Abstract
Pharmacokinetics (PK) and pharmacodynamics (PD) have become an important field in the evaluation and application of antimicrobials in all its aspects. PK/PD is used in developing drugs, optimizing therapy, setting clinical breakpoints, and preventing emergence of resistance. This chapter provides a general overview of PK/PD, the major factors that play a role, in vitro–in vivo relationships, pitfalls, and the application to clinical practice.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
ISO (2006) ISO 20776-1. Clinical Laboratory Testing and in vitro diagnostic test systems - susceptibility testing of infectious agents and evaluation of performance of antimicrobial susceptibility testing devices- Part 1. International Standards Organisation
Ericsson HM, Sherris JC (1971) Antibiotic sensitivity testing. Report of an international collaborative study. Acta Pathol Microbiol Scand B: Microbiol Immunol 217(Suppl B):1–90
NCCLS (2001) Development of in vitro susceptibility testing criteria and quality control parameters; approved guideline-Second Edition. NCCLS document M23-A2. NCCLS, Wayne
EUCAST (2003) Determination of minimum Inhibitory concentrations (MICs) of antibacterial agents by broth dilution. DISCUSSION DOCUMENT E.Dis 5.1. European Society Clinical Microbiology and Infectious Diseases, Munich, Germany
ISO (2008) ISO 20776-2. Clinical Laboratory Testing and in vitro diagnostic test systems - susceptibility testing of infectious agents and evaluation of performance of antimicrobial susceptibility testing devices- Part 2. International Standards Organisation
ISO (2014) ISO 16782. Criteria for acceptable lots of dehydrated Mueller-Hinton Agar and Broth for Antimicrobial Susceptibility Testing. International Standards Organisation
Mouton JW, Vinks AA (2005) Relationship between minimum inhibitory concentration and stationary concentration revisited: growth rates and minimum bactericidal concentrations. Clin Pharmacokinet 44(7):767–768
Garrod LP (1948) The bactericidal action of streptomycin. Br Med J 1(4547):382–386
Shah PM, Junghanns SW (1976) Bactericidal dosie-activity relationships with E. coli, K. pneumoniae and Staph. aureus (author’s transl). Dtsch Med Wochenschr 101(9):325–328
Mattie H (1981) Kinetics of antimicrobial action. Rev Infect Dis 3(1):19–27
Vogelman B, Craig WA (1986) Kinetics of antimicrobial activity. J Pediatr 108(5 Pt 2):835–840
Bouvier d’Yvoire MJY, Maire PH (1996) Dosageregimens of antibacterials. Implications of a pharmacokinetic/pharmacodynamic model. Clin Drug Invest 11:229–239
Mouton JW, Vinks AA (2005) Pharmacokinetic/pharmacodynamic modelling of antibacterials in vitro and in vivo using bacterial growth and kill kinetics: the minimum inhibitory concentration versus stationary concentration. Clin Pharmacokinet 44(2):201–210
Eagle H, Fleischman R, Levy M (1953) “Continuous” vs. “discontinuous” therapy with penicillin; the effect of the interval between injections on therapeutic efficacy. N Engl J Med 248(12):481–488
Mouton JW, Dudley MN, Cars O, Derendorf H, Drusano GL (2005) Standardization of pharmacokinetic/pharmacodynamic (PK/PD) terminology for anti-infective drugs: an update. J Antimicrob Chemother 55(5):601–607
Mouton JW, Dudley MN, Cars O, Derendorf H, Drusano GL (2002) Standardization of pharmacokinetic/pharmacodynamic (PK/PD) terminology for anti-infective drugs. Int J Antimicrob Agents 19(4):355–358
Toutain PL, Bousquet-Melou A, Martinez M (2007) AUC/MIC: a PK/PD index for antibiotics with a time dimension or simply a dimensionless scoring factor? J Antimicrob Chemother 60(6):1185–1188. doi:10.1093/jac/dkm360
Bakker-Woudenberg IA, van Gerwen AL, Michel MF (1979) Efficacy of antimicrobial therapy in experimental rat pneumonia: antibiotic treatment schedules in rats with impaired phagocytosis. Infect Immun 25(1):376–387
Gerber AU, Craig WA, Brugger HP, Feller C, Vastola AP, Brandel J (1983) Impact of dosing intervals on activity of gentamicin and ticarcillin against Pseudomonas aeruginosa in granulocytopenic mice. J Infect Dis 147(5):910–917
Vogelman B, Gudmundsson S, Leggett J, Turnidge J, Ebert S, Craig WA (1988) Correlation of antimicrobial pharmacokinetic parameters with therapeutic efficacy in an animal model. J Infect Dis 158(4):831–847
Leggett JE, Fantin B, Ebert S, Totsuka K, Vogelman B, Calame W, Mattie H, Craig WA (1989) Comparative antibiotic dose-effect relations at several dosing intervals in murine pneumonitis and thigh-infection models. J Infect Dis 159(2):281–292
Leggett JE, Ebert S, Fantin B, Craig WA (1990) Comparative dose-effect relations at several dosing intervals for beta- lactam, aminoglycoside and quinolone antibiotics against gram-negative bacilli in murine thigh-infection and pneumonitis models. Scand J Infect Dis Suppl 74:179–184
Scaglione F, Mouton JW, Mattina R, Fraschini F (2003) Pharmacodynamics of levofloxacin and ciprofloxacin in a murine pneumonia model: peak concentration/MIC versus area under the curve/MIC ratios. Antimicrob Agents Chemother 47(9):2749–2755
Ambrose PG, Bhavnani SM, Rubino CM, Louie A, Gumbo T, Forrest A, Drusano GL (2007) Pharmacokinetics-pharmacodynamics of antimicrobial therapy: it’s not just for mice anymore. Clin Infect Dis 44(1):79–86
Tompsett R, Shultz S, McDermott W (1947) The relation of protein binding to the pharmacology and antibacterial activity of penicillins X, G, dhydro F, and K. J Bacteriol 53:581–595
Craig WA (1995) Interrelationship between pharmacokinetics and pharmacodynamics in determining dosage regimens for broad-spectrum cephalosporins. Diagn Microbiol Infect Dis 22(1-2):89–96
Zeitlinger MA, Derendorf H, Mouton JW, Cars O, Craig WA, Andes D, Theuretzbacher U (2011) Protein binding: do we ever learn? Antimicrob Agents Chemother 55(7):3067–3074. doi:10.1128/AAC.01433-10
Garrison MW, Vance-Bryan K, Larson TA, Toscano JP, Rotschafer JC (1990) Assessment of effects of protein binding on daptomycin and vancomycin killing of Staphylococcus aureus by using an in vitro pharmacodynamic model. Antimicrob Agents Chemother 34(10):1925–1931
Calain P, Krause KH, Vaudaux P, Auckenthaler R, Lew D, Waldvogel F, Hirschel B (1987) Early termination of a prospective, randomized trial comparing teicoplanin and flucloxacillin for treating severe staphylococcal infections. J Infect Dis 155(2):187–191
Lowdin E, Odenholt-Tornqvist I, Bengtsson S, Cars O (1993) A new method to determine postantibiotic effect and effects of subinhibitory antibiotic concentrations. Antimicrob Agents Chemother 37(10):2200–2205
Tam VH, Nikolaou M (2011) A novel approach to pharmacodynamic assessment of antimicrobial agents: new insights to dosing regimen design. PLoS Comput Biol 7(1):e1001043
Forrest A, Nix DE, Ballow CH, Goss TF, Birmingham MC, Schentag JJ (1993) Pharmacodynamics of intravenous ciprofloxacin in seriously ill patients. Antimicrob Agents Chemother 37(5):1073–1081
Preston SL, Drusano GL, Berman AL, Fowler CL, Chow AT, Dornseif B, Reichl V, Natarajan J, Corrado M (1998) Pharmacodynamics of levofloxacin: a new paradigm for early clinical trials [see comments]. JAMA 279(2):125–129
Ambrose PG, Grasela DM, Grasela TH, Passarell J, Mayer HB, Pierce PF (2001) Pharmacodynamics of fluoroquinolones against Streptococcus pneumoniae in patients with community-acquired respiratory tract infections. Antimicrob Agents Chemother 45(10):2793–2797
Rodriguez-Tudela JL, Almirante B, Rodriguez-Pardo D, Laguna F, Donnelly JP, Mouton JW, Pahissa A, Estrella MC (2007) Correlation of the MIC and Dose/MIC ratio of fluconazole to the therapeutic response of patients with mucosal candidiasis and candidaemia. Antimicrob Agents Chemother 51(10):3599–3604
Muller AE, Punt N, Mouton JW (2013) Optimal exposures of ceftazidime predict the probability of microbiological and clinical outcome in the treatment of nosocomial pneumonia. J Antimicrob Chemother 68(4):900–906. doi:10.1093/jac/dks468, dks468 [pii]
Drusano GL, Fregeau C, Liu W, Brown DL, Louie A (2010) Impact of burden on granulocyte clearance of bacteria in a mouse thigh infection model. Antimicrob Agents Chemother 54(10):4368–4372. doi:10.1128/AAC.00133-10, AAC.00133-10 [pii]
Andes D, Craig WA (2002) Animal model pharmacokinetics and pharmacodynamics: a critical review. Int J Antimicrob Agents 19(4):261–268
Drusano GL, D’Argenio DZ, Preston SL, Barone C, Symonds W, LaFon S, Rogers M, Prince W, Bye A, Bilello JA (2000) Use of drug effect interaction modeling with Monte Carlo simulation to examine the impact of dosing interval on the projected antiviral activity of the combination of abacavir and amprenavir. Antimicrob Agents Chemother 44(6):1655–1659
Drusano GL, Preston SL, Hardalo C, Hare R, Banfield C, Andes D, Vesga O, Craig WA (2001) Use of preclinical data for selection of a phase II/III dose for evernimicin and identification of a preclinical MIC breakpoint. Antimicrob Agents Chemother 45(1):13–22
Roberts JA, Abdul-Aziz MH, Lipman J, Mouton JW, Vinks AA, Felton TW, Hope WW, Farkas A, Neely MN, Schentag JJ, Drusano G, Frey OR, Theuretzbacher U, Kuti JL, on behalf of The International Society of Anti-Infective P, the P, Pharmacodynamics Study Group of the European Society of Clinical M, Infectious D (2014) Individualised antibiotic dosing for patients who are critically ill: challenges and potential solutions. Lancet Infect Dis 14(6):498–509. doi:10.1016/S1473-3099(14)70036-2
Mouton JW, Brown DF, Apfalter P, Canton R, Giske CG, Ivanova M, Macgowan AP, Rodloff A, Soussy CJ, Steinbakk M, Kahlmeter G (2012) The role of pharmacokinetics/pharmacodynamics in setting clinical MIC breakpoints: the EUCAST approach. Clin Microbiol Infect 18(3):E37–E45. doi:10.1111/j.1469-0691.2011.03752.x
Kahlmeter G, Brown DF, Goldstein FW, MacGowan AP, Mouton JW, Osterlund A, Rodloff A, Steinbakk M, Urbaskova P, Vatopoulos A (2003) European harmonization of MIC breakpoints for antimicrobial susceptibility testing of bacteria. J Antimicrob Chemother 52(2):145–148
Kahlmeter G, Brown DF, Goldstein FW, MacGowan AP, Mouton JW, Odenholt I, Rodloff A, Soussy CJ, Steinbakk M, Soriano F, Stetsiouk O (2006) European Committee on Antimicrobial Susceptibility Testing (EUCAST) Technical Notes on antimicrobial susceptibility testing. Clin Microbiol Infect 12(6):501–503
Andes D (2006) Pharmacokinetics and pharmacodynamics of antifungals. Infect Dis Clin North Am 20(3):679–697
Seyedmousavi S, Mouton JW, Melchers WJ, Bruggemann RJ, Verweij PE (2014) The role of azoles in the management of azole-resistant aspergillosis: from the bench to the bedside. Drug Resist Updat 17(3):37–50. doi:10.1016/j.drup.2014.06.001
Drusano GL (1993) Pharmacodynamics of antiretroviral chemotherapy. Infect Control Hosp Epidemiol 14(9):530–536
McSharry JJ, Drusano GL (2011) Antiviral pharmacodynamics in hollow fibre bioreactors. Antivir Chem Chemother 21(5):183–192. doi:10.3851/IMP1770
Firsov AA, Vostrov SN, Lubenko IY, Drlica K, Portnoy YA, Zinner SH (2003) In vitro pharmacodynamic evaluation of the mutant selection window hypothesis using four fluoroquinolones against Staphylococcus aureus. Antimicrob Agents Chemother 47(5):1604–1613
Tam VH, Louie A, Deziel MR, Liu W, Leary R, Drusano GL (2005) Bacterial-population responses to drug-selective pressure: examination of garenoxacin’s effect on Pseudomonas aeruginosa. J Infect Dis 192(3):420–428
Tam VH, Louie A, Fritsche TR, Deziel M, Liu W, Brown DL, Deshpande L, Leary R, Jones RN, Drusano GL (2007) Impact of drug-exposure intensity and duration of therapy on the emergence of Staphylococcus aureus resistance to a quinolone antimicrobial. J Infect Dis 195(12):1818–1827. doi:10.1086/518003, JID37660 [pii]
Blondeau JM, Zhao X, Hansen G, Drlica K (2001) Mutant prevention concentrations of fluoroquinolones for clinical isolates of Streptococcus pneumoniae. Antimicrob Agents Chemother 45(2):433–438. doi:10.1128/AAC.45.2.433-438.2001
Zhao X, Drlica K (2002) Restricting the selection of antibiotic-resistant mutant bacteria: measurement and potential use of the mutant selection window. J Infect Dis 185(4):561–565
Goessens WH, Mouton JW, Ten Kate MT, Bijl AJ, Ott A, Bakker-Woudenberg IA (2007) Role of ceftazidime dose regimen on the selection of resistant Enterobacter cloacae in the intestinal flora of rats treated for an experimental pulmonary infection. J Antimicrob Chemother 59(3):507–516
Drusano GL, Bilello JA, Stein DS, Nessly M, Meibohm A, Emini EA, Deutsch P, Condra J, Chodakewitz J, Holder DJ (1998) Factors influencing the emergence of resistance to indinavir: role of virologic, immunologic, and pharmacologic variables. J Infect Dis 178(2):360–367
Meletiadis J, Verweij PE, TeDorsthorst DT, Meis JF, Mouton JW (2005) Assessing in vitro combinations of antifungal drugs against yeasts and filamentous fungi: comparison of different drug interaction models. Med Mycol 43(2):133–152
Yuan Z, Ledesma KR, Singh R, Hou J, Prince RA, Tam VH (2010) Quantitative assessment of combination antimicrobial therapy against multidrug-resistant bacteria in a murine pneumonia model. J Infect Dis 201(6):889–897. doi:10.1086/651024
Mouton JW, van Ogtrop ML, Andes D, Craig WA (1999) Use of pharmacodynamic indices to predict efficacy of combination therapy in vivo. Antimicrob Agents Chemother 43(10):2473–2478
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer Science+Business Media New York
About this protocol
Cite this protocol
Mouton, J.W. (2016). General Concepts of Pharmacodynamics for Anti-infective Agents. In: Rotschafer, J., Andes, D., Rodvold, K. (eds) Antibiotic Pharmacodynamics. Methods in Pharmacology and Toxicology. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4939-3323-5_1
Download citation
DOI: https://doi.org/10.1007/978-1-4939-3323-5_1
Published:
Publisher Name: Humana Press, New York, NY
Print ISBN: 978-1-4939-3321-1
Online ISBN: 978-1-4939-3323-5
eBook Packages: Springer Protocols