Chapter 12 - Optimizing Single-Drug Antibacterial and Antifungal Therapy

Abstract

Antibacterial and antifungal drugs interfere with the life cycles of infecting pathogens in various ways to help the patient’s immune system kill the organism and recover from the infection. Unfortunately, this recovery (ie, elimination of fever and other symptoms) is typically delayed from the initiation of therapy by days to weeks. Therefore, clinicians who treat infections, particularly severe, life-threatening infections, are used to the concept of measuring drug concentrations and adjusting doses to achieve concentration targets that serve as predictors of good clinical outcomes. Fundamental to this approach is the concept of a minimum inhibitory concentration (MIC). In this chapter, we consider the relationship of antibacterial and antifungal concentrations to MIC and clinical outcomes and present case vignettes to illustrate principles of therapeutic management using multiple-model Bayesian adaptive control with optimal sampling.