DoseOptimize · Clinical evidence pack
Hard ICU cases, one dependable answer each.
A curated compendium for intensivists and critical-care pharmacists: challenging antimicrobial-dosing cases run through DoseOptimize — each shown as the clinician’s pain-point and the system’s genuine output. The cases were chosen to test the tool where trust is earned: septic shock, augmented renal clearance, AKI/CRRT, and resistant organisms. Companion to the DoseOptimize clinician training module.
How to read each verdict✅ PTA ≥ 90% target reliably attained (Monte-Carlo)
🕐 extended / continuous infusion sustains time above the target
⬆ loading held · ARC dose↑ first dose never renal-reduced; augmented clearance dosed up
⚠ MIC at breakpoint · TDM-guided attainment marginal, or level-confirmed — verify
DO-01Septic shock · expanded fluid space
DO-02Acute kidney injury at presentation
DO-03CRRT started overnight
DO-04Augmented renal clearance · young trauma
DO-05MRSA bacteraemia · AUC-guided
DO-06Obesity · dosing weight
DO-07Resistant organism at the breakpoint
DO-08MRSA + rising creatinine — efficacy vs toxicity
DO-09MDR Gram-negative · aminoglycoside floor
DO-10Invasive fungal infection · narrow-index azole
DO-11Elderly · reduced clearance
DO-PNDeterminism — same case, same answer
Try it yourself — self-submission kitFill the template with de-identified values (alter any field to explore the behaviour) and submit it at your invited intake link. Every submission is reviewed & signed by a registered clinician before a report is returned — there is no instant machine output.
DO-01Septic shock · expanded fluid space
58 y M · 75 kgPneumonia + septic shockCreatinine ~1.2 · SOFA 9Heavily resuscitated
The pain-point“Septic shock, creatinine near-normal — do I renal-dose the first dose now?”
DoseOptimizeLoad 2 g, then 2 g q6hextended 4 h infusion · loading not renal-reduced
%fT>MIC (ICU target)
✅ PTA ≥ 90%🕐 extended infusion⬆ loading held
Why it earns trustIt protects a full loading dose plus an extended infusion — the expanded fluid space of sepsis under-reaches ordinary first doses exactly when it matters most. Deterministic and probabilistic attainment agree.
DO-02Acute kidney injury at presentation
66 y M · 70 kgUrosepsisCreatinine 3.0 (was 1.0)Oliguric, improving
The pain-point“Creatinine is 3.0 — surely I cut the dose across the board?”
DoseOptimizeLoad 2 g (held), then 500 mg q6hloading unchanged · maintenance follows clearance
%fT>MIC (ICU target)
⬆ loading heldextended interval✅ PTA ≥ 90%
Why it earns trustThe loading dose is unchanged — loading fills the body, which the kidneys don’t shrink — while only maintenance follows the low clearance. Cut both and you delay reaching target in the sickest patient.
DO-03CRRT started overnight
61 y F · 72 kgSeptic shock · AKICVVHDF · effluent 2.5 L/hLeft on a ‘renal dose’
The pain-point“CVVHDF just started overnight and the drug was left on a renal dose — right?”
DoseOptimizeLoad 2 g, then 2 g q6hdosed to effluent clearance, not to creatinine
%fT>MIC (ICU target)
CRRT overlay⬆ loading held✅ PTA ≥ 90%
Why it earns trustThe filter is a second kidney: the tool adds its clearance and doses to the effluent, not the creatinine. A renal-failure dose here silently under-treats.
DO-04Augmented renal clearance · young trauma
28 y M · 70 kgYoung traumaCreatinine 0.5 · high urine outputAugmented clearance
The pain-point“Young, well kidneys, textbook dose — why would this patient be under-exposed?”
DoseOptimizeLoad 2 g, then 2 g q6hcontinuous infusion preferred · confirm with a level
%fT>MIC (ICU target)
⬆ ARC — dose increased🕐 continuous infusion⚠ verify / measure level
Why it earns trustA reassuring chart hides fast clearance. The tool flags the under-exposure and lowers its confidence rather than reassuring you — the case that looks routine but isn’t.
DO-05MRSA bacteraemia · AUC-guided
55 y M · 80 kgMRSA bacteraemiaNormal renal functionSerious Gram-positive
The pain-point“MRSA bacteraemia — dose to a trough, or to something better?”
DoseOptimize750 mg q8hexposure-guided (AUC), not trough-only
AUC24/MIC 400–600
⚠ TDM-guided (AUC)✅ in target band
Why it earns trustIt targets total exposure (AUC-guided) — the current standard for serious MRSA — rather than a single trough, and lands in band.
DO-06Obesity · dosing weight
50 y M · 130 kg (BMI ~45)MRSA infectionNear-normal renal functionObesity dosing question
The pain-point“130 kg — dose to actual weight, or is that an overdose?”
DoseOptimize1750 mg q8hdosed to the appropriate dosing weight
AUC24/MIC 400–600
dosing weight, not TBW✅ in target band
Why it earns trustIt doses to the appropriate dosing weight, avoiding both the ‘fear-of-weight’ underdose and the blind actual-weight overdose.
DO-07Resistant organism at the breakpoint
60 y M · 75 kgVentilated · PseudomonasOrganism at the breakpointSOFA 7
The pain-point“Pseudomonas at the breakpoint — is my maxed regimen actually going to reach it?”
DoseOptimizeLoad 2 g, then 2 g q8hattainment marginal at a high MIC
%fT>MIC (ICU target)
⚠ MIC at breakpointverify / consider alternative🕐 extended infusion
Why it earns trustAt a breakpoint MIC even a maxed regimen may not reliably reach target — the tool says so and prompts you to verify susceptibility or add/switch. The organism, not the patient, is the reason to escalate.
DO-08MRSA + rising creatinine — efficacy vs toxicity
63 y M · 78 kgMRSA bacteraemiaCreatinine 1.8 (rising)Nephrotoxicity risk
The pain-point“MRSA to treat, but creatinine is climbing — push the dose or protect the kidney?”
DoseOptimize1250 mg q24hefficacy target held · nephrotoxicity flagged
AUC24/MIC 400–600
⚠ TDM-guided (AUC)nephrotoxicity watch
Why it earns trustIt holds the efficacy target while flagging the nephrotoxicity risk as creatinine climbs — the toxicity-versus-efficacy tension named out loud, not buried, with the interval extended to protect the kidney.
DO-09MDR Gram-negative · aminoglycoside floor
63 y F · 70 kgMDR Gram-negativeAmikacin · organism at breakpointPeak-driven agent
The pain-point“MDR Gram-negative at the amikacin breakpoint — will once-daily even reach the peak?”
DoseOptimize932 mg q24h (extended interval)peak below the efficacy floor at this MIC
Cmax/MIC ≥ 8–10
Cmax/MIC — below floor⬆ increase / combination⚠ TDM-guided
Why it earns trustFor a peak-driven aminoglycoside at the breakpoint it warns the standard dose is below the efficacy floor — prompting a higher mg/kg or combination, with mandatory monitoring. It flags under-dosing, not just toxicity.
DO-10Invasive fungal infection · narrow-index azole
49 y M · 68 kgInvasive fungal infectionVoriconazole (IV)CYP2C19 unknown
The pain-point“Invasive fungal infection on voriconazole — start standard and hope?”
DoseOptimize272 mg q12hgenotype-aware start · mandatory TDM
Trough 1–5.5 mg/L
⚠ TDM-guided (trough)hepatic + interaction caveat
Why it earns trustIt starts a genotype-aware regimen for a narrow-index antifungal and insists on TDM, flagging hepatic and drug-interaction caveats rather than assuming a standard dose fits everyone.
DO-11Elderly · reduced clearance
78 y F · 60 kgPseudomonasReduced renal clearanceElderly
The pain-point“Elderly, slow kidneys — a low dose feels safe, but is it enough?”
DoseOptimizeLoad 2 g, then 2 g q8hloading held · extended 3 h infusion sustains exposure
%fT>MIC (ICU target)
extended interval⬆ loading held✅ PTA ≥ 90%
Why it earns trustA slower kidney changes the maintenance, never the first dose: the tool holds loading, extends the interval, and keeps an extended infusion to sustain exposure despite reduced clearance.
DO-PNDeterminism — same case, same answer
58 y M · 75 kgSeptic shock (case 01, re-entered)Independently submittedIdentical inputs
The pain-point“Would a different clinician entering the same patient get the same regimen?”
DoseOptimizeLoad 2 g, then 2 g q6hidentical inputs, independently entered
%fT>MIC (ICU target)
✅ reproducible — operator-independent
Why it earns trustAn independently re-entered, identical clinical picture returns the identical regimen — reproducible and auditable, not a matter of who typed it in.