An optimal antimicrobial dose provides enough drug to achieve a clinical response while minimizing toxicity and development of drug resistance. There can be considerable variability in pharmacokinetics, for example, owing to comorbidities or other medications, which affects antimicrobial pharmacodynamics and, thus, treatment success. Although current approaches to antimicrobial dose optimization address fixed variability, better methods to monitor and rapidly adjust antimicrobial dosing are required to understand and react to residual variability that occurs within and between individuals. We review current challenges to the wider implementation of antimicrobial dose optimization and highlight novel solutions, including biosensor-based, real-time therapeutic drug monitoring and computer-controlled, closed-loop control systems. Precision antimicrobial dosing promises to improve patient outcome and is important for antimicrobial stewardship and the prevention of antimicrobial resistance.

最佳抗菌剂剂量可提供足够的药物以实现临床反应，同时最大限度地减少毒性和耐药性的发展。例如，由于合并症或其他药物，药代动力学可能存在相当大的差异，这会影响抗菌药物的药效学，从而影响治疗的成功。尽管目前的抗菌剂剂量优化方法解决了固定的变异性，但需要更好的方法来监测和快速调整抗菌剂剂量，以了解个体内部和个体之间发生的残留变异性并做出反应。我们回顾了当前在更广泛地实施抗菌剂剂量优化方面面临的挑战，并重点介绍了新颖的解决方案，包括基于生物传感器的实时治疗药物监测和计算机控制的闭环控制系统。