RESUMO
OBJECTIVE: Personalized therapy in the treatment of infections is essential to ensure optimization of antimicrobial drug levels. This strategy, together with an understanding of the activity of these drugs, decreases the risk of bacterial resistance and improves the drugs' safety profile. Alternative outes of administration, such as inhalation, and the information provided by pharmacokinetic models, are essential given the limitation of antimicrobial activity allowed by the new antimicrobials. METHOD: A non-systematic review of the literature is presented as a way of tackling and finding solutions to the problem. A search for high-quality articles on the research topic was conducted. Results: A total of 370 articles were detected, which were subjected to a further selection to discard low quality papers by a team of five clinical pharmacists and an intensivist. Finally, 153 articles were included in the review. CONCLUSIONS: The geriatric and the critical care patient population require the administration of antimicrobials with close monitoring. The routes of administration recommended for the first group are discouraged for the second. The inhaled route often results in high plasma concentrations in patients with respiratory infections. Pharmacokinetic models are a valuable tool in the treatment of geriatric patients, who are often excluded from clinical trials.
OBJETIVO: La terapia personalizada en el tratamiento de las infecciones es esencial para garantizar la optimización de los niveles de fármaco lcanzados en el paciente tratado. Adicionalmente, esta estrategia, juntamente con el conocimiento de la actividad antimicrobiana de estos fármacos, isminuye la posibilidad de desarrollar resistencias bacterianas y mejora el perfil de seguridad de estos fármacos. Las terapias por vías alternativas, como la inhalada, y el soporte de la información facilitada por modelos farmacocinéticos son esenciales debido a la limitación de la actividad aportada por los nuevos antimicrobianos.Método: Se presenta una revisión no sistemática de la literatura como medida de orientación de la problemática y soluciones a lo expuesto anteriormente. Se ha efectuado una búsqueda de artículos de alta calidad sobre el tópico planteado. RESULTADOS: Se detectaron 231 artículos que sufrieron una selección posterior, en base a la calidad de los trabajos valorada por un equipo de cinco farmacéuticos clínicos y un médico intensivista. Finalmente, se incluyeron 153 artículos que soportan la revisión que se ha desarrollado. CONCLUSIONES: La población geriátrica y la integrada por pacientes críticos presenta la necesidad de utilización de los antimicrobianos con una estrecha monitorización. Vías de administración recomendadas en la primera, están desaconsejadas en la segunda. La vía inhalada es una vía que suele relacionarse con elevadas concentraciones en pacientes con infecciones respiratorias. Los modelos farmacocinéticos son un soporte de gran valor para poblaciones como la geriátrica debido a que es mayoritariamente excluida de los ensayos clínicos.
Assuntos
Anti-Infecciosos , Administração por Inalação , Idoso , Antibacterianos/uso terapêutico , Anti-Infecciosos/uso terapêutico , Humanos , FarmacêuticosRESUMO
Thiscase report concerns a 34-year-old male with a hip prosthesis infection, under treatment with antidepressant and antihypertensive drugs, who presented with an increase in blood pressure after four days of treatment with oral tedizolid. Tedizolid was discontinued, and the dose of antihypertensive was increased. The patient progressively achieved the normalisation of blood pressure values, which allowed a reduction in the antihypertensive agent dose to its usual regimen. No cases of hypertension or serotonin toxicity are described in the initial tedizolid studies, where patients treated with other serotonergic drugs were excluded. However, this does not mean that these effects may not occur in clinical practice, especially in patients under concomitant treatment with this type of medication, because of the greater risk of drug interactions. The causality of this suspected drug reaction was analysed and it was considered as possible. The case has been reported to the pharmacovigilance system.