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The case for 'conservative pharmacotherapy'.

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Therapeutic drug monitoring (TDM) for antimicrobial precision dosing shows limited evidence of improving patient outcomes. Clinicians should critically appraise new TDM technologies and prioritize conservative pharmacotherapy until proven effective.

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Area of Science:

  • Pharmacology
  • Infectious Diseases
  • Clinical Pharmacy

Background:

  • The field of antimicrobial precision dosing via therapeutic drug monitoring (TDM) is rapidly advancing.
  • There is increasing pressure to adopt new TDM technologies and expand their application.
  • The assumption that TDM inherently improves patient outcomes is widespread but lacks robust evidence.

Purpose of the Study:

  • To critically appraise the evidence supporting the routine use of TDM for antimicrobial precision dosing.
  • To question the inevitability of TDM improving patient outcomes.
  • To advocate for a conservative approach to adopting new TDM technologies.

Main Methods:

  • Review and critical appraisal of existing evidence on TDM in antimicrobial therapy.
  • Analysis of potential resource diversion and distraction from clinical monitoring.
  • Argumentation for evidence-based adoption of pharmacotherapeutic strategies.

Main Results:

  • Current evidence supporting TDM's benefit for patient outcomes remains largely hypothetical.
  • Overemphasis on TDM may detract from essential clinical assessment of efficacy and toxicity.
  • Finite healthcare resources may be better allocated to other interventions.

Conclusions:

  • A skeptical and critical appraisal of precision dosing through TDM is warranted.
  • New TDM technologies should only be adopted after demonstrating clear value over competing priorities.
  • Conservative pharmacotherapy, prioritizing clinical judgment and proven interventions, is advocated.