Systematic Comparison of Hospital-Wide Standard and Model-Based Therapeutic Drug Monitoring of Vancomycin in Adults

Abstract

We aimed to evaluate the predictive performance and predicted doses of a single-model approach or several multi-model approaches compared with the standard therapeutic drug monitoring (TDM)-based vancomycin dosing. We performed a hospital-wide monocentric retrospective study in adult patients treated with either intermittent or continuous vancomycin infusions. Each patient provided two randomly selected pairs of two consecutive vancomycin concentrations. A web-based precision dosing software, TDMx, was used to evaluate the model-based approaches. In total, 154 patients contributed 308 pairs. With standard TDM-based dosing, only 48.1% (148/308) of all of the second concentrations were within the therapeutic range. Across the model-based approaches we investigated, the mean relative bias and relative root mean square error varied from −5.36% to 3.18% and from 24.8% to 28.1%, respectively. The model averaging approach according to the squared prediction errors showed an acceptable bias and was the most precise. According to this approach, the median (interquartile range) differences between the model-predicted and prescribed doses, expressed as mg every 12 h, were 113 [−69; 427] mg, −70 [−208; 120], mg and 40 [−84; 197] mg in the case of subtherapeutic, supratherapeutic, and therapeutic exposure at the second concentration, respectively. These dose differences, along with poor target attainment, suggest a large window of opportunity for the model-based TDM compared with the standard TDM-based vancomycin dosing. Implementation studies of model-based TDM in routine care are warranted.

Individualized, dynamic, and full-course vancomycin dosing prediction: a study on the customized dose model

“…The Bland–Altman plot of AUC 24 was first employed to evaluate the consistency of CDM and FDM ( Guo et al, 2019a ). CDM and FDM were considered consistent in predicting the dose if the AUC 24 bias was within ±48 mg·h/L (a maximum permitted estimate obtained by multiplying 24 h by an acceptable concentration bias of ±2 mg/L ( Gastmans et al, 2022 )). Otherwise, additional index for 1) area under receiver operating characteristic (ROC) curve (AUC R ) of AUC 24 on clinical efficacy and 2) correlations and consistency of the predicted efficacy on clinical efficacy were measured.…”