TDM coupled with Bayesian forecasting should be considered an invaluable tool for optimizing vancomycin daily exposure in unstable critically ill patients.
A randomized two-arm prospective study was planned to assess the role of therapeutic drug monitoring (TDM) coupled with a Bayesian approach in tailoring vancomycin dosages in unstable critically ill patients. Group A (n=16) had their regimen adjusted day-by-day according to TDM and Bayesian forecasting (D(a)); group B (n=16) had their regimen adjusted day-by-day according to Moellering's nomogram (D(M)). Blood samples were collected every 1-2 days to assess the trough and peak plasma concentrations. In group A, the tailored D(a) required for optimizing vancomycin exposure were considerably higher than the D(M) in 7/16 cases, and lower than the D(M) in 1/16 cases. In group B, standard D(M) caused under-treatment in 3/16 cases and over-treatment in 4/16 cases. Most of these patients concomitantly had some conditions that might have altered vancomycin disposition. The TDM-guided Bayesian-based approach should be considered an invaluable tool for clinicians to handle appropriately on real-time vancomycin therapy in critically ill patients.
Pea
Federico
F
Institute of Clinical Pharmacology and Toxicology, Chair of Pharmacology, Department of Experimental and Clinical Pathology and Medicine, Medical School, University of Udine, Udine, Italy. federico.pea@med.uniud.it
Bertolissi
Massimo
M
Di Silvestre
Adriana
A
Poz
Donatella
D
Giordano
Francesco
F
Furlanut
Mario
M
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use*; D001499:Bayes Theorem; D016638:Critical Illness; D016903:Drug Monitoring; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006094:Gram-Positive Bacteria / Q000187:drug effects; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014640:Vancomycin / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D014640:Vancomycin