Evaluation of Vancomycin Area Under the Concentration-Time Curve Predictive Performance Using Bayesian Modeling Software With and Without Peak Concentration: An Academic Hospital Experience for Adult Patients Without Renal Impairment.
Ann Lab Med
; 43(6): 554-564, 2023 11 01.
Article
em En
| MEDLINE
| ID: mdl-37387488
ABSTRACT
Background:
The revised U.S. consensus guidelines on vancomycin therapeutic drug monitoring (TDM) recommend obtaining trough and peak samples to estimate the area under the concentration-time curve (AUC) using the Bayesian approach; however, the benefit of such two-point measurements has not been demonstrated in a clinical setting. We evaluated Bayesian predictive performance with and without peak concentration data using clinical TDM data.Methods:
We retrospectively analyzed 54 adult patients without renal impairment who had two serial peak and trough concentration measurements in a ≤1-week interval. The concentration and AUC values were estimated and predicted using Bayesian software (MwPharm++; Mediware, Prague, Czech Republic). The median prediction error (MDPE) for bias and median absolute prediction error (MDAPE) for imprecision were calculated based on the estimated AUC and measured trough concentration.Results:
AUC predictions using the trough concentration had an MDPE of -1.6% and an MDAPE of 12.4%, whereas those using both peak and trough concentrations had an MDPE of -6.2% and an MDAPE of 16.9%. Trough concentration predictions using the trough concentration had an MDPE of -8.7% and an MDAPE of 18.0%, whereas those using peak and trough concentrations had an MDPE of -13.2% and an MDAPE of 21.0%.Conclusions:
The usefulness of the peak concentration for predicting the AUC on the next occasion by Bayesian modeling was not demonstrated; therefore, the practical value of peak sampling for AUC-guided dosing can be questioned. As this study was conducted in a specific setting and generalization is limited, results should be interpreted cautiously.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Vancomicina
/
Hospitais
Tipo de estudo:
Guideline
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adult
/
Humans
Idioma:
En
Revista:
Ann Lab Med
Ano de publicação:
2023
Tipo de documento:
Article