Applying antimicrobial pharmacodynamics to resistant gram-negative pathogens

Marc H. Scheetz*, Kristin M. Hurt, Gary A. Noskin, Catherine M. Oliphant

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

17 Scopus citations

Abstract

Purpose. Guided antibiotic adjustment for the treatment of multidrug-resistant, gram-negative pathogens is explored. Summary. Multidrug-resistant pathogens are being isolated with increasing frequency, while the production of novel agents to circumvent resistance has slowed to a near halt. Hence, antimicrobial adjustment based on drug pharmacokinetic and pharmacodynamic properties has moved to the forefront of treatment. Pharmacodynamic principles for major classes of antimicrobials are reviewed, and the use of susceptibility reports to optimize pharmacodynamics to treat gram-negative infections is described. The need for the application of antimicrobial pharmacodynamics continues to grow as resistance to the agents becomes more common. Susceptibility reports, including antibiograms, and their limitations are briefly discussed. The resistance profiles of the β-lactams (including carbapenems), aminoglycosides, fluoroquinolones, tetracyclines and glycylcyclines, and the polymyxins are reviewed, and the pharmacodynamic optimization of these profiles is explored. Conclusion. Various mechanisms account for resistance of bacteria to antibiotics. The appropriate use of pharmacokinetics and pharmacodynamics can guide antibiotic therapy and enhance the likelihood of success.

Original languageEnglish (US)
Pages (from-to)1346-1360
Number of pages15
JournalAmerican Journal of Health-System Pharmacy
Volume63
Issue number14
DOIs
StatePublished - Jul 15 2006

Keywords

  • Aminoglycosides
  • Antiinfective agents
  • Carbapenems
  • Drug use
  • Glycylcyclines
  • Methodology
  • Pharmacodynamics
  • Pharmacokinetics
  • Polymyxins
  • Quinolones
  • Rational therapy
  • Resistance
  • Tetracyclines

ASJC Scopus subject areas

  • Pharmacology
  • Health Policy

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