PHARMACOKINETICS OF ANTIMICROBIAL AGENTS IN BURNS PATIENTS

The pathophysiology associated with major burns is complex and subject to a state of flux (coexistence of pain, infectious diseases, multipl e trauma, disturbances of metabolism and acid-base status, etc) which could affect the disposition and the pharmacokinetic behaviour of drug s. In current clinical practice, practitioners often use powerful anti microbial agents; however, few pharmacokinetic studies are available i n burns patients (of the order of 30 studies). Furthermore, the method s used are sometimes questionable. After dealing with the ethical and physiological context in which such research is undertaken, the author s report a review of the pharmacokinetic studies done during the last 15 years. Concerning both aminoglycosides and glycopeptides, no therap eutic recommendations are available (therapeutic schedules). However, in this case, therapeutic monitoring is available and represents a sui table tool to better master their use. In the case of beta-lactam anti biotics and quinolones, more data are available. Some investigations h ave shown the possibility of translesional diffusion of certain agents in burns (such as gentamicin, piperacillin/tazobactam combination, or fosfomycin). This phenomenon could be a co-factor of success in treat ment. Considering the relatively meager pharmacokinetic and pharmacody namic data available in burns, it is important in the future to refine our knowledge of the distribution and metabolism of drugs in burns pa tients in order to better master their use. Finally, ethical and metho dological considerations need to be taken in account.