25 MB of information … CONTENT OF THE CD-rom Learning appropriate use of antibiotics (PK/PD and...
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Transcript of 25 MB of information … CONTENT OF THE CD-rom Learning appropriate use of antibiotics (PK/PD and...
25 MB of information …25 MB of information …
CONTENT OF THE CD-romCONTENT OF THE CD-rom
Learning appropriate use of antibiotics (PK/PD and guidelines):Learning appropriate use of antibiotics (PK/PD and guidelines): a CD-rom course for healthcare professionals and students a CD-rom course for healthcare professionals and students
E. Ampe, Y. Glupczynski, P.M. Tulkens, and F. Van Bambeke
Unité de Pharmacologie cellulaire et moléculaire, Université catholique de Louvain - Brussels - Belgium Laboratoire de microbiologie, Cliniques universitaires UCL, Mont-Godinne
Mailing address:P.M. TulkensUCL 73.70 av. Mounier 731200 Brussels - [email protected]
ABSTRACTObjectives: In a context of growing resistance and limited supply of new molecules, a rational use of antibiotics should be a high priority. Our objective is to train healthcare professionals and students in PK/PD and in a correct implementation of guidelines, since this could help to improve antibiotic use in both short and mid-terms.
Methods: We developed a PK/PD – guidelines course on CD-rom, targeted to both physicians and pharmacists but also usable by students. The course was prepared by a team of 2 pharmacists, 1 clinical microbiologist, and 1 pharmacologist. Sources of information were (i) textbooks, review papers and primary papers by internationally recognized experts (ii) materials presented at training workshops of the International Society for Antiinfective Pharmacology (ISAP; www.isap.org) during the last 3 years, (iii) national and, if not available, international guidelines for the management of respiratory tracrtor urinary tract infections.
Results: The course is organized as a series of Power Point presentations covering in a progressive fashion the followings topics : (1) bases in microbiology (in vitro properties of antibiotics); (2) pharmacokinetics (definition of the main parameters); (3) pharmacodynamics, with (A) the concepts, (B) the methods and pertinent models, and (C) the data, including the parameters to take into account to optimize the dosage of the main antibiotic classes; (4) resistance, including (A) the main mechanisms and (B) the use of pharmacodynamics to avoid the selection of resistance; (5) the appropriate use (including appropriate dosages) of antibiotics in (A) respiratory tract and (B) urinary tract infections.
Conclusions:This course promotes continuous education in the pharmacology and pharmacotherapy
of antibiotics, in a format easily usable for courses and seminars to both students and professionals.
OBJECTIVES
to develop an educational programme in which pharmacists and infectious disease specialists train healthcare professionals and students in PK/PD and in a correct implementation of guidelines.
to distribute to people following this course a CD-rom as a support that can be consulted at any time.
INTRODUCTION
Optimizing the use of current antibiotics based on pharmacokinetics and pharmacodynamics and rational application of guidelines can contribute to the limitation of resistance development.
In this respect, education of students and healthcare professionals appears as a priority and can be facilitated by making available to them easy-to-consult informative supports.
WHAT WE HOPE AND WHAT WE WILL DO:
the CD-rom should be a continuous information source that could be used for teaching pharmacology and pharmacotherapy of antibiotics to
students and healthcare professionals. may be easily consulted by healthcare professionals at any moment.
We will regularly update it and plan to evaluate its impact on education of students and on the quality of antibiotic prescribing of junior physicians
SECTION 2. DEFINITION SECTION 2. DEFINITION OF PK PARAMETERSOF PK PARAMETERS
SECTION 3. DEFINITION SECTION 3. DEFINITION OF PD PARAMETERSOF PD PARAMETERS
GUIDELINES RESPIRATORY TRACT INFECTIONS
Principles
Application of PK:PD concepts
SECTION 4. GUIDELINESSECTION 4. GUIDELINES
ACKNOWLEDGMENTS: We thank W. Peetermans (KUL- UZ Gasthuisberg) for useful comments and Bayer Belgium for financial support
UCL PK/PD Course 0-9September 2004
Programme, please ...1. Basic introduction to key microbiological parameters
2. Pharmacokinetics (PK) : the basics
3. Pharmacodynamics (PD)
A. the concepts
B. the methods
C. actual data on the main classes of antibiotics
4. Resistance
A. mechanisms and epidemiology
B. PK/PD to fight resistance
5. Clinical guidelines or how to implement PK/PD …
References
What you always wished to know but never dared to askbecause it seemed so basic … and did not know how to begin with all that stuff ...
UCL PK/PD Course 2-5September 2004
What is PK for ?
PK is the way to see if the drug can be made useful …
• does it reach the target in sufficient amounts ?
• for long enough ?
• does it each non-desired targets ?
Co
nc
.
Time0 25
0.0
0.4
Pharmacokinetics= conc. vs time
UCL PK/PD Course 3C-3September 2004
from pharmacokinetics to pharmacodynamics...
0 6 18 2412
Con
cent
ratio
n
MIC
AUC > MIC
AUC / CMI
t > MIC
Time ~ conc > MIC
CmaxCmax / CMI
Time (h)
UCL PK/PD course 1-9September 2004
MIC distributions : unimodal populations
50% 90%
MIC50MIC50 MIC90MIC90
MIC (µg/ml)0.06 012 0.25 0.5 211 840.03
SECTION 1. DEFINITION OF SECTION 1. DEFINITION OF MICROBIOLOGICAL MICROBIOLOGICAL
PARAMETERSPARAMETERS
UCL PK/PD course 5B-7september 2004
Pharyngitis: algorithm for treatment
clinical and epidemiologicalcharacteristics
StreptoPharyngitis
not suspected
StreptoPharyngitis suspected
(4 Centor’s criteria)
Patient at risk
Rapid Ag test
Throat swab culture
Symptomatic treatment Antibiotic treatment
+
+ -
-
- Fever > 38°- no cough- tonsil exsudate-Adénopathies sous-mandibulaires
- anticancer treatment- patients suffering from AAR- -hemolytic strepto B epidemy ina closed community
- severe general symptoms - Cardiac valve abnormality
justifying prophylaxis for Osler’sendocarditis
UCL PK/PD course 5B-17september 2004
Why such high doses ?
… and, hence, insure optimal coverage (T > CMI = 60 % ) for MIC < 4 mg/L
PK data: Fonseca et al (2003) AAC 47:997-1001
Limit of " R " (fully resistant) S. pneumoniae
Increasing the dosis to 80 mg/kg divided in 3 administrations will cause a dubbeling of the concentrations …
P878P878
GUIDELINES URINARY TRACT INFECTIONS
Principles
Applications of PK/PD concepts
UCL PK/PD Lessen 5C-47september 2004
Acute prostatis : treatment
First choice:
• Fluoroquinolones– Ciprofloxacin if suspicion of P. aeruginosa, 500 mg X 2 po
Second choice :
• Cotrimoxazol, 800/160 mg X 2 po
Alternatieves:
• Cephalosporins (cefuroxim)
• Amoxicillin + clavulanic acid
Minimal duration : 2 weeks, often 4 weeks(prevention of chronic infection)
UCL PK/PD Lessen 5C-14september 2004
We are in search of AB thatconcentrate in urine…
0-6 6-12 12-240.01
0.1
1
10
100
1000urine
serum
time interval (h)
con
cen
trat
ion
(m
g/L
)
PK data: Boy et al, Int J Antimicrob Agents . 2004 23 Suppl 1:S6-16
0-2 2-4 4-81
10
100
1000
SM-urine
SM-serum
TMP-urine
TMP-serum
time interval (h)
co
nc
en
tra
tio
n (
mg
/L)
PK data: Tartaglione et al , Antimicrob Agents Chemother. 1988 32 : 1640–1643
Ciprofloxacine, 500 mg po cotrimoxazole, 160/800 mg po