Personalization of Antimicrobial Dosing in Special Patient Populations: A Mandatory Issue in the Era of Precision Medicine

Dear Colleagues,

In the era of precision medicine, optimizing drug exposure is an essential part of appropriate pharmacotherapy, as it may ultimately affect clinical outcomes. This is especially true for antimicrobials. Facing the current global crisis of antimicrobial resistance and the paucity of innovative drugs on the one hand and the emergence of new special population settings due to social and demographic changes on the other hand, attaining the optimal pharmacokinetic/pharmacodynamic target of efficacy with antimicrobials is becoming more and more challenging in everyday clinical practice.   

The pharmacokinetic profile of antibiotics may be significantly altered by the patient pathophysiological conditions, and the knowledge of the peculiar characteristics of each special patient population is of utmost importance for addressing properly the effectiveness of antimicrobial therapy today.

The critically ill patient represents the archetype of a special patient population in terms of intra- and interindividual pharmacokinetic variability. Drug clearance and volume of distribution may change rapidly and repeatedly over short timeframes in this setting, thus requiring daily monitoring of antimicrobials with frequent dosage adjustments.

Two demographic phenomena are increasing in the 21st century, especially in the developed nations, namely, population aging and obesity. Dosage optimization should not overlook the frequent appearance of organ impairments in the elderly, and is a non-easily addressable issue in obese patients.

Advances in medicine during the last decades have led to the progressive increase of other special patient populations, namely oncohematological patients and transplant patients undergoing long-term immunosuppressive therapy. In the latter populations, different variables may cause augmented renal clearance, and important challenges may raise due to drug–drug interactions with immunosuppressants.

In this Special Issue, some of the most eminent experts in their field will present and discuss the criticalities of optimizing antimicrobial exposure in a specific patient population, with the intent of offering practical indications for dosage optimization to clinicians.         

Prof. Dr. Pea Federico
Dr. Pier Giorgio Cojutti
Guest Editors

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