Learning objective: understand optimal dosing strategies for different classes of antibiotics based on current pharmacodynamic models, and how these models are replacing the older concepts of bactericidal and bacteriostatic effect.
The three pharmacodynamic models and corresponding antibiotics are:
Time-dependent killing: Expressed as fT>MIC (or T>MIC), representing the percentage of the dosing interval that free (unbound) drug concentration remains above the minimum inhibitory concentration. Main examples: beta lactams.
Concentration-dependent killing with peak concentration: Expressed as Cmax/MIC, representing the ratio of maximum drug concentration to MIC. Main examples: fluoroquinolones and aminoglycosides.
Area under the curve: Expressed as AUC/MIC or AUC₀₋₂₄/MIC, representing the ratio of the 24-hour area under the concentration-time curve to MIC. Main examples: Glycopeptides (vancomycin and congeners) and lipopeptides (daptomycin).
These models are replacing the older concepts of bactericidal and bacteriostatic.
The best explanation of this I was able to find was in Chapter 56 of Goodman and Gilman, available through Access Medicine, UAMS library.
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