Comparison of the predictions of one- and two-compartment microcomputer programs for long-term tobramycin therapy

A retrospective study of patients receiving tobramycin compared the accuracy of predictions of actual trough serum concentrations using two commercially available microcomputer software programs. Twelve patients met the study criteria of intravenous tobramycin treatment for more than 10 days with serum concentration monitoring within the first 5 days and after 10 days of therapy. No patients received dialysis. Twenty-five serum concentrations were compared. Predictions within 0.2 microgram/ml were considered clinically "exact." No significant differences were found by chi-square analysis for any of the four possible choices (p less than 0.3). One of the programs, distributed by Dista Pharmaceuticals, offers a one-compartment model, a two-compartment model, and a two-compartment prenephrotoxic option. SIMKIN, a program marketed by Medical Engineering, Inc., uses a two-compartment model. Overall, the predictions errors were small, but occasionally were clinically significant. Further evaluation of microcomputer programs for therapeutic drug monitoring is necessary to document their impact on predicting drug efficacy and toxicity.