Pulmonary Pharmacokinetics/Pharmacodynamics of Commonly Used Antibiotics in the Treatment of Community-Acquired Pneumonia.

Community-acquired pneumonia (CAP) remains a major global health burden, with antibacterial therapy as the primary treatment strategy. In clinical practice, plasma drug concentrations are often used to guide therapy, yet they may not reliably reflect effective pulmonary exposure, which is particularly critical for older adults, patients with comorbidities, and critically ill populations. In recent years, targeted pulmonary pharmacokinetics/pharmacodynamics (PK/PD) studies have gained increasing attention and have become an important reference for guiding precision antimicrobial therapy in clinical settings. This review provides a comprehensive overview of the pulmonary PK characteristics of key antibiotics commonly used for CAP, including macrolides, fluoroquinolones, β-lactams, tetracyclines, and the pleuromutilin agent lefamulin. Major factors influencing drug distribution in the lung are summarized. The significance of pulmonary PK/PD targets in antibiotic selection, dose adjustment, and individualized treatment is discussed, aiming to support improved clinical outcomes, rational antibiotic use, and resistance management. A deeper understanding of pulmonary PK/PD properties is essential to advance evidence-based and optimized treatment for CAP.