Development of Vancomycin Dose Individualization Strategy by Bayesian Prediction in Patients Receiving Continuous
Kazutaka Oda1, Hirofumi Jono2,3, Hidenobu Kamohara4
1Department of Pharmacy, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto city, Kumamoto, Japan. kazutakaoda@kuh.kumamoto-u.ac.jp.
Pharmaceutical Research
|May 30, 2020
Summary
Bayesian prediction-based therapeutic drug monitoring (Bayes-TDM) improves vancomycin (VCM) dosing in continuous renal replacement therapy (CRRT) patients. This method achieved higher target concentration attainment rates compared to traditional population pharmacokinetic modeling.
Area of Science:
- Pharmacokinetics and Pharmacodynamics
- Nephrology and Critical Care
- Infectious Diseases
Background:
- Vancomycin (VCM) concentrations frequently fall outside the therapeutic range (10-20 μg/ml) in patients undergoing continuous renal replacement therapy (CRRT).
- Effective VCM dosing is crucial for treating infections in critically ill patients with impaired renal function.
Purpose of the Study:
- To develop a practical VCM population pharmacokinetic (PPK) model for CRRT patients.
- To evaluate the efficacy of Bayesian prediction-based therapeutic drug monitoring (Bayes-TDM) for individualizing VCM dosage in this population.
Main Methods:
- A VCM PPK model was constructed using 80 VCM concentrations from 17 CRRT patients.
- Bayes-TDM was subsequently assessed in 23 CRRT patients utilizing the developed PPK model.
Main Results:
- Key covariates influencing the VCM PPK model were identified as reduced urine output (RUO) and CRRT effluent flow rate.
- The Bayes-TDM approach demonstrated a significantly higher target concentration attainment rate (87.0%) compared to the PPK modeling period (53.8%).
- The variance in VCM concentrations was notably lower with Bayes-TDM (SD: 3.4 μg/ml) versus the PPK modeling period (SD: 7.1 μg/ml).
Conclusions:
- Bayes-TDM shows significant promise as a valuable tool for optimizing vancomycin dosing in patients receiving CRRT.
- Individualized VCM dosing using Bayes-TDM can lead to improved therapeutic outcomes and reduced concentration variability.
Keywords:
BayesianVancomycincontinuous renal replacement therapypopulation pharmacokineticstherapeutic drug monitoringMore Related Videos
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