By Nightingale C.H., et al. (eds.)
Taking readers from the examine laboratory to the bedside, this moment version compiles crucial details at the pharmacodynamics of all significant periods of the antimicrobial armamentarium together with penicillins, cephalosposorins, cephamycins, carbapenems, monobactams, aminoglycosides, quinolones, macrolides, antifungals, antivirals, and rising brokers at present in improvement. Written by way of skilled pros within the box, this consultant makes use of an abundance of examples to depict tips on how to observe pharmacodynamic strategies to daily medical perform.
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Extra info for Antimicrobial pharmacodynamics in theory and clinical practice
Recently, microdialysis techniques that measure only unbound-drug concentrations are increasingly being used to obtain concentration–time profiles in interstitial fluid (56–58). Thus, the strong relationship between unbound-drug concentrations in serum or plasma and those in extracellular fluid explains the good correlation found between unbound serum concentrations and in vivo effects and the lack of correlation of these effects with tissue concentrations obtained in homogenates. For intracellular infections, it is much less clear which concentrations correlate with effect.
Later, when the MIC became a standard measure of in vitro AST, Kunin in a classical experiment determined the MICs in broth with and without serum of various b-lactam antibiotics, with degrees of protein binding varying from 20% (ampicillin) to more than 90% (cloxacillin) (47). The MICs in broth with serum were higher than in broth alone in proportion to the degree of protein binding. In addition, calculating the free fraction of the drugs in the wells with serum added corresponded well to the MIC values in broth alone.
Abbreviation: MIC, minimum inhibitory concentration. Source: From Ref. 13. The second issue is the indication of the drug. At present, this is not yet consistently implemented in the registration processes of the Food and Drug Administration (FDA) and the EMEA. It is clear, however, that “if” the PD relationship is apparent “and” the MIC distribution is known “and” the dosing regimen is known by default in the registration process, a conclusion can and should be drawn as to the possible indication of the antimicrobial.
Antimicrobial pharmacodynamics in theory and clinical practice by Nightingale C.H., et al. (eds.)