Pharmacokinetic/pharmacodynamic (PK/PD) indices of antibiotics predicted by a semimechanistic PKPD model: a step toward model-based dose optimization

Antimicrob Agents Chemother. 2011 Oct;55(10):4619-30. doi: 10.1128/AAC.00182-11. Epub 2011 Aug 1.

Abstract

A pharmacokinetic-pharmacodynamic (PKPD) model that characterizes the full time course of in vitro time-kill curve experiments of antibacterial drugs was here evaluated in its capacity to predict the previously determined PK/PD indices. Six drugs (benzylpenicillin, cefuroxime, erythromycin, gentamicin, moxifloxacin, and vancomycin), representing a broad selection of mechanisms of action and PK and PD characteristics, were investigated. For each drug, a dose fractionation study was simulated, using a wide range of total daily doses given as intermittent doses (dosing intervals of 4, 8, 12, or 24 h) or as a constant drug exposure. The time course of the drug concentration (PK model) as well as the bacterial response to drug exposure (in vitro PKPD model) was predicted. Nonlinear least-squares regression analyses determined the PK/PD index (the maximal unbound drug concentration [fC(max)]/MIC, the area under the unbound drug concentration-time curve [fAUC]/MIC, or the percentage of a 24-h time period that the unbound drug concentration exceeds the MIC [fT(>MIC)]) that was most predictive of the effect. The in silico predictions based on the in vitro PKPD model identified the previously determined PK/PD indices, with fT(>MIC) being the best predictor of the effect for β-lactams and fAUC/MIC being the best predictor for the four remaining evaluated drugs. The selection and magnitude of the PK/PD index were, however, shown to be sensitive to differences in PK in subpopulations, uncertainty in MICs, and investigated dosing intervals. In comparison with the use of the PK/PD indices, a model-based approach, where the full time course of effect can be predicted, has a lower sensitivity to study design and allows for PK differences in subpopulations to be considered directly. This study supports the use of PKPD models built from in vitro time-kill curves in the development of optimal dosing regimens for antibacterial drugs.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / pharmacokinetics*
  • Anti-Bacterial Agents / pharmacology*
  • Anti-Bacterial Agents / therapeutic use
  • Area Under Curve
  • Aza Compounds / pharmacokinetics
  • Aza Compounds / pharmacology
  • Cefuroxime / pharmacokinetics
  • Cefuroxime / pharmacology
  • Computer Simulation
  • Erythromycin / pharmacokinetics
  • Erythromycin / pharmacology
  • Escherichia coli / drug effects*
  • Fluoroquinolones
  • Gentamicins / pharmacokinetics
  • Gentamicins / pharmacology
  • Humans
  • Microbial Sensitivity Tests
  • Moxifloxacin
  • Penicillin G / pharmacokinetics
  • Penicillin G / pharmacology
  • Quinolines / pharmacokinetics
  • Quinolines / pharmacology
  • Streptococcus pyogenes / drug effects*
  • Vancomycin / pharmacokinetics
  • Vancomycin / pharmacology

Substances

  • Anti-Bacterial Agents
  • Aza Compounds
  • Fluoroquinolones
  • Gentamicins
  • Quinolines
  • Erythromycin
  • Vancomycin
  • Cefuroxime
  • Penicillin G
  • Moxifloxacin