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Educational aims To explain the importance of pulmonary deposition of antimicrobials. To show that drugs that penetrate well and remain at the pulmonary sites of infection for long periods often induce therapeutic responses greater than expected on the basis of in vitro data. To illustrate why the interrelationship between pharmacokinetics and pharmacodynamics determines the dosing duration and total dose required for optimal antimicrobial activity. To examine the real effect of the interrelationship between pulmonary pharmacokinetics and pharmacodynamics on clinical and microbiological outcomes. Summary An important determinant of clinical outcome of a LRTI may be sterilisation of the infected lung, which is dependent on sustained antibiotic concentrations achieved in the lung. For this reason, recently, there has been increased interest in measuring the concentration of antimicrobial agents at different potential sites of infection in the lung. In patients with acute bronchitis, acute exacerbation of chronic bronchitis, bronchiectasis or cystic fibrosis, the infection develops within the airway lumen on the surface of mucus cells and in the mucosa itself. In patients with bacterial pneumonia, the site of infection is in the alveolar spaces or in the pulmonary interstitium. This article, adapted from the European Respiratory Society (ERS) School Course on “New perspectives in pneumonia treatment and prophylaxis”, held at the 2005 ERS conference in Glasgow, discusses the pharmacokinetics and pharmacodynamics of antibiotics with respect to clinical and microbiological outcomes.

Postgraduate Course ERS Glasgow 2004: Antibiotics