Fundamental concepts and terminology
8 important questions on Fundamental concepts and terminology
What is the post-antibiotic effect?
What are the different in curves between the concentration dependent and the time dependent antibiotics?
What is the point with the time dependent antibiotics?
Beta lactams have no post-antibiotic effect!
- The killing rate doesn't improve when the dosages is increased, the only prerequisite is that the concentration is above the MIC. Normally these drugs are given 2 or 4 times the MIC. It is also better to have short intervals between the dosages.
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Why are so less antibiotics used for continous infusion?
Nowadays prolonged infusion is applied this approaches continous infusion. In theory continous infusion is better but it is hard to find any literature about it.
So what is a summary of beta-lactam antibiotics?
- Beta-lactam antibiotics have a minimal post-MIC effect.
- Decreasing the dosing interval may increase efficacy more than increasing the dose.
- When giving a continuous infusion, target free concentration is at least 4x the MIC (but higher does not give more effect).
What is the toxicity of aminoglycosides?
The toxicity is in the next order: Gentamicin > Netilmicin > Tobramycin
This is researches and analyzed with RIFLE (Risk, Injury and Failure) Gentamicin scored worse than tobramycin.
What is the PK/PD summary of aminoglycosides?
- there is a large post-MIC effect
- there is adaptive resistance
- Increasing dose increases efficacy. peak/MIC ratio > 8
- increasing dosing interval decreases renal toxicity
- possible cumulative ototoxicity
- gentamicin is more nephrotoxic than tobramycin.
What is the summary of the fluoroquinolones?
- increasing dose increases efficacy
- AUC/MIC is the predictive parameter. (for ciprofloxacin this is > 125 for gram - bacteria and > 40 for gram + bacteria)
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