[Pharmacokinetics of antibiotics in burn patients]

The pathophysiology associated with major burns is complex and subject to a state of flux (coexistence of pain, infectious diseases, multiple trauma, disturbances of metabolism and acid-base status, etc) which could affect the disposition and the pharmacokinetic behaviour of drugs. In current clinical practice, practitioners often use powerful antimicrobial agents; however, few pharmacokinetic studies are available in burns patients (of the order of 30 studies). Furthermore, the methods used are sometimes questionable. After dealing with the ethical and physiological context in which such research is undertaken, the authors report a review of the pharmacokinetic studies done during the last 15 years. Concerning both aminoglycosides and glycopeptides, no therapeutic recommendations are available (therapeutic schedules). However, in this case, therapeutic monitoring is available and represents a suitable tool to better master their use. In the case of beta-lactam antibiotics and quinolones, more data are available. Some investigations have 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 treatment. Considering the relatively meager pharmacokinetic and pharmacodynamic data available in burns, it is important in the future to refine our knowledge of the distribution and metabolism of drugs in burns patients in order to better master their use. Finally, ethical and methodological considerations need to be taken in account.