The case for precision dosing: medical conservatism does not justify inaction.
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Issue Date
6/18/2021
Authors
Scheetz, Marc H
Lodise, Thomas P
Downes, Kevin J
Drusano, George L
Neely, Michael N
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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.
Citation
Scheetz MH, Lodise TP, Downes KJ, Drusano G, Neely M. The case for precision dosing: medical conservatism does not justify inaction. J Antimicrob Chemother. 2021 Jun 18;76(7):1661-1665. doi: 10.1093/jac/dkab086. PMID: 33843994; PMCID: PMC8212772.
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K23 HD091365/HD/NICHD NIH HHS/United States , R21 AI149026/AI/NIAID NIH HHS/United States