Benchmarking Therapeutic Drug Monitoring Software: A Review of Available Computer Tools

Abstract

Therapeutic drug monitoring (TDM) aims to optimize treatments by individualizing dosage regimens based on the measurement of blood concentrations. Dosage individualization to maintain concentrations within a target range requires pharmacokinetic and clinical capabilities. Bayesian calculations currently represent the gold standard TDM approach but require computation assistance. In recent decades computer programs have been developed to assist clinicians in this assignment. The aim of this survey was to assess and compare computer tools designed to support TDM clinical activities. The literature and the Internet were searched to identify software. All programs were tested on personal computers. Each program was scored against a standardized grid covering pharmacokinetic relevance, user friendliness, computing aspects, interfacing and storage. A weighting factor was applied to each criterion of the grid to account for its relative importance. To assess the robustness of the software, six representative clinical vignettes were processed through each of them. Altogether, 12 software tools were identified, tested and ranked, representing a comprehensive review of the available software. Numbers of drugs handled by the software vary widely (from two to 180), and eight programs offer users the possibility of adding new drug models based on population pharmacokinetic analyses. Bayesian computation to predict dosage adaptation from blood concentration (a posteriori adjustment) is performed by ten tools, while nine are also able to propose a priori dosage regimens, based only on individual patient covariates such as age, sex and bodyweight. Among those applying Bayesian calculation, MM-USC*PACK© uses the non-parametric approach. The top two programs emerging from this benchmark were MwPharm© and TCIWorks. Most other programs evaluated had good potential while being less sophisticated or less user friendly. Programs vary in complexity and might not fit all healthcare settings. Each software tool must therefore be regarded with respect to the individual needs of hospitals or clinicians. Programs should be easy and fast for routine activities, including for non-experienced users. Computer-assisted TDM is gaining growing interest and should further improve, especially in terms of information system interfacing, user friendliness, data storage capability and report generation.

Continuous and Prolonged Intravenous β-Lactam Dosing: Implications for the Clinical Laboratory

“…A catalyst for using beta-lactam TDM is the apparent advancement in computer software that enables clinicians to use drug concentration data to the greatest benefits possible, without exhaustive pre-vious training. Using Bayesian or nonlinear regression, one can use the patient's own data for adjusting beta-lactam dosage, and some programs allow even the incorporation of population pharmacokinetic data, including local data, to optimize performance (11,141). Notably, interpretation of levels produced by the laboratory should be by collaboration with clinicians knowledgeable in PD concepts and, ideally, with consideration of the MIC.…”

Balancing Vancomycin Efficacy and Nephrotoxicity: Should We Be Aiming for Trough or AUC/MIC?

“…Other advantages include the program's ability to account for changes in PK profiles and reduce the risk of trough concentrations [20 lg/mL [8,10]. Several validated software programs with Bayesian analysis capabilities such as BestDose TM , MwPharm Ó , and T.D.M.S 2000 TM are available to clinicians, and are currently being used clinically for therapeutic drug monitoring purposes [11].…”

How severe is antibiotic pharmacokinetic variability in critically ill patients and what can be done about it?

“…There are a number of software packages which may be used for dosage adaption (Fuchs et al 2013). Optimised dosing using an estimation of an individual's PK to identify the optimal dosage has not been undertaken with anti-bacterial agent.…”