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Optimizing Patient Care

Optimizing Patient Care

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Optimizing Patient Care

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  1. Optimizing Patient Care From Bench to Bedsideand Back Again

  2. Optimizing Patient Care From Beside to Bench and Back Again

  3. Day 1 Day 2 Day 3 From bedside to bench to bedside... What's missing?

  4. And back again... • So what’s needed to complete the picture? • The MIC of the pathogen • Sufficient (free) drug level measurements from the patient to estimate PD target attainment(are 2 levels enough? or 1 if giving by continuous infusion)

  5. The MIC

  6. The Levels

  7. What’s needed to complete the picture • For agents where the relevant PK/PD parameter is known • Agreement about the PD target values • For agents where the relevant PK/PD parameter is not known • Please work it out! • More drug assays with rapid TAT and software development to PD target attainment estimates (including confidence intervals?) and therefore dosing individualization

  8. What’s also needed... • Better understanding of the variance in MIC measurement • the logarithmic distribution can also have a significant impact • Recognition of natural (placebo) response rate

  9. The MIC is the MIC is the MIC CLSI AST Subcommittee agenda papers June 2004 and 2005

  10. Variance in MIC estimations

  11. Grepafloxacin in AECBBacteriological Cure 100 90 % probability of bacteriological cure 80 70 60 50 10 100 1000 10000 AUIC 13 Forrest et al., J Antimicrob Chemother.1997.40 (Suppl A):45-57

  12. Are we now ready for Prime Time at the patient level?

  13. Billy?

  14. Out to lunch ICAAC Madison Bermuda

  15. Victoria, AUS

  16. And sometimes at home

  17. Thank youFrom your extended family