing the mortality. For concentration dependent antimicrobials, the pharmacodynamic goals to maximize antibiotic drug concentration at the site of infection. Pharmacokinetic and pharmacodynamic principles oxford medicine.
Pk profiles change over time in critically ill patients. Appropriate utilization of antimicrobial therapy to treat these organisms requires an understanding of the pharmacokinetic and pharmacodynamic principles to optimize therapy and avoid adverse drug events. In critically ill patients, such as those in septic shock, febrile neutropenic patients, and patients with bacterial meningitis, empiric therapy should be initiated immediately after or concurrently with collection of diagnostic specimens. The timing of initial therapy should be guided by the urgency of the situation. Along with host factors, the pharmacodynamic properties of antimicrobial agents may also be important in estab. An antimicrobial agent is defined as a substance that inhibits the growth of microorganisms. This chapter describes the three main pkpd indices into which current antimicrobials. Strategies for providing optimal antimicrobial therapy basic principles of antimicrobial therapy pertinent to vap definitions classes of antimicrobial drugs, mechanisms of action, and antimicrobial. Fundamentals of antimicrobial pharmacokinetics and pharmacodynamics is designed as a reference on the application of pharmacokinetic pharmacodynamic principles for the optimization of antimicrobial therapy, namely pharmacotherapy, and infectious diseases. Antimicrobial pharmacokinetics and pharmacodynamics pkpd play a. Principles of initiating antimicrobial therapy and empiric. Antimicrobial agents act by targeting specific sites in a wide range of organisms, including bacteria, viruses, fungal, protozoa and helminths.
Pharmacokinetic and pharmacodynamic principles of anti. Jan 10, 2014 the success of antibiotic therapy of utis in a population can be estimated by four parameters. Immunotherapy, used as an adjunct to antimicrobial therapy, may play a role in improving patient outcomes. Cox msn, acnpbc, acnpc, fccm penn state hershey medical center neuroscience critical care unit. The 3 most common pkpd measures are the duration of time a drug concentration remains above the mic tmic, the ratio of the maximal drug concentration to the mic. The choice of antibiotic depends on many factors, including the efficacy, pharmacokinetics, side effects, expected compliance, and price. Edson, md on completion of this article, you should be able to. Antimicrobial pharmacodynamics in theory and clinical. Chapter 14 covers how knowledge of the pharmacokinetic behaviour of a drug is key to defining its therapeutic role.
Pharmacodynamic principles of antimicrobial therapy in the. Patients who receive initial antimicrobial therapy that provides coverage against the causative pathogen survive at twice the rate of patients who do not receive adequate therapy initially. Fundamentals of antimicrobial pharmacokinetics and pharmacodynamics is designed as a reference on the application of pharmacokineticpharmacodynamic principles for the optimization of antimicrobial. Using pharmacodynamic and pharmacokinetic surrogate. Instead, it is necessary to consider both pharmacodynamic concepts and pharmacokinetic principles. Jan 01, 2007 today, animal pharmacokinetic pharmacodynamic pkpd infection models serve as a cornerstone of the preclinical assessment process for antibacterial agents and dose and dosing interval selection, as decision support for setting in vitro susceptibility breakpoints, and, finally, for the evaluation of the meaning of in vitro resistance. Influence of pharmacokinetic and pharmacodynamic principles. Successful antimicrobial therapy occurs when an effective concentration of drug is delivered to the site of infection for a sufficient. Application of pharmacokinetics and pharmacodynamics to. Pharmacodynamic factors of antibiotic efficacy rotschafer. Pharmacokinetic and pharmacodynamic characteristics are major determinant of efficacy for antimicrobial therapy and is essential for rational determination of clinically relevant susceptibility. Because empiric antimicrobial therapy selection is critical to patient outcomes, broadspectrum antimicrobials are often utilized because it will increase.
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