Vancomycin Area under the Concentration-Time Curve Estimation Using Bayesian Modeling versus First-Order Pharmacokinetic Equations: A Quasi-Experimental Study

Abstract

Aim: To evaluate the efficiency of Bayesian modeling software and first-order pharmacokinetic (PK) equations to calculate vancomycin area under the concentration-time curve (AUC) estimations. Methods: Unblinded, crossover, quasi-experimental study at a tertiary care hospital for patients receiving intravenous vancomycin. Vancomycin AUC monitoring was compared using Bayesian modeling software or first-order PK equations. The primary endpoint was the time taken to estimate the AUC and determine regimen adjustments. Secondary endpoints included the percentage of vancomycin concentrations usable for AUC calculations and acute kidney injury (AKI). Results: Of the 124 patients screened, 34 patients had usable vancomycin concentrations that led to 44 AUC estimations. Without electronic health record (EHR) integration, the time from assessment to intervention in the Bayesian modeling platform was a median of 9.3 min (quartiles Q1–Q3 7.8–12.4) compared to 6.8 min (Q1–Q3 4.8–8.0) in the PK equations group (p = 0.004). With simulated Bayesian software integration into the EHR, however, the median time was 3.8 min (Q1–Q3 2.3–6.9, p = 0.019). Vancomycin concentrations were usable in 88.2% in the Bayesian group compared to 48.3% in the PK equation group and there were no cases of AKI. Conclusion: Without EHR integration, Bayesian software was more time-consuming to assess vancomycin dosing than PK equations. With simulated integration, however, Bayesian software was more time efficient. In addition, vancomycin concentrations were more likely to be usable for calculations in the Bayesian group.

Blood, dose recommendation reports and phone calls: Experiences of a therapeutic drug monitoring advisory service for vancomycin

“…Software integration would reduce staff workload, for example, avoiding manual data collection and report publication, thus reducing costs. This has been demonstrated in a recent study where integration of a Bayesian modelling software into the electronic health record reduced the time for reporting from a median of 9.3 to 3.8 min 15 . Transitioning to a pharmacist‐led approach could further streamline resource needs.…”

“…This has been demonstrated in a recent study where integration of a Bayesian modelling software into the electronic health record reduced the time for reporting from a median of 9.3 to 3.8 min. 15 Transitioning to a pharmacist-led approach could further streamline resource needs. Pharmacists are commonly embedded in treating teams and could facilitate dose recommendation acceptance and improve team knowledge.…”

Acute Kidney Injury Incidence With Bayesian Dosing Software Versus 2-Level First-Order Area Under the Curve–Based Dosing of Vancomycin With Piperacillin-Tazobactam

“…The authors found that vancomycin concentrations in the 1-level group were usable in 88.2% of patients compared with 48.3% of the 2-level monitoring group ( P = 0.001). 18 Both of these results are important because it suggests the utility that 1-level Bayesian dosing does not rely on a specifically timed draw to best predict AUC and monitoring of patients.…”

Agreement Between Two-Concentration and One-Concentration Area Under the Curve (AUC) Estimates When Using Bayesian Modeling to Dose Vancomycin in Patients With Obesity

“…As an example, one study found that Bayesian modeling allowed for 88.2% of usable vancomycin concentrations, compared with 48.3% when using first-order pharmacokinetic equations to estimate AUC. 2 In addition to alleviating logistical concerns, collecting a single vancomycin concentration may also have a cost-beneficial effect. 3 Pharmacokinetic analyses by Neely et al 4 and Shingde et al 5 have demonstrated a high level of accuracy when estimating vancomycin AUC with a single concentration in nonobese adults.…”

“…As an example, one study found that Bayesian modeling allowed for 88.2% of usable vancomycin concentrations, compared with 48.3% when using first-order pharmacokinetic equations to estimate AUC. 2 In addition to alleviating logistical concerns, collecting a single vancomycin concentration may also have a cost-beneficial effect. 3…”