Thread by @jac_amr

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This week’s Tweetorial topic at @jac_amr:

Two to tango? Moving towards individualized antibiotic therapy to identify patients who would benefit from combination therapy
#IDTwitter @lab_rao

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doi.org/10.1016/S1473-…
doi.org/10.1016/S1473-…
@jesusrbano @ElenaSalamancaR

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Combination therapy is only associated with improved survival among patients with a high probability of death as measured by the INCREMENT-CPE mortality score

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In addition to patient-related factors like severity, comorbidities and source of infections, as measured by the INCREMENT-CPE mortality score, treatment and pathogen-associated factors should be included as these factors have an influence on treatment outcomes

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Antibiotic concentrations at the site of action, its mechanism of action, pathogen susceptibility, possible resistance mechanisms and presence of certain virulence factors need to be taken into consideration to determine if combination therapy is necessary

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Given the rapid global spread of antimicrobial resistance, using antibiotics appropriately but only as much as needed and as little as possible by moving towards an individualized approach is the key – this includes identifying patients in need of combination therapy

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To identify the best tailored antibiotic treatment for the individual patient, it is critical to implement systems that use patient-based clinical scoring, like INCREMENT-CPE, which are easy to include in routine clinical practice

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These must be complemented by pathogen- and treatment-related factors using advanced novel point-of-care diagnostics to determine drug concentrations, pathogen and patient factors combined with PK/PD monitoring