New paradigm for rapid achievement of appropriate therapy in special populations: coupling antibiotic dose optimisation rapid microbiological methods

Some special patient populations (e.g. critically ill, burns, haematological malignancy, post-major surgery, post-major trauma) have characteristics that lead to higher rates of failure and mortality associated with infection. Choice of effective antibiotics and optimised doses are challenging in these patients that are commonly infected by multi-drug resistant pathogens Areas covered: A review of the importance of diagnosis and the place of newer microbiological methods (e.g. whole genome sequencing) to ensure rapid transition from empiric to directed antibiotic therapy is provided. The effects of pathophysiological changes on antibiotic pharmacokinetics is also provided. Expert opinion: Product information dosing regimens do not address the pharmacokinetic alterations that can occur in special patient populations and increase the likelihood of therapeutic failure and the emergence of bacterial resistance. Altered dosing approaches, supplemented with the use of dosing software and TDM, may be needed to ensure optimal antibiotic exposure and better therapeutic outcomes in these patients with severe infection. Dose optimization needs to be coupled with advanced microbiological techniques which enable rapid microbiological identification and characterization of resistance mechanism to ensure that maximally effective directed therapy can be chosen