Personalised antimicrobial dosing: standing on the shoulders of giants

Abstract

Suboptimal use of antimicrobial drugs contributes to increasing antimicrobial resistance and may lead to therapeutic failure at the individual patient level. Considering the significant pharmacokinetic (PK) variation in special patient populations and the variability in pathogen susceptibility, personalised dosing of antimicrobial drugs is pivotal. Dosing based on PK and pharmacodynamic properties of antibiotics guided by therapeutic drug monitoring (TDM) maximises efficacy and minimises toxicity for individual patients. Model-informed precision dosing (MIPD) provides a means of predicting drug response and dose requirements in individual patients based on individual patient and pathogen characteristics. Clear concentration targets should be defined to make use of MIPD and TDM in clinical practice. Target selection, validation and publication in the drug label should be part of drug licensing.