RESUMO
La selección de microorganismos multirresistentes, como efecto indeseable de la utilización de los antimicrobianos, y la escasez de novedades terapéuticas que se prevé para los próximos años obligan a una utilización racional de los antimicrobianos de uso habitual. La optimización de los regímenes terapéuticos mediante la utilización del análisis farmacocinético/farmacodinámico (PK/PD) sin duda contribuirá a alargar la vida útil de los antimicrobianos y a la contención de la resistencia bacteriana. Se revisa la importancia de la adecuada selección del régimen de dosificación de los antimicrobianos, la aplicación del análisis PK/PD en antibioterapia, la simulación de Montecarlo, los índices de eficacia y los puntos de corte PK/PD.El análisis PK/PD también se puede aplicar para la prevención de resistencias. Para estudiar los principios que predicen su aparición y difusión se pueden utilizar diferentes métodos: modelos in vitro, modelos animales y métodos para la evaluación de la prevención de resistencias (ventanas de selección de mutantes).Aunque el análisis PK/PD en antibioterapia es una herramienta muy útil que facilita la selección del tratamiento antimicrobiano más adecuado, presenta una serie de limitaciones para su aplicación en la práctica clínica
The selection of multiresistant microorganisms, as a side-effect of the use of antimicrobials, together with the lack of new therapeutic drugs expected in the near future, forces to a rational use of antibiotics. The optimisation of antibacterial treatments based on pharmacokinetic/pharmacodynamic analysis (PK/PD) may contribute to prolong the life of antibiotics and to contain the bacterial resistance to them. A review is made of the importance of the appropriateness of the dose regimen selected, the application of PK/PD analysis of antimicrobials, the Monte Carlo simulation, PK/PD indices for efficacy, and PK/PD cut-off points.PK/PD analysis is also applicable to the prevention of bacterial resistance. Different methods have been used to study the factors that lead to its emergence and spread, such as in vitro and animal models, and resistance prevention studies (mutant selection window).Although the PK/PD analysis is a very useful tool for the selection of the most appropriate dose regimen of antibiotics, several problems limit its use in clinical practice
Assuntos
Humanos , Animais , Anti-Infecciosos/farmacocinética , Antibacterianos/farmacologia , Infecções/tratamento farmacológico , Resistência a Múltiplos Medicamentos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Resultado do Tratamento , Modelos Animais de DoençasRESUMO
The selection of multiresistant microorganisms, as a side-effect of the use of antimicrobials, together with the lack of new therapeutic drugs expected in the near future, forces to a rational use of antibiotics. The optimisation of antibacterial treatments based on pharmacokinetic/pharmacodynamic analysis (PK/PD) may contribute to prolong the life of antibiotics and to contain the bacterial resistance to them. A review is made of the importance of the appropriateness of the dose regimen selected, the application of PK/PD analysis of antimicrobials, the Monte Carlo simulation, PK/PD indices for efficacy, and PK/PD cut-off points. PK/PD analysis is also applicable to the prevention of bacterial resistance. Different methods have been used to study the factors that lead to its emergence and spread, such as in vitro and animal models, and resistance prevention studies (mutant selection window). Although the PK/PD analysis is a very useful tool for the selection of the most appropriate dose regimen of antibiotics, several problems limit its use in clinical practice.
