Cmax

They just need to punch through the outer defenses.

For these drugs, what matters is the brute force ratio of the maximal drug concentration to the MIC, the Cmax to MIC ratio.

A slow infusion won't work here.

You want a massive intermittent bolus dose to physically overwhelm the efflux pumps and flood the ribosomes.

A 45-year-old severely obese patient is admitted to the ICU with a life-threatening gram-negative infection.

You plan to start an aminoglycoside, which is a hydrophilic concentration-dependent killer.

Based on PKPD principles, what is the best dosing strategy, continuous infusion versus intermittent bolus? And how should you calculate their initial loading dose versus their maintenance dose to maximize the Cmax to MIC ratio while avoiding nephrotoxicity? So listener, as requested for your educational content, here's a short review exercise you can drop at the end of your lecture to test your student's grasp of today's deep dive.

Use these insights to build out your curriculum.

And we've got a little picture in the prep notes pointing out the different PD parameters that we've got.

That plasma peak is Cmax, and usually that is expressed as a multiple of your MIC of your organism.

So if your MIC of your organism is set at 1... to make the math simple, and your Cmax is 5, then your Cmax as a function of MIC is 5.

If your MIC is 2 and your Cmax is 10...

Your Cmax-MIC ratio is also 5.

Yes, and then you've got the amount of time that your plasma level is spending above the MIC.

So here you don't care how high the Cmax gets, and you don't really care about the AUC, which is the next thing that we're about to talk about.

You just care how long the plasma level stays above the MIC of the organism.