Is it possible to treat persister infections serendipitously?

Even though persister infections are difficult to treat with antibiotics, it may be possible to eliminate persister bacteria serendipitiously as per Lewis (2007).   

“The goal of established therapies is to maintain the plasma level of an antibiotic at a maximum concentration, in order to discourage the development of resistance. Most importantly, an optimal pulse-dosing regimen would probably vary from patient to patient. However, it seems that some patients might have inadvertently taken solving the problem of intractable persistent infections into their own hands. Individuals who suffer from persistent infections that require a lengthy therapy are often cured, but why a year-long regimen is better than a month-long one is unclear. An efficacious fluctuating dose of antibiotics administered serendipitously by the patient might be responsible for persister eradication in these cases. The patients might adjust drug dosing simply through being absent-minded, which sooner or later could produce the perfect drug-administration regimen. Curing persistent infections might therefore result from patient non-compliance. Analysing how persistent infections are cured might shed light on the likelihood of developing a rational regimen for the pulse-dosing sterilization of infection.”

Is maintaining the plasma level of antibiotics at maximum concentration always the goal of antibiotic therapy? This goal may be true for those antibiotics exhibiting concentration-dependent killing. However, for time-dependent killing antibiotics, percentage of time the concentration of the antibiotic is maintained above MIC (t>MIC) is the most important parameter determining the efficacy of the antibiotic.

Can the suggestion that patient non-compliance or serendipitous administration of antibiotics by the patient may cure persistent infections be supported by any pharmacokinetic/pharmacodynamic models? Isn’t true that, one of the reasons for the development of drug resistance leading to antibiotic treatment failure is the non-adherence to antibiotic regimen by patients?

Next- Don't miss those 1.5 hours to treat persistent infections

Lewis, K. (2007). Persister cells, dormancy and infectious diseases. Nat Rev Microbiol. 5(1): 48-56.