Antibiotic Resistance and The Right Dose, Right Drug, Right Time

Robert McLeay, PhD

It’s pleasing to see the report issued this week by the Australian Commission on Safety and Quality in Health Care showing how significant the ‘superbug’ problem is to Australia.

While hand-hygiene and other infection control measures are critically important to prevent the spread, there are efforts to reduce the development of antibiotic-resistant bacteria in our hospital facilities by ensuring that patients receive the right dose at the right time.

In the CARAlert report issued this week, more than 1,000 infections resistant to last-line antibiotics were detected in the 12 month period to March 2017. The report shows that 86 entries were made to CARAlert system each month on average, with 63% of all critical antimicrobial resistances (CARs) were from hospital patients.

Antimicrobial stewardship is ensuring that our antibiotics remain available for future generations. The CDC reports that up to 50% of antibiotics are prescribed inappropriately within US hospitals, and this key area of focus is where DoseMeRx assists healthcare practitioners to enhance their outcomes. Similarly, using vancomycin data from Australian hospitals prior to the rollout of DoseMe, we find a similar proportion of doses are non-therapeutic – risking the development of further antimicrobial resistance.

The CDC recommend “dose optimization, including dose adjustments based on therapeutic drug monitoring, optimizing therapy for highly drug-resistant bacteria [to achieve] central nervous system penetration, extended-infusion administration of beta-lactams”, and these are core features of the DoseMeRx platform.

While the media tends to beat up superbugs as a big scare coming soon to make our antibiotics useless, the reality is actually far more frightening. In medicine today, antibiotics are used not just to treat infections, but also prophylactically to prevent infections. Somewhat counter-intuitively, consumers are told time and time again not to do this – preventative use of antibiotics is generally frowned upon in community care, but in hospitals, this use is critical to being able to perform many modern procedures. Organ transplants, cancer treatment, orthopaedic and other major surgery, and even treatment of significant trauma all rely on the use of antibiotics.

For chemotherapy patients and transplant patients, antibiotics are not an optional addition to make the treatment more pleasant or lower some minor risk further – chemotherapy drugs and organ transplant drugs suppress the immune system of patients, and thus we use antibiotics to keep these patients alive during their treatment.

We must continue to give the right drug and the right dose at the right time, so that future generations don’t talk wistfully of the era when organ transplants and cancer treatments once were possible.

About the Author

Robert McLeay is the Founder and Chief Scientific Officer at DoseMe. At DoseMe, he combines his love of modelling biological data with his background in IT to provide safer, and more effective precision dosing to patients via easy-to-use software designed for clinicians rather than researchers.

Originally trained in software development, Robert had a range of roles leading software development teams. Robert then returned to university to complete a PhD in Bioinformatics, using computational techniques to model and understand genetic and biological data. Robert has applied modelling and bioinformatics to a range of fields, and is published in areas including genomic data analysis, developmental biology, glioblastoma, and schizophrenia research.

Robert holds a Bachelor of Information Technology, Bachelor of Science, and a PhD (Bioinformatics) from The University of Queensland.