Individualized antimicrobial dose optimization: a systematic review and meta-analysis of randomized controlled trials

Area of Science:

• Pharmacology
• Infectious Diseases
• Clinical Pharmacy

Background:

• Therapeutic drug monitoring and Model-informed precision dosing enable personalized medication regimens to enhance drug effectiveness and minimize toxicity.
• Individualized dosing strategies are crucial for optimizing antimicrobial therapy in diverse patient populations.

Approach:

• A systematic meta-analysis was conducted, synthesizing data from ten peer-reviewed randomized controlled trials published up to November 2022.
• The analysis included 1241 adult participants receiving antibiotic or antifungal drugs, comparing individualized dosing with standard care.
• The Cochrane risk-of-bias tool assessed study quality, and a random-effects model was used for meta-analysis.

Key Points:

• Individualized antimicrobial dosing significantly improved target attainment rates (RR 1.41) and reduced treatment failure (RR 0.70).
• A significant decrease in nephrotoxicity risk (RR 0.55) was observed with individualized dosing.
• While not statistically significant, individualized dosing showed a numerical decrease in mortality (RR 0.86) and trends toward improved clinical and microbiological cure.

Conclusions:

• Individualized antimicrobial dose optimization significantly enhances target attainment, reduces treatment failure, and lowers the risk of nephrotoxicity.
• The findings support the clinical utility of precision dosing in antimicrobial therapy, warranting further investigation into its impact on mortality and cure rates.