Desirability of outcome ranking (DOOR) and response adjusted for duration of antibiotic risk (RADAR)

Scott R. Evans, Daniel Rubin, Dean Follmann, Gene Pennello, W. Charles Huskins, John H. Powers, David Schoenfeld, Christy Chuang-Stein, Sara E. Cosgrove, Vance G. Fowler, Ebbing Lautenbach, Henry F. Chambers

Research output: Contribution to journalArticlepeer-review

92 Scopus citations


Clinical trials that compare strategies to optimize antibiotic use are of critical importance but are limited by competing risks that distort outcome interpretation, complexities of noninferiority trials, large sample sizes, and inadequate evaluation of benefits and harms at the patient level. The Antibacterial Resistance Leadership Group strives to overcome these challenges through innovative trial design. Response adjusted for duration of antibiotic risk (RADAR) is a novel methodology utilizing a superiority design and a 2-step process: (1) categorizing patients into an overall clinical outcome (based on benefits and harms), and (2) ranking patients with respect to a desirability of outcome ranking (DOOR). DOORs are constructed by assigning higher ranks to patients with (1) better overall clinical outcomes and (2) shorter durations of antibiotic use for similar overall clinical outcomes. DOOR distributions are compared between antibiotic use strategies. The probability that a randomly selected patient will have a better DOOR if assigned to the new strategy is estimated. DOOR/RADAR represents a new paradigm in assessing the risks and benefits of new strategies to optimize antibiotic use.

Original languageEnglish (US)
Pages (from-to)800-806
Number of pages7
JournalClinical Infectious Diseases
Issue number5
StatePublished - Sep 1 2015


  • Antibiotic use strategies
  • DOOR

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases


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