Pharmacodynamics of antimicrobials: treatment optimisation

Abstract

As bacterial resistance continues to increase, optimising the potential for successful clinical outcomes with antimicrobial therapy requires consideration of pharmacodynamic concepts in order to maximise bacterial eradication and minimise the potential for further resistance. Based on the pharmacodynamic characteristics of specific antibiotics, dosage modifications can be implemented to improve the likelihood of bactericidal exposure. Considering their concentration-dependent bactericidal activity, aminoglycosides benefit from increased dosages and infrequent administration, so as to achieve a maximum concentration/minimum inhibitory concentration (MIC) of 10-12. In contrast, beta-lactams are concentration-independent killers and benefit greatest by increasing the time above the MIC (T > MIC). This can be accomplished with the use of prolonged or continuous infusion. By optimising pharmacodynamic parameters with these methodologies, successful treatment of pathogens may be possible in patient populations for whom standard dosing regimens are not effective.