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IF 2.8 4区医学 Q2 MEDICAL LABORATORY TECHNOLOGY

Therapeutic Drug Monitoring Pub Date : 2025-03-28 DOI:10.1097/FTD.0000000000001323

Ba Hai Le, Chi Kien Phung, Olivia Yip, Anjum Gupta, Thi Linh Phan, Helen Lai, Lana Hoang, Thanh Hai Nguyen, Thi Dua Nguyen, Thi Thao Nguyen, Thi Lien Huong Nguyen, Jennifer Le

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引用次数: 0

摘要

背景：建议对儿科患者使用贝叶斯曲线下面积（AUC）指导的万古霉素剂量，最好使用 2 个样本（2S）。然而，在临床环境中，取样时间并不总是很方便。在中低收入国家，由于软件成本高昂，采用贝叶斯方法的模型信息精准给药（MIPD）的实施仍然受到限制。作者使用贝叶斯分析法的 MIPD 比较了中点策略和指南推荐的 2S 策略的准确性和精确性，评估了一个开源软件包的临床实用性，并将其与 PrecisePK 进行了比较：这项回顾性队列研究于 2022 年 4 月至 2023 年 4 月在两家拥有 2000 张床位的儿科医院进行。作者选取了年龄在 3 个月至 16 岁之间、至少接受过 2 次万古霉素治疗且至少测量过 2 次药物浓度的患者：Cmax（输液结束后 1-2 小时）、Cmid（给药间隔的中点）和 Ctrough（下一次给药前 30 分钟-1 小时）。药代动力学参数的准确度和精密度分别用和计算：结果：共纳入了 80 名万古霉素浓度为 226 的儿童。中位年龄为 1.6（四分位距为 0.88-3.01）岁，平均体重为 10.0（8.0-12.0）千克，基线血清肌酐浓度为 0.43（0.38-0.53）毫克/分升，万古霉素经验剂量为 60（57-61）毫克/千克/天。大多数受试者因肺炎（75%）和菌血症（26%）接受了万古霉素治疗，75%的受试者住进了重症监护室。与 2S 监测状态相比，贝叶斯推导的 AUC24 值的中点准确度和精确度分别为 5.02% 和 6.45%。与 PrecisePK 相比，Shiny 估算 AUC24 的准确度和精确度分别为-5.58%和 6.09%：中点浓度为准确监测住院儿科患者的万古霉素治疗提供了一种便捷的取样方法。Shiny 可作为贝叶斯 MIPD 工具的替代品，用于越南儿童万古霉素治疗的剂量和监测。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Model-Informed Precision Dosing of Vancomycin in Vietnamese Children: Innovative Midpoint Concentration Monitoring Using 2 Bayesian Programs.

Background: Bayesian area under the curve (AUC)-guided vancomycin dosing, preferably with 2 samples (2S), is recommended for pediatric patients. However, the timing of sampling may not always be convenient in the clinical setting. In low- to middle-income countries, the implementation of model-informed precision dosing (MIPD) using the Bayesian approach remains limited because of high software costs. Using MIPD with Bayesian analysis, the authors compared the accuracy and precision of midpoint and guideline-recommended 2S strategies and evaluated the clinical utility of an open-source software package and compared it with PrecisePK.

Methods: This retrospective cohort study was conducted at 2 pediatric hospitals with a combined 2000 beds from April 2022 to April 2023. The authors enrolled patients aged from 3 months to 16 years who received at least 2 doses of vancomycin and had at least 2 measured drug concentrations: Cmax (1-2 hours after the end of infusion), Cmid (midpoint of the dosing interval), and Ctrough (30 minutes-1 hour before the next dose). The accuracy and precision of pharmacokinetic parameters were calculated using and , respectively.

Results: Eighty children with 226 vancomycin concentrations were included. The median age was 1.6 (interquartile range 0.88-3.01) years, the average weight was 10.0 (8.0-12.0) kg, the baseline serum creatinine concentration was 0.43 (0.38-0.53) mg/dL, and the empirical vancomycin dose was 60 (57-61) mg/kg/d. Most subjects received empirical vancomycin for pneumonia (75%) and bacteremia (26%), and 75% were admitted to the intensive care unit. Compared with the 2S monitoring state, the accuracy and precision of the midpoint for the Bayesian-derived AUC24 values were 5.02% and 6.45%, respectively. Compared with PrecisePK, the AUC24 estimation by Shiny exhibited an accuracy and precision of -5.58% and 6.09%, respectively.

Conclusions: Midpoint concentration offers a convenient sampling approach to accurately monitor vancomycin therapy in hospitalized pediatric patients. Shiny serves as an alternative Bayesian MIPD tool for dosing and monitoring vancomycin therapy in children in Vietnam.

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来源期刊

Therapeutic Drug Monitoring 医学-毒理学

CiteScore

5.00

自引率

8.00%

发文量

213

审稿时长

4-8 weeks

期刊介绍： Therapeutic Drug Monitoring is a peer-reviewed, multidisciplinary journal directed to an audience of pharmacologists, clinical chemists, laboratorians, pharmacists, drug researchers and toxicologists. It fosters the exchange of knowledge among the various disciplines–clinical pharmacology, pathology, toxicology, analytical chemistry–that share a common interest in Therapeutic Drug Monitoring. The journal presents studies detailing the various factors that affect the rate and extent drugs are absorbed, metabolized, and excreted. Regular features include review articles on specific classes of drugs, original articles, case reports, technical notes, and continuing education articles.