Pharmacokinetic and Pharmacodynamic Principles of Anti-infective Dosing

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• 作者：Nikolas J. Onufrak ; PharmD ; Alan Forrest ; PharmD ; Daniel Gonzalez ; PharmD ; PhD ; ^{daniel.gonzalez@unc.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：antibiotic ; dosing ; exposure ; pharmacodynamics ; pharmacokinetics
• 刊名：Clinical Therapeutics
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：38
• 期：9
• 页码：1930-1947
• 全文大小：742 K

文摘

An understanding of the pharmacokinetic (PK) and pharmacodynamic (PD) principles that determine response to antimicrobial therapy can provide the clinician with better-informed dosing regimens. Factors influential on antibiotic disposition and clinical outcome are presented, with a focus on the primary site of infection. Techniques to better understand antibiotic PK and optimize PD are acknowledged.

Methods

PubMed (inception–April 2016) was reviewed for relevant publications assessing antimicrobial exposures within different anatomic locations and clinical outcomes for various infection sites.

Findings

A limited literature base indicates variable penetration of antibiotics to different target sites of infection, with drug solubility and extent of protein binding providing significant PK influences in addition to the major clearing pathway of the agent. PD indices derived from in vitro studies and animal models determine the optimal magnitude and frequency of dosing regimens for patients. PK/PD modeling and simulation has been shown an efficient means of assessing these PD endpoints against a variety of PK determinants, clarifying the unique effects of infection site and patient characteristics to inform the adequacy of a given antibiotic regimen.

Implications

Appreciation of the PK properties of an antibiotic and its PD measure of efficacy can maximize the utility of these life-saving drugs. Unfortunately, clinical data remain limited for a number of infection site–antibiotic exposure relationships. Modeling and simulation can bridge preclinical and patient data for the prescription of optimal antibiotic dosing regimens, consistent with the tenets of personalized medicine.