Personalized tobramycin dosing in children with cystic fibrosis: a comparative clinical evaluation of log-linear and Bayesian methods.
J Antimicrob Chemother
; 77(12): 3358-3366, 2022 11 28.
Article
em En
| MEDLINE
| ID: mdl-36172897
ABSTRACT
BACKGROUND:
Children with cystic fibrosis (CF) pulmonary exacerbations receive IV tobramycin therapy, with dosing guided by either log-linear regression (LLR) or Bayesian forecasting (BF).OBJECTIVES:
To compare clinical and performance outcomes for LLR and BF. PATIENTS ANDMETHODS:
A quasi-experimental intervention study was conducted at a tertiary children's hospital. Electronic medical records were extracted (from January 2015 to September 2021) to establish a database consisting of pre-intervention (LLR) and post-intervention (BF) patient admissions and relevant outcomes. All consecutive patients treated with IV tobramycin for CF pulmonary exacerbations guided by either LLR or BF were eligible.RESULTS:
A total of 376 hospital admissions (LLRâ=â248, BFâ=â128) for CF pulmonary exacerbations were included. Patient demographics were similar between cohorts. There were no significant differences found in overall hospital length of stay, rates of re-admission within 1â month of discharge or change in forced expiratory volume in the first second (Δ FEV1) at the end of tobramycin treatment. Patients treated with LLR on average had twice the number of therapeutic drug monitoring (TDM) blood samples collected during a single hospital admission. The timeframe for blood sampling was more flexible with BF, with TDM samples collected up to 16â h post-tobramycin dose compared with 10â h for LLR. The tobramycin AUC0-24 target of ≥100â mg/L·h was more frequently attained using BF (72%; 92/128) compared with LLR (50%; 124/248) (Pâ<â0.001). Incidence of acute kidney injury was rare in both groups.CONCLUSIONS:
LLR and BF result in comparable clinical outcomes. However, BF can significantly reduce the number of blood collections required during each admission, improve dosing accuracy, and provide more reliable target concentration attainment in CF children.
Texto completo:
1
Coleções:
01-internacional
Contexto em Saúde:
1_ASSA2030
Base de dados:
MEDLINE
Assunto principal:
Infecções por Pseudomonas
/
Fibrose Cística
Tipo de estudo:
Prognostic_studies
Limite:
Child
/
Humans
Idioma:
En
Revista:
J Antimicrob Chemother
Ano de publicação:
2022
Tipo de documento:
Article