The development of individualized dosing methods based on pharmacokinetics/pharmacodynamics (PK/PD) for PK of antimicrobials and their effects at the site of infection is essential for developing precise prevention and treatment strategies for infectious diseases. We conducted translational and clinical research to establish an individualized optimal dosing method of antimicrobials for the prevention and treatment of infectious diseases based on PK/PD analysis. This review summarizes the evaluation of the PK/PD analysis.

1) During cardiovascular surgery, ampicillin/sulbactam (ABPC/SBT) was administered at a dose of 1.5 g every 4 h at a creatinine clearance (CLcr) of 60 and 90 mL/min, and at an interval of 6 h in patients with cardiopulmonary bypass. In dialysis patients, there is no need for re-administration during prolonged surgery (12 h).

2) SBT, a β-lactamase inhibitor, was effective against Acinetobacter baumannii. The mouse thigh infection model showed the best PK/PD index when the free drug concentration remained above the minimum inhibitory concentration (fT > MIC) (R² = 0.987). SBT showed maximum bactericidal activity against A. baumannii when fT > MIC of ≥60％. PK/PD simulations showed that 1 g every 6 h at a CLcr of 60 mL/min was sufficient against A. baumannii.

3) The evaluation of the dosing regimen of meropenem in hemodiafiltration patients using a drug elimination model showed that a dose of 0.25 g once daily for MIC ≤ 8 µg/mL (usual treatment of infection) and a dose of 0.5 g once daily for MIC = 16 µg/mL (severe infection) were effective.

The management of effective and safe chemotherapy is an important responsibility of oncology-specialized pharmacists. In this review, we introduce the efforts undertaken for the management of cisplatin-induced nephrotoxicity (CIN) and taxane-associated acute pain syndrome (T-APS) and safer chemotherapy procedures.

(1) CIN management

We evaluated the nephroprotective effect of magnesium premedication using clinical and fundamental studies, suggesting that magnesium attenuates CIN by regulating the renal transporter expression to reduce the renal platinum accumulation. Additionally, we revealed that non-steroidal anti-inflammatory drugs (NSAIDs) affect CIN.

(2) T-APS management

We revealed that the situation of pre-administered NSAIDs does not affect T-APS and additional dexamethasone prophylaxis attenuates T-APS severity. Furthermore, we assessed the risk factors for T-APS incidence under dexamethasone premedication, revealing that pegfilgrastim co-administration and ages <55 years are independently associated.

(3) Safer chemotherapy procedure

Chemotherapy regimen management is an important oncological pharmacy practice. We evaluated the availability of the pharmaceutical review and demonstrated its utility, appropriate regimen review coverage, and quality practice sharing between the oncology-specialized and non-specialized pharmacists. Moreover, we developed a management system for safer denosumab administration focusing on hypocalcemia and evaluated its use, suggesting that early intervention prevents severe symptom prevalence. Additionally, we revealed that approximately 70％ of pharmaceutical proposals attenuate the patient’s painful symptoms in outpatient chemotherapy, suggesting that continuous pharmaceutical care in cancer treatment is necessary.

As the evaluation of pharmaceutical care and adverse effects management contributes to advanced cancer care, further assessments are required.

The Pharmacy Vision for Patients calls for all pharmacies to function as family pharmacies by 2025, and it is necessary for the public to understand the roles of pharmacies and pharmacists, and to be able to select a family pharmacy based on their evaluation. A study was conducted to investigate the image of pharmacists and the evaluation of pharmacists among the participants of a public event, and to analyze the relationship between the two to gain the insight necessary to broaden understanding of the family pharmacy and pharmacist. Three factors were extracted by factor analysis: “basic medication instruction,” “health support for local community,” and “work required to enhance interpersonal operations.” The results of the covariance structure analysis showed that the relationship between these factors and the overall evaluation differed depending on the frequency of pharmacy use. In the group with regular use of pharmacies, “basic medication instruction” and “work required to enhance interpersonal operations” were related to the overall evaluation, while in the group without regular use of pharmacies, only “basic medication instruction” was related to the overall evaluation. None of the groups showed any association with the overall evaluation of “health support for local community.” Toward the goal of having all pharmacies become family pharmacies, it is necessary to accelerate specific efforts to ensure that the health support function, as well as the expertise and functions of pharmacists and pharmacies, are understood and evaluated in the community regardless of the frequency of pharmacy use.

Appropriate antimicrobial use is essential for antimicrobial resistance (AMR) improvement; therefore, antimicrobial stewardship (AS) is expected to play a crucial role in AMR. A possible inappropriate use of oral antimicrobial agents in patients with acute respiratory tract infection (ARTI) and acute diarrhea (AD) treated in an outpatient department is described in the Manual of Antimicrobial Stewardship by the government of Japan. This study evaluated the impact of AS in patients with ARTI and AD treated in an outpatient department. Oral antibiotic prescription rates, antimicrobial use density (AUD), days of therapy (DOT), bundle compliance rates, and the proportion of antimicrobial resistant bacteria from April 2011 to March 2016 (before AS) and from April 2016 to March 2021 (after AS) were assessed and compared between before AS and after AS. The numbers of eligible patients were 11,457 for ARTI (before AS: 6,610; after AS: 4,847) and 4,909 for AD (before AS: 2,945; after AS: 1,964). In patients with ARTI and AD, the oral antibiotic prescribing rates, AUD, and DOT of third-generation cephalosporins after AS were significantly lower than those before AS. In patients with ARTI, the proportion of Pseudomonas aeruginosa and Escherichia coli resistant to levofloxacin and the proportion of Streptococcus pneumoniae resistant to erythromycin after AS were also significantly decreased. In contrast, several bundle compliance rates were significantly increased. AS in the outpatient department may improve the use of antimicrobials and AMR in patients with ARTI and AD.