Complicated urinary tract infections and the choice of antibiotics

Abstract

Komplicirane infekcije mokraćnog sustsva (IMS) su heterogena skupina bolesti koje često predstavljaju terapijski problem zbog potrebe multidisciplinarnog pristupa, a zbog porasta rezistencije izoliranih patogena na antibiotike sve veća je nepredvidljivost antibiotske osjetljivosti. Prema smjernicama za antimikrobno liječenje i profilaksu sastavljene na inicijativu Interdisciplinarne sekcije za kontrolu rezistencije na antibiotike (ISKRA) Ministarstva zdravstva i socijalne skrbi RH, a u skladu s IDSA (Infectious Diseases Society of America) i ESCMID (European Society of Clinical Microbiology and Infectious Diseases) komplicirane infekcije mokraćnog sustava dijele se na: IMS muškaraca, komplicirane IMS uz prisustvo funkcionalnih ili anatomskih abnormalnosti urotrakta, bolničke IMS i IMS uz prisustvo stranog tijela (kateter), IMS u trudnica i IMS u žena u postmenopauzi. Odabrani lijek treba imati odgovarajući spektar djelovanja na dokazanog ili vjerojatnog patogena i dobru penetraciju. Različitosti u farmakokinetici, farmakodinamici i njihovom odnosu, imaju utjecaj na optimalni režim doziranja antibiotika. Određeni farmakokinetski i farmakodinamski pokazatelji (PK/PD): Cmax/MIC, AUC i T>MIC, predviđaju mikrobiološki i klinički odgovor. Neuspijeh u liječenju nerijetko je rezultat i nedovoljnog poznavanja farmakokinetskih i farmakodinamskih svojstava antibiotika.Complicated urinary tract infections (UTI) are a heterogenous group of diseases which present a therapeutic problem because of the need for multidisciplinary approach and because of unpredicted antibiotic susceptibility due to the emergence of antibiotic resistance among isolated pathogens. According to the guidelines for antimicrobial treatment and prophylaxis of urinary tract infections developed by the Interdisciplinary Section for Antibiotic Resistance Control (ISKRA) of the Croatian Ministry of Health and Social Welfare, in accordance with the IDSA (Infectious Diseases Society of America) and ESCMID (European Society of Clinical Microbiology and Infectious Diseases), complicated urinary tract diseases are classified as: UTI of adult men, complicated UTI in the presence of functional or anatomic abnormalities of the urotract, nosocomial UTI and UTI in the presence of indwelling foreign bodies (catheters), UTI in pregnant women and UTI in women in postmenopause. The selected drug should have appropriate spectrum of activity against a specific or probable pathogen and good penetration properties. Differences in pharmacokinetics and pharmacodynamics and their relations, have an influence on optimal antibiotic dosage regimen. Defined pharmacokinetic and pharmacodynamic factors (PK/PD) such as Cmax/MIC, AUC and T>MIC, are excellent predictors of microbiological and clinical efficacy. Treatment failure is often the result of insufficient knowledge of pharmacokinetic and pharmacodynamic properties of antibiotics