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A. Antimicrobial Pharmacokinetics, Pharmacodynamics and General Pharmacology

 

Meet-the-Experts

 

Intra- and Extracellular Activities of Anti-Infective Agents 

Developed in cooperation with the International Society of Anti-Infective Pharmacology (ISAP).

This session will focus on the methodology of determining the intracellular activity of antimicrobial drugs both in vitro and in vivo, the caveats of interpreting the data, and how the knowledge of the intracellular penetration and pharmacodynamics of antimicrobials can be used to optimize dosing against various types of infections. 

Upon completion of this Meet-the-Experts Session, the participant should be able to:

• Describe the importance of targeting both intra- and extracellular pathogens;
• Describe the methodology available for estimating the intracellular penetration and activity of antimicrobials; and 
• Identify the issues and difficulties in estimating the intracellular activity in vitro and in vivo of antimicrobials. 

Convener:
Niels Frimodt-Møller, MD, DMSc; Hvidovre Hosp., Copenhagen, Denmark.

Experts:
Francoise Van Bambeke, PharmD; Univ. Catholique de Louvain, Brussels, Belgium.
Anne Sandberg-Schaal, PharmD, PhD; Statens Serum Inst., Copenhagen, Denmark.

 

Surgical Prophylaxis: Dosage Recommendations, Tissue Penetration, and Pharmacokinetic Considerations

Guidelines for antimicrobial prophylaxis for surgery have recently been updated. This Meet-the-Experts session will discuss the current guidelines with regards to antibiotic selection and dosage recommendations. The pharmacological rationale and tissue penetration data to support these recommendations will be reviewed. Issues regarding the time of prophylactic dosing, need for re-dosing during surgery, and dosage regimens for the obese patients will be appraised.
Upon completion of this Meet-the-Experts Session, the participant should be able to:

• List the current dosage recommendations of antimicrobial agents commonly used for surgical prophylaxis;
• Describe the pharmacokinetic/pharmacodynamic and tissue penetration considerations of antimicrobial agents for surgical prophylaxis; and 
• Evaluate current dosing recommendations for surgical prophylaxis in obese patients. 

Experts:
Joseph S. Solomkin, MD; Univ. of Cincinnati Coll. of Med., Cincinnati, OH.
Douglas N. Fish, PharmD; Univ. of Colorado Sch. of Pharmacy, Aurora, CO.
Kevin W. Garey, PharmD, MS; Univ. of Houston, Coll. of Pharmacy, Houston, TX.

 

Top Papers in Anti-Infective and Antiretroviral PK/PD

Developed in cooperation with the Society of Infectious Diseases Pharmacists (SIDP).

This session will provide an overview and discussion of the most important papers published in 2011 on anti-infective and antiretroviral PK/PD as viewed from the two invited experts.
Upon completion of this Meet-the-Experts Session, the participant should be able to:

• Describe the latest developments within the field of anti-infective PK/PD;
• Describe the most recent findings of importance in anti-infective PK/PD and their consequences for dosing of such drugs; and 
• Identify the issues and difficulties in implementing recent PK/PD data in the clinic. 

Convener:
Keith A. Rodvold, PharmD; Coll. of Pharmacy and Med., Univ. of Illinois, Chicago, IL.

Experts:
Johan W. Mouton, MD, PhD; Radboud Univ. Nijmegen Med. Ctr., Nijmegen, Netherlands.
Courtney V. Fletcher, PharmD; Coll. of Pharmacy, Univ. of Nebraska Med. Ctr., Omaha, NE.

 

Symposia

 

Aerosol Drug Delivery: Getting Anti-Infective Agents to the Lung

Developed in cooperation with the Society of Infectious Diseases Pharmacists (SIDP).

Aerosol delivery of anti-infective agents is increasingly being used for the treatment of serious respiratory tract infections. In addition, several anti-infective agents and aerosol drug delivery devices are actively being pursued in drug development programs. This symposium is aimed at providing clinicians and researchers with the latest developments on devices for aerosol delivery of anti-infective agents, pharmacokinetic/pharmacodynamic considerations with aerosol anti-infective agents, and current applications of aerosolized anti-infective agents in patients with cystic fibrosis and ventilator-associated pneumonia.

Upon completion of this Symposium Session, the participant should be able to:

• Recognize the advantages and disadvantages of devices used for aerosol delivery of anti-infective agents;
• Describe the pharmacokinetic/pharmacodynamic issues associated with aerosol delivery of drugs; and 
• Evaluate the role of aerosolized anti-infective agents in patients with pneumonia and cystic fibrosis. 

Conveners:
Michael Dudley, PharmD; Rempex Pharmaceuticals, San Diego, CA.
Larry H. Danziger, PharmD; Univ. of Illinois, Coll. of Pharmacy and Med., Chicago, IL.

Presentations:
Devices for Aerosol Delivery of Anti-Infective Agents
David E. Geller, MD; Nemours Children's Clinic, Orlando, FL.

Pharmacokinetic/Pharmacodynamic Issues of Aerosol Anti-Infective Agents
Michael Dudley, PharmD; Rempex Pharmaceuticals, San Diego, CA.

Aerosolized Anti-Infective Agents for Cystic Fibrosis
Patrick A. Flume, MD; Med. Univ. of South Carolina, Charleston, SC.

Ventilator-Associated Pneumonia: Can Aerosol Drug Delivery Help?
Jean Chastre, MD; Univ. Sch. of Med., Groupe Hosp. Pitié-Salpêtriére, Paris, France.

 

Pharmacodynamics of Antifungal Agents

Developed in cooperation with the International Society of Anti-Infective Pharmacology (ISAP).

In this session, experts will provide an update on the present knowledge of in vitro activity determination of antifungals including the background for setting clinical breakpoints. Further, the session will describe how optimal dosing of antifungals is based on the pharmacokinetics and pharmacodynamics of these drugs as based on data from in vitro and in vivo studies, including experimental and clinical investigations. Dosing adjustments according to knowledge of adverse effects of the different drugs will also be covered.

Upon completion of this Symposium Session, the participant should be able to:

• Recognize the challenges in making dosage selections of antifungal agents;
• Describe pharmacokinetic/pharmacodynamic methods involved in optimal dose selection; and 
• Identify issues and difficulties in estimating the optimal effect in vitro and in vivo of antifungal agents. 

Conveners:
David R. Andes, MD; Univ. of Wisconsin, Madison, WI.
William Hope, MD, PhD; The Univ. of Manchester, Manchester, United Kingdom.

Presentations:
The Antifungal Pharmacodynamic Target: Impact of Organism, Host, and Infection
William W. Hope, MD, PhD; The Univ. of Manchester, Manchester, United Kingdom.

Antifungal Pharmacodynamics: Beyond Candida
Nathan P. Wiederhold, PharmD; Univ. of Texas at Austin Coll. of Pharmacy, Univ. of Texas Hlth. Sci. Ctr., San Antonio, TX.

Analysis of Clinical Pharmacodynamic Data of Antifungal Agents
David R. Andes, MD; Univ. of Wisconsin, Madison, WI.

Using Antifungal Pharmacodynamics to Set Susceptibility Breakpoints
Russell Lewis, PharmD; Univ. of Houston Coll. of Pharmacy, Univ. of Texas MD Anderson Cancer Ctr., Houston, TX.

 

Targeting Gram-Negative Superbugs with Polymyxins: From Lab-Bench to Bedside

Developed in cooperation with the Society of Infectious Diseases Pharmacists (SIDP) and the International Society of Anti-Infective Pharmacology (ISAP).

Multidrug resistance in gram-negative 'superbugs' is identified at the top of the agenda of infectious diseases. The polymyxins are increasingly being used for treatment of infections caused by gram-negative pathogens that are resistant to all other antibiotics. Over the last few years there is evolving and growing information on the mechanism of activity, inhaled polymyxins in patients with pneumonia and cystic fibrosis, clinical use of combinations with other antibiotics, and mechanisms of nephrotoxicity. This symposium is aimed at providing clinicians with the latest achievements in pharmacology and clinical use of polymyxins (i.e., colistin and polymyxin B), the last-line therapy against gram-negative superbugs. 

Upon completion of this Symposium Session, the participant should be able to:

• Identify the mechanisms of activity and resistance of polymyxin agents;
• Recognize the role of inhaled polymyxins in patients with pneumonia and cystic fibrosis; 
• Evaluate recommendations for combination therapy with polymyxin agents; and 
• Describe the mechanisms of nephrotoxicity and dose-limiting adverse effects of polymyxins. 

Conveners:
Jian Li, PhD; Monash Inst. of Pharmaceutical Sci., Monash Univ., Parkville, Australia.
Keith Kaye, MD, MPH; Wayne State Univ. and Detroit Med. Ctr., Detroit, MI.

Presentations:
Mechanisms of Activity of Polymyxins and Resistance
Jian Li, PhD; Monash Inst. of Pharmaceutical Sci., Monash Univ., Parkville, Australia.

Polymyxin Therapy: What Does Combination Therapy Offer in the Clinical Setting?
Keith Kaye, MD, MPH; Wayne State Univ. and Detroit Med. Ctr., Detroit, MI.

What Do Polymyxin Combinations Offer in the Clinic?
William Couet, PhD; Univ. de Poitiers, Poitiers, France.

Polymyxin Nephrotoxicity: What Do We Know and How Might Understanding its Mechanism Help?
Vincent H. Tam, PharmD; Univ. of Houston Coll. of Pharmacy, Houston, TX.

 

Use of Pharmacokinetics/Pharmacodynamics for Risk Reduction of Adverse Events

Developed in cooperation with the International Society of Anti-Infective Pharmacology (ISAP).

Adverse drug events may occur following a single dose or prolonged drug administration, or be the result of drug-drug interactions. Relationships between drug exposure and adverse events have been commonly described for anti-infective agents such as the aminoglycosides. A limited number of recent studies have applied pharmacokinetic/pharmacodynamic modeling and simulations to assess adverse drug events. This symposium will describe pharmacokinetic/pharmacodynamic modeling techniques useful in risk reduction of adverse events. In addition, trimethoprim-sulfamethoxazole adverse events and hepatic safety of antibiotics will be critically appraised.

Upon completion of this Symposium Session, the participant should be able to: 

• Describe in hepatic safety issues associated with commonly used antibiotics; 
• Appraise the use pharmacodynamic modeling to assess adverse events associated with antibiotics; 
• Assess the relationships between antibiotic exposure and the probability of adverse events; and 
• Recognize trimethoprim-sulfamethoxazole induced adverse events in various patient populations. 

Conveners:
Sujata M. Bhavnani, PharmD, MS; Inst. for Clinical Pharmacodynamics, Latham, NY.
Paul M. Tulkens, MD; Univ. of Catholique de Louvain, Brussels, Belgium.

Presentations:
Hepatic Safety of Antibiotics
Paul M. Tulkens, MD; Univ. Catholique de Louvain, Brussels, Belgium.

Pharmacodynamic Modeling the Risk of Myelosuppression with Linezolid
Alan Forrest, PharmD; SUNY Buffalo Sch. of Pharmacy, Inst. of Clinical Pharmacodynamics, Buffalo, NY.

Daptomycin Exposure and the Probability of Creatine Phosphokinase Elevations
Sujata M. Bhavnani, PharmD, MS; Inst. for Clinical Pharmacodynamics, Latham, NY.

Case-Control Studies of Trimethoprim-Sulfamethoxazole
Tony Antoniou, PharmD; Univ. of Toronto, St. Michael's Hosp., Toronto, Canada.

 

Vancomycin: What Do We Know Now About Pharmacokinetics/Pharmacodynamics?

Developed in cooperation with the Society of Infectious Diseases Pharmacists (SIDP).

Vancomycin continues to be the mainstay of antibiotic therapy for serious gram-positive infections caused by methicillin-resistant Staphylococcus aureus. Despite over 50 years of clinical use, questions still remain about the optimal dose and clinical use of vancomycin. This symposium will discuss the applicability of in vitro models evaluating glycopeptide- and lipopeptide-resistant pathogens and the significance of high minimum inhibitory concentrations on the clinical outcomes with vancomycin therapy. In addition, the clinical use of pharmacokinetic/pharmacodynamic indices and the risks of nephrotoxicity with high-dose vancomycin therapy will be critically appraised.

Upon completion of this Symposium Session, the participant should be able to: 

• Describe in vitro bactericidal activity of glycopeptide- and lipopeptide-resistant pathogens; 
• Appraise whether high minimum inhibitory concentrations of vancomycin influence clinical outcomes; 
• Evaluate the risks of vancomycin-associated nephrotoxicity with high-dose therapy; and 
• Recognize the role of pharmacokinetic/pharmacodynamic indices of vancomycin. 

Conveners:
Annie Wong-Beringer, PharmD; Univ. of Southern California Sch. of Pharmacy, Los Angeles, CA.
Keith A. Rodvold, PharmD; Univ. of Illinois, Coll. of Pharmacy and Med., Chicago, IL.

Presentations:
Pharmacokinetic/Pharmacodynamic In Vitro Models: Lessons from Glycopeptide- and Lipopeptide-Resistant Pathogens
Michael J. Rybak, PharmD: Wayne State Univ. Coll. of Pharmacy & Hlth. Sci., Detroit, MI.

Do High MIC Values Influence Clinical Outcomes of Vancomycin?
Natasha Holmes, MBBS; Austin Hlth., Heidelberg, Australia.

Vancomycin-Associated Nephrotoxicity: A Critical Appraisal of Risk with High-Dose Therapy
Annie Wong-Beringer, PharmD; Univ. of Southern California Sch. of Pharmacy, Los Angeles, CA.

When to Change Methicillin-Resistant Staphylococcus aureus Therapy: Can Pharmacokinetic/Pharmacodynamic Indices Guide the Decision?
Vance Fowler Jr., MD; Duke Univ. Sch. of Med., Durham, NC.