The potential of 4D's approach in curbing antimicrobial resistance among bacterial pathogens

Antibiotics are life-saving drugs but irrational/inappropriate use leads to the emergence of antibiotic-resistant bacterial superbugs, making their treatment extremely challenging. Increasing antimicrobial resistance (AMR) among bacterial pathogens is becoming a serious public health concern globally. If ignorance persists, there would not be any antibiotics available to treat even a common bacterial infection in future.

This article intends to collate and discuss the potential of 4D's (right Drug, Dose, Duration, and De-escalation of therapy) approach to tackle the emerging problem of AMR. For this, we searched PubMed, Google Scholar, Medline, and clinicaltrials.gov databases primarily using keywords 'optimal antibiotic therapy,' 'antimicrobial resistance,' 'higher versus lower dose antibiotic treatment,' 'shorter versus longer duration antibiotic treatment,' 'de-escalation study', and 'antimicrobial stewardship measures' and based on the findings, form and expressed our opinion.

More efforts are needed for developing diagnostics for rapid, accurate, point-of-care, and cost-effective pathogen identification and antimicrobial susceptibility testing (AST) to facilitate rational use of antibiotics. Current dosing and duration of therapies also need to be redefined to maximize their impact. Furthermore, de-escalation approaches should be developed and encouraged in the clinic. This altogether will minimize selection pressure on the pathogens and reduce emergence of AMR.