Optimizing antimicrobial use: challenges, advances and opportunities

An optimal antimicrobial dose provides enough drug to achieve a clinical response while minimizing toxicity and development of drug resistance. There can be considerable variability in pharmacokinetics, for example, owing to comorbidities or other medications, which affects antimicrobial pharmacodyn...

Full description

Saved in:
Bibliographic Details
Published in:Nature reviews. Microbiology 2021-12, Vol.19 (12), p.747-758
Main Authors: Rawson, Timothy M, Wilson, Richard C, O'Hare, Danny, Herrero, Pau, Kambugu, Andrew, Lamorde, Mohammed, Ellington, Matthew, Georgiou, Pantelis, Cass, Anthony, Hope, William W, Holmes, Alison H
Format: Article
Language:English
Subjects:
Anti-infective agents
Anti-Infective Agents - pharmacokinetics
Antimicrobial agents
Antimicrobial resistance
Antimicrobial Stewardship
Artificial Intelligence
Bacterial Infections - drug therapy
Biosensing Techniques
Biosensors
Complications and side effects
Control
Control systems
Decision Support Systems, Clinical
Dosage
Dosage and administration
Dose-response relationship (Biochemistry)
Drug dosages
Drug Monitoring - methods
Drug resistance
Drug resistance in microorganisms
Drug Resistance, Microbial
Humans
Optimization
Pharmacodynamics
Pharmacokinetics
Pharmacology
Pharmacology, Experimental
Therapeutic drug monitoring
Toxicity
Variability
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:An optimal antimicrobial dose provides enough drug to achieve a clinical response while minimizing toxicity and development of drug resistance. There can be considerable variability in pharmacokinetics, for example, owing to comorbidities or other medications, which affects antimicrobial pharmacodynamics and, thus, treatment success. Although current approaches to antimicrobial dose optimization address fixed variability, better methods to monitor and rapidly adjust antimicrobial dosing are required to understand and react to residual variability that occurs within and between individuals. We review current challenges to the wider implementation of antimicrobial dose optimization and highlight novel solutions, including biosensor-based, real-time therapeutic drug monitoring and computer-controlled, closed-loop control systems. Precision antimicrobial dosing promises to improve patient outcome and is important for antimicrobial stewardship and the prevention of antimicrobial resistance.
ISSN:1740-1526
1740-1534
DOI:10.1038/s41579-021-00578-9