Marisa Caetano

The pathophysiological situation of burn assault, together with the intensive care procedures, might alter the pharmacokinetic (PK) and the pharmacodynamic (PD) parameters and, therefore, the antimicrobial concentrations in the body, the outcome of the therapy and the patient’s recovery.

Usually, there is a balance between the bound and unbound drug concentrations in plasma. Only unbound drug is able to access the tissue, where a new equilibrium is established between the tissue concentrations of bound and unbound drug. At the site of infection, only the unbound antimicrobial is responsible for the effect.

Selective pressure affects pathogens to decrease their susceptibility to the antibiotic, and higher MICs (minimum inhibitory concentrations) are observed. Hence, increasing resistance against multiple currently available antibiotics is leading to a rapid loss of treatment options against infectious diseases.

Since antibiotic resistance is due, in part, to the misuse or abuse of antibiotics, this situation can be reversed by improving their use.

Inappropriate drug selection and suboptimal dosing are two key factors that must be considered, since they lead to the emergence of drug resistance and, consequently, poorer clinical outcomes.

Regarding dosing, the use of pharmacokinetics (PK) and pharmacodynamics (PD) to detail antimicrobial exposures is useful to maximize bacterial killing or growth inhibition. One such method for improving antimicrobial dosing in individual patients is through the application of therapeutic drug monitoring (TDM), in order to personalize the treatment.

Therefore, it is necessary to optimize the use of antimicrobials, to improve clinical outcomes of infections, to reduce the development of antimicrobial resistance and for the sustainability of health systems.