Pharmacokinetic/pharmacodynamic (PK/PD) considerations in the management of Gram-positive bacteraemia

Bloodstream infections are amongst the most serious infections of hospitalised patients and are associated with high mortality, especially amongst those with severe sepsis and septic shock. A range of organ dysfunctions, together with drug interactions and other therapeutic interventions (e.g. haemodynamically active drugs and continuous renal replacement therapies) may have a strong impact on antimicrobial drug pharmacokinetics in critically ill patients. Intrinsic pharmacokinetic (PK) and pharmacodynamic (PD) properties are the major determinants of the in vivo efficacy of antimicrobial agents. Knowledge of PK/PD parameters is essential in facilitating the translation of microbiological activity into clinical situations and ensuring a successful outcome. This review analyses the typical patterns of antimicrobial activity of classes of agent commonly utilised against Gram-positive pathogens in hospital settings, and their corresponding PK/PD parameters, focusing on the PK/PD dosing approach.