Farmakokinetyczno-farmakodynamiczne zasady stosowania antybiotyków u chorych leczonych z powodu sepsy

*Piotr Smuszkiewicz¹, Edyta Szałek², Hanna Tomczak³, Iwona Trojanowska¹, Maciej Błaszyk¹

Summary
Contemporary antimicrobial therapy should be directed by objective criteria which allow for maximal effectiveness of treatment with minimal side effects. ITU patients are at special risk because of profound changes in the organism that may alter both the pharmacokinetics and the pharmacodynamics of drugs. Therapeutic concentrations are frequently not achieved, leading to multiple bacterial resistance. Typical parameters (Cl, Vd, T_0,5, AUC, C_max) do not adequately describe the altered PK/PD in sepsis. Three other indicators, C_max/MIC, AUC/MIC, and T>MIC allow for better prediction of therapeutic effects. For drugs where effectiveness is concentration dependent (eg. aminoglycosides), the C_max/MIC indicator should be used. For the successful use of the AUC dependent drugs (fluorchinolones), the AUC/MIC indicator should used and kept above>125. The T>MIC indicator is important for betalactam antibiotics, macrolides and clindamycin.
The standardization of these indicators should improve the effectiveness of antimicrobial therapy is sepsis.

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