Accuracy of Bayesian, Sawchuk-Zaske, and nomogram dosing methods for vancomycin.
The predictive performance of a Bayesian method for vancomycin dosing was compared with that of two nomogram-based methods and the Sawchuk-Zaske method. Prospectively collected serum concentration data were evaluated retrospectively in patients who had at least two steady-state peak and trough serum vancomycin concentrations obtained during two different dosage regimens. The methods evaluated were a Bayesian program that uses a one-compartment weighted-sum-of-squares expression; the nomogram methods of Moellering and Matzke, which derive vancomycin clearance from urinary creatinine clearance; and the Sawchuk-Zaske method, which uses equations for one-compartment, first-order elimination. The ability of each method to predict the second set of serum concentrations when given the first set of concentrations was evaluated using mean prediction error (ME), mean absolute error (MAE), and root mean squared error (RMSE). To compare the predictions made by each of the four methods, the differences in mean error and the differences in the natural logarithm of mean absolute error and their 95% confidence intervals were compared. No significant difference in ME (bias) or MAE (precision) was found between the Moellering and Matzke methods. The Sawchuk-Zaske method was significantly more precise than the Matzke method in predicting peak serum concentrations and more precise than the Moellering or Matzke method in predicting trough concentrations. The Bayesian program was significantly more precise and less biased than the Moellering and Matzke methods and less biased than the Sawchuk-Zaske method in predicting both peak and trough concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)
D000293:Adolescent; D000328:Adult; D000368:Aged; D001499:Bayes Theorem; D003404:Creatinine / Q000493:pharmacokinetics; D004334:Drug Administration Schedule; D005069:Evaluation Studies as Topic; D005260:Female; D005454:Fluorescence Polarization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011336:Probability; D014640:Vancomycin / Q000008:administration & dosage* / Q000097:blood
D014640:Vancomycin; D003404:Creatinine