Antimicrobial Pharmacokinetic and Pharmacodynamic Considerations in Special Populations: A Call to Action

Authors

• Marguerite L. Monogue, US Medical Affairs, bioMérieux, Salt Lake City, Utah, USA.
• James M. Sanders, Department of Pharmacy, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
• Nicholas J. Mercuro, Division of Infectious Diseases, Department of Pharmacy, MaineHealth Maine Medical Center, Portland, Maine, USA.
• Crystal K. Hodge, Department of Pharmacy, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
• Esther Golnabi, Department of Pharmacy, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
• Tyla Carettini, Department of Pharmacy, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
• Christina F. Yen, Division of Infectious Diseases, Department of Internal Medicine, MaineHealth Maine Medical Center, Portland, Maine, USA.
• James B. Cutrell, Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.

Document Type

Article

Publication Date

3-3-2026

Institution/Department

Pharmacy

Journal Title

Open forum infectious diseases

Abstract

Pharmacokinetic (PK) and pharmacodynamic (PD) variability in special populations can impact antimicrobial efficacy and safety. This review highlights the importance of PK/PD optimization in patients known to have altered PK, including those with obesity, cystic fibrosis, renal dysfunction, critical illness, transplantation, pregnancy, and/or significant burns. Historically, PK/PD data are underrepresented in these populations, leading to suboptimal dosing recommendations and increased risks of therapeutic failure or toxicity. Herein, we discuss key physiological alterations affecting antimicrobial PK/PD, regulatory challenges, and currently available solutions. To bridge these knowledge gaps, we advocate for broader patient inclusion in clinical trials, improved PK modeling, real-world data collection, and increased investment in precision dosing strategies. Addressing these issues has the potential to enhance patient outcomes, reduce antimicrobial resistance, and improve infectious diseases management. This review serves as a call to action for researchers, clinicians, and policymakers to prioritize PK/PD research in special patient populations.

ISSN

2328-8957

First Page

ofag093

Recommended Citation

Monogue, Marguerite L.; Sanders, James M.; Mercuro, Nicholas J.; Hodge, Crystal K.; Golnabi, Esther; Carettini, Tyla; Yen, Christina F.; and Cutrell, James B., "Antimicrobial Pharmacokinetic and Pharmacodynamic Considerations in Special Populations: A Call to Action" (2026). MaineHealth Maine Medical Center. 4393.
https://knowledgeconnection.mainehealth.org/mmc/4393