Sequential, Multiple-Assignment, Randomized Trials for COMparing Personalized Antibiotic StrategieS (SMART-COMPASS).

Journal Article (Journal Article)

Patient management is not based on a single decision. Rather, it is dynamic: based on a sequence of decisions, with therapeutic adjustments made over time. Adjustments are personalized: tailored to individual patients as new information becomes available. However, strategies allowing for such adjustments are infrequently studied. Traditional antibiotic trials are often nonpragmatic, comparing drugs for definitive therapy when drug susceptibilities are known. COMparing Personalized Antibiotic StrategieS (COMPASS) is a trial design that compares strategies consistent with clinical practice. Strategies are decision rules that guide empiric and definitive therapy decisions. Sequential, multiple-assignment, randomized (SMART) COMPASS allows evaluation when there are multiple, definitive therapy options. SMART COMPASS is pragmatic, mirroring clinical, antibiotic-treatment decision-making and addressing the most relevant issue for treating patients: identification of the patient-management strategy that optimizes the ultimate patient outcomes. SMART COMPASS is valuable in the setting of antibiotic resistance, when therapeutic adjustments may be necessary due to resistance.

Full Text

Duke Authors

Cited Authors

  • Evans, SR; Follmann, D; Liu, Y; Holland, T; Doernberg, SB; Rouphael, N; Hamasaki, T; Jiang, Y; Lok, JJ; Tran, TTT; Harris, AD; Fowler, VG; Boucher, H; Kreiswirth, BN; Bonomo, RA; Van Duin, D; Paterson, DL; Chambers, H

Published Date

  • May 17, 2019

Published In

Volume / Issue

  • 68 / 11

Start / End Page

  • 1961 - 1967

PubMed ID

  • 30351426

Pubmed Central ID

  • PMC6522685

Electronic International Standard Serial Number (EISSN)

  • 1537-6591

Digital Object Identifier (DOI)

  • 10.1093/cid/ciy912


  • eng

Conference Location

  • United States