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J Antimicrob Chemother. 2018 Mar 1;73(3):564-568. doi: 10.1093/jac/dkx427.

MIC-based dose adjustment: facts and fables.

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Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands.
Department of Medical Microbiology, Haaglanden Medical Centre, The Hague, The Netherlands.
Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYIS), Madrid, Spain.
Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden.
Department of Clinical Microbiology, Central Hospital, 351 85, Växjö, Sweden.
Adelaide Medical School, University of Adelaide, Adelaide, Australia.


Over recent decades, several publications have described optimization procedures for antibiotic therapy in the individual patient based on antimicrobial MIC values. Most methods include therapeutic drug monitoring and use a single MIC determination plus the relevant pharmacokinetics/pharmacodynamics to adjust the dose to optimize antimicrobial drug exposure and antibacterial effects. However, the use of an MIC obtained by a single MIC determination is inappropriate. First, routine clinical laboratories cannot determine MICs with sufficient accuracy to guide dosage owing to the inherent assay variation in the MIC test. Second, the variation in any MIC determination, whatever method is used, must be accounted for. If dose adjustments are made based on therapeutic drug monitoring and include MIC determinations, MIC variation must be considered to prevent potential underdosing of patients. We present the problems and some approaches that could be used in clinical practice.


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