Andrew S Jarrell1, Rachel M Kruer1, Dachelle Johnson1, Pamela A Lipsett2. 1. 1 Department of Pharmacy, The Johns Hopkins Hospital , Baltimore, Maryland. 2. 2 Departments of Surgery, Anesthesiology, Critical Care Medicine, and Nursing, Johns Hopkins University Schools of Medicine and Nursing , Baltimore.
Abstract
BACKGROUND: Antimicrobial medications are beneficial when used appropriately, but adverse effects and resistance sometimes limit therapy. These effects may be more problematic with inappropriate antimicrobial use. Consideration of the pharmacokinetic and pharmacodynamic properties of these medications can help optimize drug use. METHODS: Review of the pertinent English-language literature. RESULTS: The pharmacokinetic principles of absorption, distribution, metabolism, and elimination determine whether an appropriate dose of medication reaches the intended pathogen. The pharmacodynamic properties of antimicrobial medications define the relation between the drug concentration and its observed effect on the target pathogen. Improvements in clinical outcomes have been observed when antimicrobial agents are dosed optimally according to these properties. In surgical patients, substantial changes in the volume of distribution and elimination necessitate a clear understanding of these principles. Additionally, less adverse drug effects and antimicrobial resistance may occur with optimal use of these drugs. CONCLUSION: Selecting and dosing antimicrobial medications with consideration of pharmacokinetics and pharmacodynamics may improve patient outcomes and avoid adverse effects.
BACKGROUND: Antimicrobial medications are beneficial when used appropriately, but adverse effects and resistance sometimes limit therapy. These effects may be more problematic with inappropriate antimicrobial use. Consideration of the pharmacokinetic and pharmacodynamic properties of these medications can help optimize drug use. METHODS: Review of the pertinent English-language literature. RESULTS: The pharmacokinetic principles of absorption, distribution, metabolism, and elimination determine whether an appropriate dose of medication reaches the intended pathogen. The pharmacodynamic properties of antimicrobial medications define the relation between the drug concentration and its observed effect on the target pathogen. Improvements in clinical outcomes have been observed when antimicrobial agents are dosed optimally according to these properties. In surgical patients, substantial changes in the volume of distribution and elimination necessitate a clear understanding of these principles. Additionally, less adverse drug effects and antimicrobial resistance may occur with optimal use of these drugs. CONCLUSION: Selecting and dosing antimicrobial medications with consideration of pharmacokinetics and pharmacodynamics may improve patient outcomes and avoid adverse effects.