Mutant prevention concentration-based pharmacokinetic/pharmacodynamic indices as dosing targets for suppressing the enrichment of levofloxacin-resistant subpopulations of Staphylococcus aureus

Antimicrob Agents Chemother. 2011 May;55(5):2409-12. doi: 10.1128/AAC.00975-10. Epub 2011 Feb 22.

Abstract

MIC- and mutant prevention concentration (MPC)-based pharmacokinetic/pharmacodynamic (PK/PD) indices were compared for suitability as attainment targets for restricting amplification of levofloxacin-resistant mutant subpopulations. When three Staphylococcus aureus strains were examined with a hollow-fiber PK/PD model, area under the concentration-time curve over 24 h (AUC24)/MPC values of >25 and maximum concentration of drug in serum (Cmax)/MPC values of >2.2 predicted resistance outcome among different isolates with an interisolate kappa coefficient of 1. MIC-based mutant-restrictive PK/PD values varied >8-fold and exhibited only a moderate interisolate agreement (kappa coefficient of 0.5). Thus, MPC-based PK/PD indices are more suitable than MIC-based indices for predicting mutant-restricting fluoroquinolone doses when multiple bacterial isolates are considered.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents / pharmacokinetics*
  • Anti-Bacterial Agents / pharmacology*
  • Drug Resistance, Bacterial / genetics*
  • Levofloxacin*
  • Microbial Sensitivity Tests
  • Ofloxacin / pharmacokinetics*
  • Ofloxacin / pharmacology*
  • Staphylococcus aureus / drug effects*

Substances

  • Anti-Bacterial Agents
  • Levofloxacin
  • Ofloxacin