Burns, Trauma and Critical Care Research Centre, The University of Queensland, Level 7 Block 6, Royal Brisbane & Women's Hospital, Brisbane Queensland 4029, Australia.
Crit Care Clin. 2011 Jan;27(1):19-34. doi: 10.1016/j.ccc.2010.09.006.
Antimicrobial pharmacokinetics (PK) and pharmacodynamics (PD) are important considerations, particularly in critically ill patients with severe sepsis and septic shock. The pathophysiologic changes that occur in these conditions can have a major effect on pharmacokinetic parameters, which in turn could result in failure to achieve pharmacodynamic targets for antimicrobials thus adversely affecting clinical outcome. This paper discusses the pathophysiologic changes that occur during severe sepsis and septic shock and the consequent effects on antimicrobial PK and PD. The effect of PK/PD on specific antimicrobial classes is discussed and a rational framework for antimicrobial dosing is provided. Knowledge of PK/PD properties of antimicrobials can be used to personalize dosing regimens not only to maximize antimicrobial activity but also to minimize toxicity and reduce the development of antimicrobial resistance.
抗菌药物药代动力学（PK）和药效学（PD）是重要的考虑因素，尤其是在患有严重脓毒症和感染性休克的重症患者中。这些情况下发生的病理生理变化会对 PK 参数产生重大影响，这反过来又可能导致抗菌药物无法达到药效学目标，从而对临床结果产生不利影响。本文讨论了严重脓毒症和感染性休克期间发生的病理生理变化及其对抗菌药物 PK 和 PD 的影响。讨论了 PK/PD 对特定抗菌药物类别的影响，并提供了一个合理的抗菌药物给药框架。对抗菌药物 PK/PD 特性的了解可用于个体化给药方案，不仅可最大限度地提高抗菌活性，还可最大限度地降低毒性和减少抗菌药物耐药性的发展。
