Optimizing clinical outcomes by the use of pharmokinetic and pharmacodynamic principles

Since the advent of antimicrobial chemotherapy, considerable controversy has existed as to the most appropriate method to administer antibiotics to maximize the killing of microorganisms, while minimizing toxicity to the patient. Over the past decade, data gained from animal models of infection, in vitro pharmacodynamic studies, volunteer studies and human clinical trials have enabled us to establish the best mode of drug administration to achieve these goals. The clinician should be aware that appropriate antibiotic selection and dosing depends on pharmacodynamic concepts where there is an integration of the drug's microbiological activity, pharmacokinetic properties and mode of bacterial killing

Transitional [intravenous to oral] antibiotic therapy

Most clinicians feel the best clinical outcome occurs when patients are treated for serious infections with injections for the entire illness. Unfortunately, this type of prescribing style results in considerable indirect costs such as those involved in increased labor [nursing, pharmacy, intravenous technician time], supplies [needles, syringes, intravenous solutions, administration sets, infusion pumps] and nosocomial bacteremia.It now appears from pharmacodynamic and pharmacoeconomic information that this traditional prescribing behavior should change in the management of many infectious diseases, particularly in those clinically stable patients who can ingest or digest a medication. With the presence of numerous antibiotics with high bioavailability, many infections in such patients can now be successfully treated with an oral agent. This review provides examples of common infections [such as community- and hospital-acquired pneumonias, intra-abdominal infections, urinary tract infections, and skin, soft tissue, and bone infections] in which oral therapy can replace parenteral agents