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Antimicrobial Agents and Chemotherapy, April 1998, p. 744-748, Vol. 42, No. 4
Department of Medical Microbiology and
Infectious Diseases,
Received 17 April 1997/Returned for modification 16 October
1997/Accepted 5 January 1998
Combination therapy with antimicrobial agents can be used against
bacteria that have reduced susceptibilities to single agents. We
studied various tobramycin and ceftazidime dosing regimens against four
resistant Pseudomonas aeruginosa strains in an in vitro
pharmacokinetic model to determine the usability of combination therapy
for the treatment of infections due to resistant bacterial strains. For
the selection of an optimal dosing regimen it is necessary to determine
which pharmacodynamic parameter best predicts efficacy during
combination therapy and to find a simple method for susceptibility
testing. An easy-to-use, previously described E-test method was
evaluated as a test for susceptibility to combination therapy. That
test resulted in a MICcombi, which is the MIC of, for
example, tobramycin in the presence of ceftazidime. By dividing the
tobramycin and ceftazidime concentration by the MICcombi at each time point during the dosing interval, fractional inhibitory concentration (FIC) curves were constructed, and from these curves new
pharmacodynamic parameters for combination therapy were calculated (i.e., AUCcombi, Cmax-combi,
T>MIC-combi, and
T>FICi, where AUCcombi,
Cmax-combi,
T>MIC-combi, and
T>FICi are the area under the
FICcombi curve, the peak concentration of
FICcombi, the time that the concentration of the
combination is above the MICcombi, and the time above the
FIC index, respectively). By stepwise multilinear regression analysis,
the pharmacodynamic parameter T>FICi proved to
be the best predictor of therapeutic efficacy during combination
therapy with tobramycin and ceftazidime (R2 = 0.6821; P < 0.01).
We conclude that for combination therapy with tobramycin and
ceftazidime the T>FICi is the parameter best
predictive of efficacy and that the E-test for susceptibility testing
of combination therapy gives promising results. These new
pharmacodynamic parameters for combination therapy promise to provide
better insight into the rationale behind combination therapy.
0066-4804/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.
Use of Pharmacodynamic Parameters To Predict
Efficacy of Combination Therapy by Using Fractional Inhibitory
Concentration Kinetics
*
Corresponding author. Present address: Department of
Internal Medicine, Zuiderziekenhuis, Groene Hilledijk 315, 3075 EA
Rotterdam, The Netherlands. Phone: 31-10-2903000, ext. 109. Fax:
31-10-2903361.
Antimicrobial Agents and Chemotherapy, April 1998, p. 744-748, Vol. 42, No. 4
0066-4804/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.
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