PKPD of Antimicrobial Agents Flashcards
What are the three pkpd indices of antimicrobial agents?
%T > MIC
Cmax: MIC
AUC : MIC
What agents have a %T > MIC pkpd indice?
COMP-C
C: Cephalosporins
O: Oxazolidiones
M: Macrolides
P: Penicillins
C: Carbapenems
We should adjust dose for these drugs by increasing infusion times, using continuous infusions, decreasing dose intervals and increasing doses.
What Agents have a Cmax: MIC pkpd indice?
Aminoglycosides and Quinolones
To optimize dosing–> use extended interval dosing and maximize safe dose.
What agents follow AUC:MIC pkpd indice?
VAT
V: Vancomycin
A: Azithromycin
T: Tetracycline
Hydrophilic Antimicrobials
LAG-B
L: Lipopeptides
A: Amioglycosides
G: Glycopeptides
B: Beta-Lactams
Which antimicrobials are renally cleared?
Hydrophillic
Where do hydrophillic and hydrophobic antimicrobials distribute?
Hydrophillic = ECF
Hydrophobic = ICF
Which antimicrobials should have dose adjustments in sepsis?
Hydrophilic
When would you adjust the dose of a hydrophobic antimicrobial agent?
Liver Failure
Which Antibiotics do not need renal dose adjustments:
CLEAN Dox MeT QD
C: Clindamycin and Ceftriaxone
L: Linezolid
E: Erythromycin
A: Azithromycin
N: Nafcillin
D: Doxycycline
M: Moxifloxacin and Metronidazole
T: Tigecycline
Q: Quinpristine
D: Dalfupristin
Rapid Resistors
QCR
Q: Quinolones
C: Clindamycin
R: Rifampin
Fluoroquinolone AUC Goals
AUC:MIC 125-250
Do not let AUC:MIC <100 —> Resistance concerns
Vancomycin AUC: MIC Ratio
> 400 mg*hr/L
Old-School Trough Goals for vancomycin
10-15/15-20
Vancomycin dose
15 mg/kg/Q12 hr –> Round to the nearest 250 mg dose.
Explain how the following will effect the concentration of a hydrophilic antimicrobial agent:
1.) Decreased Cardiac Output
2.) Increased Capillary Leakiness
3) AKI
4) CKD
- Reduced CL –> Higher Concentrations
- increased Vd —> Lower Concentrations
- AKI–> Increased or Decreased CL
- Reduced CL–> Higher Concentrations.
Where do most infections in healthy people typically occur?
Highly perfused tissues.
In gram negative bacteria, the ____ serves as a significant barrier to a number of antibiotics.
Outer membrane.
Which anaerobes are typically more pathogenic?
Gram Negative.
______: In every population of bacteria there are some which have the resistant gene. Therefore, when antibiotics are given, we are positively selecting for resistant populations which will grow when sensitive populations are killed off.
Heteroresistance.
