Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast Episode 56: Bugs and Drugs Part 1 with Rachel Kruer
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Sep 28, 2017 Rachel Kruer, a clinical pharmacy specialist in surgical critical care at Johns Hopkins, dives deep into the world of antibiotics. She explains the difference between pharmacodynamics and pharmacokinetics, covering how various antibiotics work against common bacteria. The discussion includes critical topics like interpreting MICs for effective antibiotic selection, the role of rapid diagnostics, and options for those with penicillin allergies. Rachel also emphasizes the importance of local antibiograms to tailor treatment effectively.
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Pharmacodynamics Determines Dosing Strategy
- Time-dependent antibiotics need adequate time above the MIC to work optimally.
- Concentration-dependent drugs need high peaks, while some use AUC/MIC for total exposure.
Pick Drugs By Penetration And Synergy
- Choose antibiotics based on tissue penetration, achievable concentrations, and toxicity.
- Combine agents with different mechanisms for synergy against resistant gram-negatives.
Interpret MICs With Breakpoints
- Always check the lab's breakpoint interpretation (susceptible/intermediate/resistant).
- Prefer agents labeled susceptible and consider resistance trends before choosing therapy.