M.R. Jacobs Clinical Microbiology and Infection

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Presentation transcript:

Optimisation of antimicrobial therapy using pharmacokinetic and pharmacodynamic parameters M.R. Jacobs Clinical Microbiology and Infection Volume 7, Issue 11, Pages 589-596 (November 2001) DOI: 10.1046/j.1198-743x.2001.00295.x Copyright © 2001 European Society of Clinical Infectious Diseases Terms and Conditions

Figure 1 Time above MIC — correlation of serum pharmacokinetics with MIC (susceptibility) of an organism. Drug A is present at a concentration of 2 mg/L for 50% of the dosing interval, while drug B is present at a concentration of 2 mg/L for 30% of the dosing interval. Clinical Microbiology and Infection 2001 7, 589-596DOI: (10.1046/j.1198-743x.2001.00295.x) Copyright © 2001 European Society of Clinical Infectious Diseases Terms and Conditions

Figure 2 AUC/MIC and peak/MIC ratios — correlation of serum pharmacokinetics with MIC (susceptibility) of an organism. The MIC at which the magnitudes of these ratios that are required for clinical success are achieved becomes the pharmacokinetic/pharmacodynamic breakpoint. Clinical Microbiology and Infection 2001 7, 589-596DOI: (10.1046/j.1198-743x.2001.00295.x) Copyright © 2001 European Society of Clinical Infectious Diseases Terms and Conditions

Figure 3 Fluoroquinolone AUC: MIC90 ratios for S. pneumoniae at standard dosing regimens. Levofloxacin, moxifloxacin and gatifloxacin achieve target ratios for free drugs of 25, while moxifloxacin achieves a ratio of 100. Ciprofloxacin does not achieve the minimum target ratio of 25. Dosing regimens are in mg per dose at dosing frequencies shown. Adapted from Turnidge [29]. CIP, ciprofloxacin; LEV, levofloxacin; MOX, moxifloxacin; GAT, gatifloxacin; bid, twice a day; d, once a day. Clinical Microbiology and Infection 2001 7, 589-596DOI: (10.1046/j.1198-743x.2001.00295.x) Copyright © 2001 European Society of Clinical Infectious Diseases Terms and Conditions

Figure 4 Correlation of pharmacokinetic/pharmacodynamic parameters in 134 hospitalised patients with respiratory tract, skin or complicated urinary tract infections treated with 500 mg intravenous levofloxacin daily for 5-14 days. Numbers above each bar are numbers of patients. Adapted from Preston et al. [25]. Clinical Microbiology and Infection 2001 7, 589-596DOI: (10.1046/j.1198-743x.2001.00295.x) Copyright © 2001 European Society of Clinical Infectious Diseases Terms and Conditions

Figure 5 Fluoroquinolone peak: MIC90 ratios for S. pneumoniae. Levofloxacin, moxifloxacin and gatifloxacin achieve target ratios for free drugs of 3, while moxifloxacin achieves a ratio of 9. Ciprofloxacin does not achieve the minimum target ratio of 3. Dosing regimens are in mg per dose at dosing frequencies shown. Adapted from Turnidge [29]. Clinical Microbiology and Infection 2001 7, 589-596DOI: (10.1046/j.1198-743x.2001.00295.x) Copyright © 2001 European Society of Clinical Infectious Diseases Terms and Conditions