Systematic Comparison of Hospital-Wide Standard and Model-Based Therapeutic Drug Monitoring of Vancomycin in Adults
We aimed to evaluate the predictive performance and predicted doses of a single-model approach or several multi-model approaches compared with the standard therapeutic drug monitoring (TDM)-based vancomycin dosing. We performed a hospital-wide monocentric retrospective study in adult patients treate...
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MDPI AG
2022-07-01
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| Series: | Pharmaceutics |
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| Online Access: | https://www.mdpi.com/1999-4923/14/7/1459 |
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| author | Heleen Gastmans Erwin Dreesen Sebastian G. Wicha Nada Dia Ellen Spreuwers Annabel Dompas Karel Allegaert Stefanie Desmet Katrien Lagrou Willy E. Peetermans Yves Debaveye Isabel Spriet Matthias Gijsen |
| author_facet | Heleen Gastmans Erwin Dreesen Sebastian G. Wicha Nada Dia Ellen Spreuwers Annabel Dompas Karel Allegaert Stefanie Desmet Katrien Lagrou Willy E. Peetermans Yves Debaveye Isabel Spriet Matthias Gijsen |
| author_sort | Heleen Gastmans |
| collection | DOAJ |
| description | We aimed to evaluate the predictive performance and predicted doses of a single-model approach or several multi-model approaches compared with the standard therapeutic drug monitoring (TDM)-based vancomycin dosing. We performed a hospital-wide monocentric retrospective study in adult patients treated with either intermittent or continuous vancomycin infusions. Each patient provided two randomly selected pairs of two consecutive vancomycin concentrations. A web-based precision dosing software, TDMx, was used to evaluate the model-based approaches. In total, 154 patients contributed 308 pairs. With standard TDM-based dosing, only 48.1% (148/308) of all of the second concentrations were within the therapeutic range. Across the model-based approaches we investigated, the mean relative bias and relative root mean square error varied from −5.36% to 3.18% and from 24.8% to 28.1%, respectively. The model averaging approach according to the squared prediction errors showed an acceptable bias and was the most precise. According to this approach, the median (interquartile range) differences between the model-predicted and prescribed doses, expressed as mg every 12 h, were 113 [−69; 427] mg, −70 [−208; 120], mg and 40 [−84; 197] mg in the case of subtherapeutic, supratherapeutic, and therapeutic exposure at the second concentration, respectively. These dose differences, along with poor target attainment, suggest a large window of opportunity for the model-based TDM compared with the standard TDM-based vancomycin dosing. Implementation studies of model-based TDM in routine care are warranted. |
| first_indexed | 2024-03-09T10:13:03Z |
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| institution | Directory Open Access Journal |
| issn | 1999-4923 |
| language | English |
| last_indexed | 2024-03-09T10:13:03Z |
| publishDate | 2022-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Pharmaceutics |
| spelling | doaj.art-03280ebdc630475d9ea33fa66a6fd5bb2023-12-01T22:34:47ZengMDPI AGPharmaceutics1999-49232022-07-01147145910.3390/pharmaceutics14071459Systematic Comparison of Hospital-Wide Standard and Model-Based Therapeutic Drug Monitoring of Vancomycin in AdultsHeleen Gastmans0Erwin Dreesen1Sebastian G. Wicha2Nada Dia3Ellen Spreuwers4Annabel Dompas5Karel Allegaert6Stefanie Desmet7Katrien Lagrou8Willy E. Peetermans9Yves Debaveye10Isabel Spriet11Matthias Gijsen12Pharmacy Department, UZ Leuven, 3000 Leuven, BelgiumClinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, BelgiumDepartment of Clinical Pharmacy, Institute of Pharmacy, University of Hamburg, 20146 Hamburg, GermanyClinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, BelgiumPharmacy Department, UZ Leuven, 3000 Leuven, BelgiumDepartment of Information Technology, University Hospitals Leuven, 3000 Leuven, BelgiumClinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, BelgiumLaboratory of Clinical Bacteriology and Mycology, Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, BelgiumLaboratory of Clinical Bacteriology and Mycology, Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, BelgiumLaboratory of Clinical Infectious and Inflammatory Disease, Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, BelgiumLaboratory for Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, 3000 Leuven, BelgiumPharmacy Department, UZ Leuven, 3000 Leuven, BelgiumPharmacy Department, UZ Leuven, 3000 Leuven, BelgiumWe aimed to evaluate the predictive performance and predicted doses of a single-model approach or several multi-model approaches compared with the standard therapeutic drug monitoring (TDM)-based vancomycin dosing. We performed a hospital-wide monocentric retrospective study in adult patients treated with either intermittent or continuous vancomycin infusions. Each patient provided two randomly selected pairs of two consecutive vancomycin concentrations. A web-based precision dosing software, TDMx, was used to evaluate the model-based approaches. In total, 154 patients contributed 308 pairs. With standard TDM-based dosing, only 48.1% (148/308) of all of the second concentrations were within the therapeutic range. Across the model-based approaches we investigated, the mean relative bias and relative root mean square error varied from −5.36% to 3.18% and from 24.8% to 28.1%, respectively. The model averaging approach according to the squared prediction errors showed an acceptable bias and was the most precise. According to this approach, the median (interquartile range) differences between the model-predicted and prescribed doses, expressed as mg every 12 h, were 113 [−69; 427] mg, −70 [−208; 120], mg and 40 [−84; 197] mg in the case of subtherapeutic, supratherapeutic, and therapeutic exposure at the second concentration, respectively. These dose differences, along with poor target attainment, suggest a large window of opportunity for the model-based TDM compared with the standard TDM-based vancomycin dosing. Implementation studies of model-based TDM in routine care are warranted.https://www.mdpi.com/1999-4923/14/7/1459vancomycintherapeutic drug monitoringpopulation pharmacokineticsprecision dosingpredictive performancemodel averaging |
| spellingShingle | Heleen Gastmans Erwin Dreesen Sebastian G. Wicha Nada Dia Ellen Spreuwers Annabel Dompas Karel Allegaert Stefanie Desmet Katrien Lagrou Willy E. Peetermans Yves Debaveye Isabel Spriet Matthias Gijsen Systematic Comparison of Hospital-Wide Standard and Model-Based Therapeutic Drug Monitoring of Vancomycin in Adults Pharmaceutics vancomycin therapeutic drug monitoring population pharmacokinetics precision dosing predictive performance model averaging |
| title | Systematic Comparison of Hospital-Wide Standard and Model-Based Therapeutic Drug Monitoring of Vancomycin in Adults |
| title_full | Systematic Comparison of Hospital-Wide Standard and Model-Based Therapeutic Drug Monitoring of Vancomycin in Adults |
| title_fullStr | Systematic Comparison of Hospital-Wide Standard and Model-Based Therapeutic Drug Monitoring of Vancomycin in Adults |
| title_full_unstemmed | Systematic Comparison of Hospital-Wide Standard and Model-Based Therapeutic Drug Monitoring of Vancomycin in Adults |
| title_short | Systematic Comparison of Hospital-Wide Standard and Model-Based Therapeutic Drug Monitoring of Vancomycin in Adults |
| title_sort | systematic comparison of hospital wide standard and model based therapeutic drug monitoring of vancomycin in adults |
| topic | vancomycin therapeutic drug monitoring population pharmacokinetics precision dosing predictive performance model averaging |
| url | https://www.mdpi.com/1999-4923/14/7/1459 |
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