Defining antibiotic dosing in lung infections
Defining optimal antibiotic dosing for treatment of lung infections is challenging because of the interrelationship between patient characteristics (eg, pathophysiological changes of lung during an infection, albumin level, renal function), antibiotic characteristics (eg, physicochemical properties,...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Lippincott Williams & Wilkins
2013
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| Online Access: | http://irep.iium.edu.my/30511/1/Ain_2013-1.CPM.pdf |
| _version_ | 1825647334917144576 |
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| author | Jamal, Jannatul-Ain Abdul Aziz, Mohd. Hafiz Lipman, Jeffrey Roberts, Jason A. |
| author_facet | Jamal, Jannatul-Ain Abdul Aziz, Mohd. Hafiz Lipman, Jeffrey Roberts, Jason A. |
| author_sort | Jamal, Jannatul-Ain |
| collection | IIUM |
| description | Defining optimal antibiotic dosing for treatment of lung infections is challenging because of the interrelationship between patient characteristics (eg, pathophysiological changes of lung during an infection, albumin level, renal function), antibiotic characteristics (eg, physicochemical properties, protein binding), and bacterial pathogen susceptibility. Measurement of antibiotic concentration in the lung compartments, such as epithelial lining fluid (ELF), is important to describe the drug exposure at site of infection. This article reviews published data on antibiotic penetration described by the ELF to plasma (ELF:plasma) ratios and the probability of pharmacokinetic/pharmacodynamics (PK/PD) attainment at the target site with current dosing regimens to outline dosing strategies that could optimize the PK/PD indices. Antibiotic physicochemical properties could be used to predict the extent of penetration into the lung tissues. Lipophilic antibiotics penetrate well into the lung compartments; however, standard dosing regimens generally seem to be insufficient to achieve optimal PK/PD indices in the ELF, particularly during severe infections. Aggressive dosing regimens are required for antibiotics that poorly or moderately penetrate the lung tissues, whereas nebulization could be the alternative method to enhance antibiotic concentration at the target site. Special populations such as the critically ill, patients on renal replacement therapy, and those with renal impairment need dosing to be individualized, as these populations have high PK variability. Dosing based on free drug concentrations should be considered preferred, as these concentrations frequently reflect the antibiotic concentration at the target site. Therefore, the use of therapeutic drug monitoring should be considered necessary, whenever possible, to guide dosing in lung infection. |
| first_indexed | 2024-03-05T23:16:06Z |
| format | Article |
| id | oai:generic.eprints.org:30511 |
| institution | International Islamic University Malaysia |
| language | English |
| last_indexed | 2024-03-05T23:16:06Z |
| publishDate | 2013 |
| publisher | Lippincott Williams & Wilkins |
| record_format | dspace |
| spelling | oai:generic.eprints.org:305112014-04-08T21:46:02Z http://irep.iium.edu.my/30511/ Defining antibiotic dosing in lung infections Jamal, Jannatul-Ain Abdul Aziz, Mohd. Hafiz Lipman, Jeffrey Roberts, Jason A. R Medicine (General) RM Therapeutics. Pharmacology RS Pharmacy and materia medica Defining optimal antibiotic dosing for treatment of lung infections is challenging because of the interrelationship between patient characteristics (eg, pathophysiological changes of lung during an infection, albumin level, renal function), antibiotic characteristics (eg, physicochemical properties, protein binding), and bacterial pathogen susceptibility. Measurement of antibiotic concentration in the lung compartments, such as epithelial lining fluid (ELF), is important to describe the drug exposure at site of infection. This article reviews published data on antibiotic penetration described by the ELF to plasma (ELF:plasma) ratios and the probability of pharmacokinetic/pharmacodynamics (PK/PD) attainment at the target site with current dosing regimens to outline dosing strategies that could optimize the PK/PD indices. Antibiotic physicochemical properties could be used to predict the extent of penetration into the lung tissues. Lipophilic antibiotics penetrate well into the lung compartments; however, standard dosing regimens generally seem to be insufficient to achieve optimal PK/PD indices in the ELF, particularly during severe infections. Aggressive dosing regimens are required for antibiotics that poorly or moderately penetrate the lung tissues, whereas nebulization could be the alternative method to enhance antibiotic concentration at the target site. Special populations such as the critically ill, patients on renal replacement therapy, and those with renal impairment need dosing to be individualized, as these populations have high PK variability. Dosing based on free drug concentrations should be considered preferred, as these concentrations frequently reflect the antibiotic concentration at the target site. Therefore, the use of therapeutic drug monitoring should be considered necessary, whenever possible, to guide dosing in lung infection. Lippincott Williams & Wilkins 2013-05 Article PeerReviewed application/pdf en http://irep.iium.edu.my/30511/1/Ain_2013-1.CPM.pdf Jamal, Jannatul-Ain and Abdul Aziz, Mohd. Hafiz and Lipman, Jeffrey and Roberts, Jason A. (2013) Defining antibiotic dosing in lung infections. Clinical Pulmonary Medicine, 20 (3). pp. 121-128. ISSN 1536-5956 (O), 1068-0640 (P) http://journals.lww.com/clinpulm/Abstract/2013/05000/Defining_Antibiotic_Dosing_in_Lung_Infections.3.aspx 10.1097/CPM.0b013e31828fc646 |
| spellingShingle | R Medicine (General) RM Therapeutics. Pharmacology RS Pharmacy and materia medica Jamal, Jannatul-Ain Abdul Aziz, Mohd. Hafiz Lipman, Jeffrey Roberts, Jason A. Defining antibiotic dosing in lung infections |
| title | Defining antibiotic dosing in lung infections |
| title_full | Defining antibiotic dosing in lung infections |
| title_fullStr | Defining antibiotic dosing in lung infections |
| title_full_unstemmed | Defining antibiotic dosing in lung infections |
| title_short | Defining antibiotic dosing in lung infections |
| title_sort | defining antibiotic dosing in lung infections |
| topic | R Medicine (General) RM Therapeutics. Pharmacology RS Pharmacy and materia medica |
| url | http://irep.iium.edu.my/30511/1/Ain_2013-1.CPM.pdf |
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