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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
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Implementation of Vancomycin Therapeutic Monitoring Guidelines: Focus on Bayesian Estimation Tools in Neonatal and

Jihye Han1, Jason Sauberan2, Martin Tuan Tran3

  • 1Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, Louisiana Jolla.

Therapeutic Drug Monitoring
|June 19, 2021
PubMed

Insights

This study reviewed vancomycin pharmacokinetic models and Bayesian tools for children. DoseMeRx, InsightRx, and PrecisePK are recommended for optimizing vancomycin dosing in neonatal and pediatric patients.

Area of Science:

  • Pharmacokinetics
  • Therapeutic Drug Monitoring
  • Pediatric Pharmacology

Background:

  • 2020 guidelines recommend Bayesian estimation for vancomycin dosing in pediatric patients.
  • Individualized vancomycin therapy is crucial for optimal outcomes in children.
  • Population-based pharmacokinetic (PK) models and Bayesian tools are essential for this approach.

Purpose of the Study:

  • To assess and compare published population-based PK vancomycin models for neonates and children.
  • To evaluate available Bayesian estimation tools for vancomycin therapeutic monitoring in pediatric populations.
  • To support the implementation of institutional guidelines for vancomycin dosing in children.

Main Methods:

  • Searched PubMed and Embase databases (1994-2020) for vancomycin PK models in neonates and pediatrics.
  • Identified and assessed six Bayesian software programs: Adult and Pediatric Kinetics, BestDose, DoseMeRx, InsightRx, MwPharm++, and PrecisePK.
  • Included 14 neonatal and 20 pediatric PK models in the review.

Main Results:

  • Frymoyer et al and Capparelli et al developed neonatal models using large PK samples with external validation.
  • Le et al developed a pediatric model with the largest sample size and multiple external validations.
  • DoseMeRx, InsightRx, and PrecisePK were identified as Bayesian programs utilizing clinically validated neonatal and pediatric models.

Conclusions:

  • Clinicians should select PK models that best fit their specific pediatric patient population.
  • Utilizing Bayesian estimation tools is recommended for area under the curve-targeted vancomycin dosing.
  • Effective therapeutic drug monitoring is key to optimizing vancomycin use in neonates and children.
Abstract

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