The escalating global crisis of antimicrobial resistance (AMR) necessitates a shift from empirical antibiotic therapy toward precision medicine integrating microbiological data with host inflammatory markers. This review evaluates personalized antibiotic protocols combining culture and susceptibility testing (CAST) with dynamic biomarkers, particularly procalcitonin (PCT) and C-reactive protein (CRP). Although CAST provides definitive susceptibility data, its turnaround time may delay treatment optimization. Biomarker-guided strategies offer real-time insights into host response and facilitate early de-escalation of broad-spectrum antibiotics.
We reviewed recent literature published between 2018 and 2026, focusing on high-impact studies. PCT-guided algorithms have reduced antibiotic duration by 2–5 days without increasing mortality or treatament failure across clinical settings, including community-acquired pneumonia and sepsis. Rapid molecular diagnostics and host-response transcriptomics further improve differentiation between colonization and active infection. Mathematical modeling and pharmacokinetic/pharmacodynamic (PK/PD) optimization enable individualized dosing, particularly in critically ill patients with altered drug clearance.
Clinical Decision Support Systems (CDSS) integrated with antibiotic stewardship programs enhance guideline adherence and reduce unnecessary antibiotic use. Despite challenges related to biomarker standardization, cost-effectiveness, and population validation, integrating artificial intelligence, genomics, and point-of-care diagnostics may enable continuous monitoring and proactive intervention. Ultimately, multimodal precision strategies can improve patient outcomes while reducing antimicrobial selective pressure and supporting sustainable AMR control.