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

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dc.contributor.authorScheetz, Marc H
dc.contributor.authorLodise, Thomas P
dc.contributor.authorDownes, Kevin J
dc.contributor.authorDrusano, George L
dc.contributor.authorNeely, Michael N
dc.contributor.orcidhttps://orcid.org/0000-0002-4730-0655
dc.date.accessioned2025-02-07T19:34:56Z
dc.date.available2025-02-07T19:34:56Z
dc.date.issued6/18/2021
dc.description.abstractThe 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.
dc.description.grantGrant Funded
dc.description.sponsorshipK23 HD091365/HD/NICHD NIH HHS/United States
dc.description.sponsorshipR21 AI149026/AI/NIAID NIH HHS/United States
dc.description.urihttps://doi.org/10.1093/jac/dkab086
dc.description.urihttp://www.ncbi.nlm.nih.gov/pmc/articles/pmc8212772
dc.identifier.citationScheetz 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.
dc.identifier.issn0305-7453
dc.identifier.other33843994
dc.identifier.urihttps://hdl.handle.net/20.500.14303/720
dc.language.isoen
dc.publisherOxford University Press
dc.relation.ispartofThe Journal of Antimicrobial Chemotherapy
dc.rightsThis Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). http://rightsstatements.org/vocab/InC/1.0/
dc.subjectAnti-Bacterial Agents/therapeutic use
dc.subjectDrug Monitoring
dc.subjectHumans
dc.titleThe case for precision dosing: medical conservatism does not justify inaction.
dc.typeArticle
local.departmentprogramDepartment of Pharmacy Practice
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