Optimizing antimicrobial use: challenges, advances and opportunities

Timothy M. Rawson, Richard C. Wilson, Danny O’Hare, Pau Herrero, Andrew Kambugu, Mohammed Lamorde, Matthew Ellington, Pantelis Georgiou, Anthony Cass, William W. Hope, Alison H. Holmes*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

14 Citations (Scopus)

Abstract

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.

There is considerable variability in antimicrobial pharmacokinetics and pharmacodynamics, which can pose challenges for treatment of infection and antimicrobial resistance development. In this Review, Holmes and colleagues discuss how precision antimicrobial therapy, including biosensors and individualized treatment, can contribute to antimicrobial stewardship.

Original languageEnglish
Pages (from-to)747-758
Number of pages12
JournalNature Reviews Microbiology
Volume19
Issue number12
Early online date22 Jun 2021
DOIs
Publication statusE-pub ahead of print - 22 Jun 2021

Bibliographical note

Publisher Copyright:
© 2021, Springer Nature Limited.

Keywords

  • VIVO CHEMICAL SENSORS
  • ANTIBIOTIC-RESISTANCE
  • ELECTROCHEMICAL BIOSENSORS
  • IMPLANTABLE BIOSENSORS
  • ILL PATIENTS
  • PHARMACODYNAMICS
  • PHARMACOKINETICS
  • THERAPY
  • COST
  • STEWARDSHIP

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