The document discusses critical questions regarding antibiotic therapy, emphasizing the need to assess whether a patient requires antibiotics and if the benefits outweigh the risks, including the potential for antibiotic resistance. It highlights the importance of better diagnostics, alternative therapies, and optimal dosing regimens to improve clinical efficacy while minimizing resistance. Additionally, it references a study on the duration of antimicrobial treatment for various infections and stresses the need to balance clinical outcomes with the consequences of resistance.

1. Looking ahead:
Science and Data Needs
2018 NIAA Antibiotics Symposium
Brian Lubbers, DVM, PhD, DACVCP
Director of Clinical Microbiology

2. Question #1a
• Does this patient need an antibiotic?

3. Question #1b
• Do the benefits of antibiotic therapy outweigh the risks of antibiotic
exposure or risk of not treating (by an acceptable margin) in this
particular patient?

4. Science and Data Needs
• DEFINED ACCEPTABLE RISK
– Promotion of antibiotic resistance
• Risk to individual
• Risk to society
– Serious drug adverse events
– Negative outcomes from withholding therapy
• Improved (better, faster, less invasive & cheaper) diagnostics
– Detection of underlying resistance
– Disease confirmation
• Effective adjunct / alternative therapies
• Optimal dosing regimens

5. Question #2
• What is the dosing regimen with the greatest chance for clinical
efficacy and lowest probability of resistance selection?
“Hostage to history: The duration of antimicrobial treatment for
acute streptococcal pharyngitis”
Radetsky, M.
Pediatric Infectious Disease Journal May 2017

6. 0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Durward Tone Sawyer Drekonja Munoz Iskander
PercentClinicalSuccess
Short duration Long duration
Diabetic
osteomyelitis
Intra-abdominal
infections
Intra-abdominal
infections (murine)
Urinary tract
infections
EndocarditisPerioperative
(colic)

7. Science and Data Needs
• Balance clinical outcome with resistance consequences of specific
exposures
– Drug
– Dose
– Duration
– Frequency

8. Thank You!