HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Owens, R. C. Articles by Shorr, A. F. Search for Related Content PubMed PubMed Citation Articles by Owens, R. C., Jr. Articles by Shorr, A. F.

ROBERT C. OWENS JR., PHARM.D., is Co-Director, Antimicrobial Stewardship Program, Department of Pharmacy, and Clinical Pharmacy Specialist, Infectious Diseases, Division of Infectious Diseases, Maine Medical Center, Portland, ME. ANDREW F. SHORR, M.D., M.P.H., is Associate Director, Pulmonary Critical Care, Department of Medicine, Washington Hospital Center, Washington, DC.

Address correspondence to Dr. Owens at the Department of Pharmacy, Maine Medical Center, 22 Bramhall Street, Portland, ME 04102-3175 (owensr{at}mmc.org).

Purpose. Using the principles of pharmacokinetic (PK) and pharmacodynamic (PD) dosing, the optimal dosing strategies of beta-lactams, macrolides, fluoroquinolones, and aminoglycosides for the treatment of community-acquired pneumonia (CAP) are reviewed. Summary. The optimal dosing of antimicrobials according to PK and PD principles is one method to reduce the misuse and overuse of the agents and antimicrobial resistance. Based on PK/PD profiles, antimicrobial agents are divided into three groups: agents with concentration-dependent killing (e.g., fluoroquinolones, aminoglycosides), agents with time- dependent killing and minimal or no persistent effects (e.g., beta-lactams in most circumstances), and agents with time-dependent killing and moderate-to-prolonged persistent effects (e.g., azithromycin).19 With concentration-dependent agents such as fluoroquinolones, it is the total amount of drug administered that determines efficacy. With time-dependent agents such as macrolides and beta-lactams, it is the duration of exposure to a specific minimum inhibitory concentration (MIC). That part is straight forward. When a concentration-dependent killing drug is able to achieve its optimal peak:MIC, peak:MIC becomes the determinant of efficacy. When such a drug cannot achieve its optimal peak:MIC, AUC:MIC should be used to determine efficacy. Conclusion. Optimizing the dose and duration of antimicrobial therapy via PK/PD principles is one strategy to reduce antimicrobial resistance. PK/PD-based dosing provides patient- and pathogen-specific therapy and have the potential to make antimicrobial therapy safer and more effective by accounting for factors such as renal function, underlying pathogen, and local patterns of resistance. Index terms: Aminoglycosides; Antibiotics; Antiinfective agents; Community acquired infections; Dosage; Macrolides; Methodology; Minimum inhibitory concentration; Pharmacokinetics; Pneumonia; Quinolones; Rational therapy; Resistance