Artificial intelligence and prescription of antibiotic therapy: present and future

Abstract

Introduction: In the past few years, the use of artificial intelligence in healthcare has grown exponentially. Prescription of antibiotics is not exempt from its rapid diffusion, and various machine learning (ML) techniques, from logistic regression to deep neural networks and large language models, have been explored in the literature to support decisions regarding antibiotic prescription.

Areas covered: In this narrative review, we discuss promises and challenges of the application of ML-based clinical decision support systems (ML-CDSSs) for antibiotic prescription. A search was conducted in PubMed up to April 2024.

Expert opinion: Prescribing antibiotics is a complex process involving various dynamic phases. In each of these phases, the support of ML-CDSSs has shown the potential, and also the actual ability in some studies, to favorably impacting relevant clinical outcomes. Nonetheless, before widely exploiting this massive potential, there are still crucial challenges ahead that are being intensively investigated, pertaining to the transparency of training data, the definition of the sufficient degree of prediction explanations when predictions are obtained through black box models, and the legal and ethical framework for decision responsibility whenever an antibiotic prescription is supported by ML-CDSSs.

Keywords: Artificial intelligence; XAI; antibiotic prescription; antimicrobial resistance; antimicrobial stewardship; clinical decision support systems; machine learning.