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The post-antibiotic sub-MIC effect in vitro and in vivo
1Department of Infectious Diseases, University Hospital, Uppsala, Sweden.
Abstract:
The post-antibiotic effect (PAE) has been recognized as a pharmacodynamic parameter which may influence optimal dosage intervals. During the post-antibiotic phase, various bacteria have been shown to be very sensitive to a repeated exposure to the same antibiotic. A long period of growth suppression may be obtained when a low concentration (< or = 0.3 x MIC) is added to bacteria previously exposed to a supra-inhibitory concentration. This phenomenon has been named the post-antibiotic sub-MIC effect (PA SME). Since a period with sub-inhibitory concentrations will often exist between the doses when intermittent dosing of antibiotics is used, the PA SME probably reflects the in-vivo situation more closely than the PAE. The published literature on the PA SME is reviewed and its possible role in antibiotic dosing discussed.
Insights
The post-antibiotic sub-MIC effect (PA SME) enhances antibiotic efficacy by prolonging bacterial growth suppression after initial exposure. This phenomenon, observed with low antibiotic concentrations, may offer a more accurate model for intermittent antibiotic dosing strategies in clinical settings.
Area of Science:
- Microbiology
- Pharmacology
- Infectious Diseases
Background:
- The post-antibiotic effect (PAE) is a known pharmacodynamic parameter influencing antibiotic dosing intervals.
- Bacteria exhibit increased sensitivity to antibiotics during the post-antibiotic phase.
Purpose of the Study:
- To review the literature on the post-antibiotic sub-MIC effect (PA SME).
- To discuss the potential role of PA SME in optimizing antibiotic dosing strategies.
Main Methods:
- Literature review of studies investigating the PA SME.
- Analysis of bacterial response to repeated low-concentration antibiotic exposure following supra-inhibitory concentrations.
Main Results:
- A prolonged period of bacterial growth suppression can be achieved with low antibiotic concentrations (< or = 0.3 x MIC) after prior exposure.
- The PA SME phenomenon has been identified and characterized.
Conclusions:
- The PA SME may more accurately reflect in-vivo conditions during intermittent antibiotic dosing compared to PAE.
- Understanding PA SME could lead to improved antibiotic dosage regimens for enhanced therapeutic outcomes.