Craig WA

Language: Spanish
References: 21
Page: 172-177
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ABSTRACT

Increasing antimicrobial resistance among respiratory pathogens has the potential to reduce the efficacy of standard dosage regimens for many oral drugs. The goal of antimicrobial therapy is to maximize bactericidal activity. The duration of time that serum concentrations exceed the MIC is the pharmacokinetic/pharmacodynamic parameter that determines efficacy for β-lactams, macrolides, and trimethoprim/sulfamethoxazole.
Studies in animal models suggest that serum levels of β-lactams need to exceed the MIC for about half of the dosing interval to obtain maximum antimicrobial efficacy. Studies in children with acute otitis media also demonstrate that serum concentrations need to exceed the MIC for 40% or more of the dosing interval to obtain bacteriologic cure in over 85% of patients. With the oral β-lactams used against penicillin-resistant Streptococcus pneumoniae, this goal is obtained only with amoxicillin and amoxicillin/clavulanate. For Haemophilus influenzae, several β-lactams including cefixime, cefpodoxime, and amoxicillin/clavulanate provide serum levels with the longest durations above the MIC. Antimicrobial resistance has also stimulates the search for new potent antimicrobials, altered but effective dosing regimens, and resistance control measures, such as the prudent use, optimal infection control practice, and vaccines to reduce colonization and subsequent infection. C 1996 Elsevier Science Inc.

REFERENCES

1. Andes D, Urban A, Craig WA. In-vivo activity of amoxicillin and amoxicillin-clavulanate against penicillin-resistant pneumococci. Abstract A82. In: Proceedings and Abstracts of the 55th Interscience Conference on Antimicrobial Agents and Chemotherapy. Washington, DC: American Society for Microbiology, 1995.

2. Craig WA, Ebert SC. Killing and growth of bacteria in vitro: A review. Scand J Infect Dis 1991; 74: S63-70.

3. Craig W, Rickardsdottir S, Watanabe Y. In-vivo and in-vitro postantibiotic effects (PAEs) of azithromycin. Abstract. In: Program and Abstracts of the 32nd Interscience Conference on Antimicrobial Agent and Chemotherapy. Washington, DC: American Society for Microbiology, 1992.

4. Craig WA, Ebert S, Watanabe Y. Differences in time above MIC required for efficacy of beta-lactams in animal infection models. Abstract 86. In: Proceedings and Abstracts of the 35th Interscience Conference on Antimicrobial Agent and Chemotherapy. Washington, DC: American Society for Microbiology, 1993.

5. Craig WA. Interrelationship between pharmacokinetics and pharmacodynamics in determining dosage regimens for broad spectrum cephalosporins. Diagn Microbiol Infect Dis 1995; 22: 89-96.

6. Craig WA, Andes DR. Parenteral versus oral antibiotic therapy. Med Clin North Am 1995; 79: 497-508.

7. Craig WA, Andes D. Pharmacokinetics and pharmacodynamics of antibiotics in otitis media. Pediatr Infect Dis J 1996; 15: 255-9.

8. Craig WA. Penicillins. In: Andriole V, editor. Current infectious diseases drugs. Philadelphia: Current Medicine, 1996: 62-104.

9. Dagan R, Abramson O, Leibovitz E, Lang R, Goshen S, Greenberg D, et al. Impaired bacteriologic response to oral cephalosporins in acute otitis media (AOM) caused by intermediately penicillin-resistant pneumococci (I-PRP). Abtstract LB-25. In: Proceedings and Abstracts of the 35th Interscience Conference on Antimicrobial Agent and Chemotherapy. Washington, DC: American Society for Microbiology, 1995.

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16. Leggett JE, Ebert S, Fantin B, Craig WA. Comparative dose-effect relations at several dosing intervals for beta-lactams, aminoglycoside and quinolone antibiotics and pneumonitis models. Scand J Infect Dis 1991; 74: S179-84.

17. Meyers BR, Gurtman AC, Farrington JM. Cephalosporins. In: Andriole V, editor. Current infectious disease drugs. Philadeliphia: Current Medicine 1996: 13-61.

18. Moine P, Vallee E, Azoulay-Dupouis E, Bourget P, Bedos JP, Bauchet J, et al. In vivo efficacy of a broad-spectrum cephalosporin, ceftriaxone, against penicillin-susceptible and-resistant strains of Streptococcus pneumoniae in a mouse pneumonia model. Antimicrob Agents Chemother 1994; 38: 1953-8.

19. Spangler SK, Jacobs MR, Appelbaum PC. In vitro susceptibilities of 185 penicillin-susceptible and-resistant pneumococci to WY 49605 (SUN/SY 5555), a new oral penem, compared with those to penicillin G, amoxicillin, amoxicillin-clavulanate, cefixime, cafaclor, cefpodoxime, cefuroxime, and cefdinir. Antimicrob Agents Chemother 1994; 38: 2902-4.

20. Urban A, Andes D, Craig WA. In-vivo activity of cefpodoxime against penicillin-resistant pneumococci. Abstract 2229. In: Final Program and Abstracts of the 19th International Congress of Chemotherapy. Ottawa, Canada: Canadian Infectious Disease Society, 1995.

21. Vogelman B, Gudmundsson S, Leggett J, Turnidge J, Ebert S, Craig WA. Correlation of antimicrobial pharmacokinetic parameters with therapeutic efficacy in an animal model. J Infect Dis 1988; 158: 831-47.