Cystic fibrosis affects several organs, predisposing patients to severe bacterial respiratory infections, including those caused by methicillin-resistant Staphylococcus aureus. Cystic fibrosis is also associated with a wide spectrum of pathological changes that can significantly affect the absorption, distribution, metabolism and/or elimination of several drugs, including antibacterial agents. Awareness of the pharmacokinetic derangements in patients with cystic fibrosis is, therefore, mandatory for the optimization of antibiotic therapy. This review discusses the basic principles of pharmacokinetics and the pathophysiology of the pharmacokinetics-changes associated with cystic fibrosis, providing also an update of available data for the most widely used antibiotics. Indeed, evidence accumulated in the last few years has clearly shown that a significant amount of cystic fibrosis patients treated with conventional dosing schemes have sub-therapeutic antibiotic concentrations, increasing their risk of therapeutic failure and/or the emergence of resistant pathogens. Some proposals to optimize antibiotic therapies in this clinical setting based on therapeutic drug monitoring are also discussed.Copyright © 2021. Published by Elsevier Ltd.
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