Interethnic Differences in Pharmacokinetics of Antibacterials

Danny Tsai, Janattul Ain Jamal, Joshua Davis, Jeffrey Lipman, Jason Roberts

    Research output: Contribution to journalArticlepeer-review

    Abstract

    Background: Optimal antibacterial dosing is imperative for maximising clinical outcome. Many factors can contribute to changes in the pharmacokinetics of antibacterials to the extent where dose adjustment may be needed. In acute illness, substantial changes in important pharmacokinetic parameters such as volume of distribution and clearance can occur for certain antibacterials. The possibility of interethnic pharmacokinetic differences can further complicate attempts to design an appropriate dosing regimen. Factors of ethnicity, such as genetics, body size and fat distribution, contribute to differences in absorption, distribution, metabolism and elimination of drugs. Despite extensive previous work on the altered pharmacokinetics of antibacterials in some patient groups such as the critically ill, knowledge of interethnic pharmacokinetic differences for antibacterials is limited.

    Objectives: 
    This systematic review aims to describe any pharmacokinetic differences in antibacterials between different ethnic groups, and discuss their probable mechanisms as well as any clinical implications.

    Methods: 
    We performed a structured literature review to identify and describe available data of the interethnic differences in the pharmacokinetics of antibacterials.

    Results: 
    We found 50 articles that met our inclusion criteria and only six of these compared antibacterial pharmacokinetics between different ethnicities within the same study. Overall, there was limited evidence available. We found that interethnic pharmacokinetic differences are negligible for carbapenems, most β-lactams, aminoglycosides, glycopeptides, most fluoroquinolones, linezolid and daptomycin, whereas significant difference is likely for ciprofloxacin, macrolides, clindamycin, tinidazole and some cephalosporins. In general, subjects of Asian ethnicity achieve drug exposures up to two to threefold greater than Caucasian counterparts for these antibacterials. This difference is caused by a comparatively lower volume of distribution and/or drug clearance.

    Conclusion: 
    Interethnic pharmacokinetic differences of antibacterials are likely; however, the clinical relevance of these differences is unknown and warrants further research.
    Original languageEnglish
    Pages (from-to)243-260
    Number of pages18
    JournalClinical Pharmacokinetics
    Volume54
    Issue number3
    DOIs
    Publication statusPublished - Mar 2015

    Fingerprint

    Dive into the research topics of 'Interethnic Differences in Pharmacokinetics of Antibacterials'. Together they form a unique fingerprint.

    Cite this