| Antibiotic class |
Pharmacodynamic (PD) profile |
PD parameter |
Clinical optimization strategy |
| Aminoglyosides |
concentration-dependent |
fCmax/MIC ³ 10 to 12;
total AUC/MIC ³ 156 |
High-dose, once-daily or extended interval dosing; dosing strategy can use a nomogram (Hartford Nomogram) or be individualized using therapeutic drug monitoring and MIC |
b-lactams
penicillins
carbapenems
cephalosporins |
time-dependent
time-dependent
time-dependent |
fT>MIC ³ 50
fT>MIC ³ 30-40
fT>MIC ³ 50-70 |
Continuous or prolonged infusion; can be combined with greater doses to treat higher MIC organisms |
| Fluoroquinolones |
concentration-dependent |
fCmax/MIC ³ 10 to 12;
total AUC/MIC > 125 for gram-negatives; fAUC/MIC > 30-50 for gram-positives |
Increase dose related to MIC; however careful of increases in toxicity associated with higher concentrations; Use the most potent agent (i.e., lowest MIC) to maximize AUC/MIC ratio |
Glycopeptides/Lipopeptides
daptomycin
vancomycin |
concentration-dependent
time-dependent |
fAUC/MIC; fCmax/MIC *
total AUC/MIC > 400 |
Maximize dose in relation to MIC
Maximize over daily dose in relation to MIC; target trough concentrations of 15-20 mcg/ml |
| Macrolides/Azalides |
time-dependent |
AUC/MIC * |
N/A |
| Oxazolidinone (linezolid) |
time-dependent |
total AUC/MIC > 110 |
Maximize overall daily dose in relation to MIC; standard dose optimized for most susceptible bacteria up to MIC of 2 mcg/ml. |
| Polymyxins |
concentration-dependent |
fAUC/MIC > 12 to 15;
total AUC/MIC > 60 |
Maximize overall daily dose in relation to MIC while considering nephrotoxicity; Consider algorithm for loading and maintenance doses by Garonzik (70) |
Tetracyclines/Glycylcyclines
doxycycline
tigecycline |
time-dependent
time-dependent |
AUC/MIC *
fAUC/MIC |
N/A
Approved dosage optimized for most susceptible bacteria in intra-abdominal infections and complicated skin infections; if tolerated, increase overall daily dose to 200mg daily to maximize pharmacodynamics for more serious infections or Acinetobacter spp. |
*Clinically relevant AUC/MIC targets for these antibiotics have not been well established