Use of appropriate breakpoints in antimicrobial surveillance studies

[Pseudomonas aeruginosa and beta-lactam antibiotics at the time of Europe]

Breakpoints harmonization concerning six European committees is being conducted within the European Committee for Antimicrobial Susceptibility Testing for a few years and is now finalized for beta-lactam antibiotics. This article describes the impact of breakpoint modifications on percentage of susceptibility of P. aeruginosa to beta-lactams in comparison with previous French National Committee breakpoints (CA-SFM). This harmonization leads to the need for new recommendations about diameter breakpoints and for updating breakpoints in antibiotic susceptibility testing automated devices. Moreover, it points out the importance of MICs and quantitative diameter data in order to follow the evolution of antibiotic susceptibility.

Application of pharmacokinetics and pharmacodynamics to antimicrobial therapy of respiratory tract infections

The pharmacologic field that studies antimicrobial pharmacokinetics and pharmacodynamics (PK/PD) has had a major impact on the choice and dosing regimens used for many antibiotics especially those used in the treatment of respiratory tract infections. PK/PD parameters are particularly important in light of increasing antimicrobial resistance. Drug pharmacokinetic features, such as serum concentrations over time and area under the concentration-time curve, when integrated with minimum inhibitory concentration (MIC) values of antibiotics against pathogens, can predict the probability of bacterial eradication and clinical success. These pharmacokinetic and pharmacodynamic relationships also are important in preventing the selection and spread of resistant strains and have led to the description of the mutation prevention concentration, which is the lowest concentration of antimicrobial that prevents selection of resistant bacteria from high bacterial inocula. b-lactams are time-dependent agents without significant post-antibiotic effects, resulting in bacterial eradication when unbound serum concentrations exceed MICs of these agents against infecting pathogens for >40% to 50% of the dosing interval. Macrolides, azaolides, and lincosamides are time-dependent agents with prolonged post-antibiotic effects, and fluoroquinolones are concentration-dependent agents, resulting in both cases in bacterial eradication when unbound serum area-under-the-curve to MIC ratios exceed 25 to 30. These observations have led to changes in recommended antimicrobial dosing against respiratory pathogens and are used to assess the role of current agents, develop new formulations, and assess potency of new antimicrobials.