The economic potential of dual individualisation methodologies.

Cost-effective treatment of patients with bacterial infections can best be accomplished by facilitating a rapid response. Achieving a more rapid cure of the infection should result in reduced utilisation of healthcare resources. An innovative means of achieving a more rapid response to antibacterial therapy has been termed dual individualisation. Dual individualisation allows for the simultaneous consideration of the pharmacokinetic interaction between an antibacterial agent and a patient, with the pharmacodynamic interaction between the antibacterial agent and the bacterial pathogen. Integrating the pharmacokinetic parameter of area under the curve (AUC), with the pharmacodynamic measure of minimum inhibitory concentration (MIC) yields a ratio called the area under the inhibitory curve (AUIC). Clinical studies using dual individualisation to achieve a target AUIC24h of 125-250 have been performed with cephalosporins and fluoroquinalones. Economic evaluation of the results demonstrate that dual individualisation is cost-effective. Dual individualisation can be implemented in most practice setting using existing clinical data. Use of a computer model allows for cost-effective calculation of AUIC24h without having to measure serum drug concentrations of bacterial MIC. By adjusting antibacterial regimens to achieve a target AUIC, optimisation of antibacterial therapy can be achieved with resultant economic benefits.