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dc.contributor.authorHeffernan, AJ
dc.contributor.authorSime, FB
dc.contributor.authorLipman, J
dc.contributor.authorRoberts, JA
dc.date.accessioned2019-05-29T13:09:35Z
dc.date.available2019-05-29T13:09:35Z
dc.date.issued2018
dc.identifier.issn0012-6667
dc.identifier.doi10.1007/s40265-018-0891-9
dc.identifier.urihttp://hdl.handle.net/10072/381480
dc.description.abstractThe scourge of antibiotic resistance threatens modern healthcare delivery. A contributing factor to this significant issue may be antibiotic dosing, whereby standard antibiotic regimens are unable to suppress the emergence of antibiotic resistance. This article aims to review the role of pharmacokinetic and pharmacodynamic (PK/PD) measures for optimising antibiotic therapy to minimise resistance emergence. It also seeks to describe the utility of combination antibiotic therapy for suppression of resistance and summarise the role of biomarkers in individualising antibiotic therapy. Scientific journals indexed in PubMed and Web of Science were searched to identify relevant articles and summarise existing evidence. Studies suggest that optimising antibiotic dosing to attain defined PK/PD ratios may limit the emergence of resistance. A maximum aminoglycoside concentration to minimum inhibitory concentration (MIC) ratio of > 20, a fluoroquinolone area under the concentration–time curve to MIC ratio of > 285 and a β-lactam trough concentration of > 6 × MIC are likely required for resistance suppression. In vitro studies demonstrate a clear advantage for some antibiotic combinations. However, clinical evidence is limited, suggesting that the use of combination regimens should be assessed on an individual patient basis. Biomarkers, such as procalcitonin, may help to individualise and reduce the duration of antibiotic treatment, which may minimise antibiotic resistance emergence during therapy. Future studies should translate laboratory-based studies into clinical trials and validate the appropriate clinical PK/PD predictors required for resistance suppression in vivo. Other adjunct strategies, such as biomarker-guided therapy or the use of antibiotic combinations require further investigation.
dc.description.peerreviewedYes
dc.languageEnglish
dc.publisherADIS International Ltd.
dc.publisher.placeNew Zealand
dc.relation.ispartofpagefrom621
dc.relation.ispartofpageto641
dc.relation.ispartofissue6
dc.relation.ispartofjournalDrugs
dc.relation.ispartofvolume78
dc.subject.fieldofresearchPharmacology and Pharmaceutical Sciences not elsewhere classified
dc.subject.fieldofresearchPharmacology and Pharmaceutical Sciences
dc.subject.fieldofresearchcode111599
dc.subject.fieldofresearchcode1115
dc.titleIndividualising Therapy to Minimize Bacterial Multidrug Resistance
dc.typeJournal article
dc.type.descriptionC1 - Articles
dc.type.codeC - Journal Articles
gro.facultyGriffith Health, School of Medicine
gro.hasfulltextNo Full Text
gro.griffith.authorHeffernan, Aaron J.


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