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
- 주제(키워드) Area under the curve , Peak , Therapeutic drug monitoring , Trough , Vancomycin
- 등재 SCOPUS
- OA유형 All Open Access; Gold Open Access
- 발행기관 NLM (Medline)
- 발행년도 2023
- 총서유형 Journal
- URI http://www.dcollection.net/handler/ewha/000000209560
- 본문언어 영어
- Published As https://doi.org/10.3343/alm.2023.43.6.554
- PubMed 37387488
초록/요약
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.
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