The case for precision dosing: medical conservatism does not justify inaction.

TitleThe case for precision dosing: medical conservatism does not justify inaction.
Publication TypeJournal Article
Year of Publication2021
AuthorsScheetz MH, Lodise TP, Downes KJ, Drusano G, Neely M
JournalJ Antimicrob Chemother
Date Published2021 Apr 12
ISSN1460-2091
Abstract

The need for precision dosing has been challenged on the basis of insufficient evidence. Herein, we argue that adequate evidence exists to conduct therapeutic drug monitoring (TDM) and precisely target antibiotic exposures. While achievement of any antibiotic concentration does not guarantee efficacy sans toxicity for any single patient, stochastic control optimizes the probability of achieving favourable responses across patients. We argue that variability in targets (such as the organism's MIC) can be considered with models. That is, complexity alone does not relegate the decision-making framework to 'clinician intuition'. We acknowledge the exposure-response relationships are modified by patient-specific factors (other drugs, baseline organ functional status etc.) and describe how precision dosing can inform clinical decision making rather than protocolize it. Finally, we call for randomized, controlled trials; however, we suggest that these trials are not necessary to make TDM standard of care for multiple classes of antibiotics.

DOI10.1093/jac/dkab086
Alternate JournalJ Antimicrob Chemother
PubMed ID33843994
Grant ListR21 AI149026 / AI / NIAID NIH HHS / United States