Pharmacokinetics and pharmacodynamics of antibiotics in intensive care

• Published in: Medizinische Klinik, Intensivmedizin und Notfallmedizin Vol. 112; no. 1; pp. 11 - 23
• Main Authors: Sörgel, F, Höhl, R, Glaser, R, Stelzer, C, Munz, M, Vormittag, M, Kinzig, M, Bulitta, J, Landersdorfer, C, Junger, A, Christ, M, Wilhelm, M, Holzgrabe, U
• Format: Journal Article
• Language: German
• Published: Germany 01-02-2017
• Subjects: Anti-Bacterial Agents - pharmacokinetics; Anti-Bacterial Agents - therapeutic use; Critical Care; Drug Monitoring; Female; Half-Life; Humans; Intensive Care Units; Male; Mass Spectrometry; Metabolic Clearance Rate - physiology; Microbial Sensitivity Tests; Penicillins - pharmacokinetics; Penicillins - therapeutic use; Protein Binding - physiology; Reference Values; Vancomycin - pharmacokinetics; Vancomycin - therapeutic use; Therapeutic drug monitoring; Antibiotics; Critically ill; Mass spectrometry; Penicillin
• ISSN: 2193-6226
• DOI: 10.1007/s00063-016-0185-5

Optimized dosage regimens of antibiotics have remained obscure since their introduction. During the last two decades pharmacokinetic(PK)-pharmacodynamic(PD) relationships, originally established in animal experiments, have been increasingly used in patients. The action of betalactams is believed to be governed by the time the plasma concentration is above the minimum inhibitory concentration (MIC). Aminoglycosides act as planned when the peak concentration is a multiple of the MIC and vancomycin seems to work best when the area under the plasma vs. time curve (AUC) to MIC has a certain ratio. Clinicians should be aware that these relationships can only be an indication in which direction dosing should go. Larger studies with sufficiently high numbers of patients and particularly severely sick patients are needed to prove the concepts. In times where all antibiotics can be measured with new technologies, the introduction of therapeutic drug monitoring (TDM) is suggested for ICUs (Intensive Care Unit). The idea of a central lab for TDM of antibiotics such as PEAK (Paul Ehrlich Antibiotika Konzentrationsmessung) is supported.