ISSN: 1859 - 2872
Applying population pharmacokinetics in optimizing vancomycin dosing regimens for patients in the surgical intensive care unit at Viet Duc University Hospital
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Abstract
Objective: To identify the best-fit population pharmacokinetic (popPK) model for non-neurosurgical patients in the surgical intensive care unit (SICU) and propose optimal initial maintenance doses for each patient’s renal function (ClCr) subgroup. Subject and method: PopPK models identified through a systematic review of the PubMed database were externally validated using data from 45 patients and 58 vancomycin serum concentrations. The model was considered clinically acceptable if it demonstrated a relative bias within ± 30%, a low relative root mean square error, and the best performance in goodness-of-fit plots and prediction-corrected Visual Predictive Checks. Subsequently, we conducted Monte Carlo simulations (n = 1000) using the best-fit model to establish the initial maintenance dose depending on the patient’s renal function. Result: Among the nine validated models, the Thomson model displayed the best predictive performance for patients in the hospital. Simulations indicated that the suggested doses for patients with ClCr < 130 mL/min were consistent with the current dosing regimen recommended at the hospital. Meanwhile, for patients with ClCr > 130 mL/min, the total daily dose may need to be increased to 4500 mg/day. Conclusion: Our study affirmed the appropriateness of the current vancomycin doses applied for most patients, except for those with ClCr > 130 mL/min, a higher dose of up to 4500 mg/day was suggested to achieve therapeutic targets. The Thomson model could be applied into vancomycin dosing adjustments for non-neurosurgical SICU patients at Viet Duc University Hospital.
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References
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