Antimicrobial treatment imprecision: an outcome-based model to close the data-to-action loop.

Health-care systems, food supply chains, and society in general are threatened by the inexorable rise of antimicrobial resistance. This threat is driven by many factors, one of which is inappropriate antimicrobial treatment. The ability of policy makers and leaders in health care, public health, regulatory agencies, and research and development to deliver frameworks for appropriate, sustainable antimicrobial treatment is hampered by a scarcity of tangible outcome-based measures of the damage it causes. In this Personal View, a mathematically grounded, outcome-based measure of antimicrobial treatment appropriateness, called imprecision, is proposed. We outline a framework for policy makers and health-care leaders to use this metric to deliver more effective antimicrobial stewardship interventions to future patient pathways. This will be achieved using learning antimicrobial systems built on public and practitioner engagement; solid implementation science; advances in artificial intelligence; and changes to regulation, research, and development. The outcomes of this framework would be more ecologically and organisationally sustainable patterns of antimicrobial development, regulation, and prescribing. We discuss practical, ethical, and regulatory considerations involved in the delivery of novel antimicrobial drug development, and policy and patient pathways built on artificial intelligence-augmented measures of antimicrobial treatment imprecision.

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Declaration of interests AH declares consulting work for Pfizer outside of the submitted work. BW sits on the board of the York Health Economics Consortium. IB holds a senior investigator award with the National Institute for Health and Care Research and fees via University of Liverpool Consult service as Chief Data Scientist Advisor for AstraZeneca, outside of the submitted work. WH holds or has held research grants with United Kingdom Research and Innovation, EU, F2G, Spero Therapeutics, Antabio, Pfizer, Bugworks, Phico Therapeutics, BioVersys, Global Antibiotic Research & Development Partnership (GARDP), and NAEJA-RGM. WH is or has been a consultant for Appili Therapeutics, F2G, Spero Therapeutics, NAEJA-RGM, Centauri, Pfizer, Phico Therapeutics, Pulmocide, Amplyx, Mundipharma Research, and VenatoRx. WH is a member of the Specialist Advisory Committee for GARDP and the Specialty National co-lead for Infectious Diseases for the National Institute of Health Research. A-GM holds a ZonMW Rubicon Postdoctoral Fellowship Dutch Research Council. All other authors declare no competing interests.