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. 1990 Jun;34(6):1165–1171. doi: 10.1128/aac.34.6.1165

Application of a Bayesian method to monitor and adjust vancomycin dosage regimens.

A K Hurst 1, M A Yoshinaga 1, G H Mitani 1, K A Foo 1, R W Jelliffe 1, E C Harrison 1
PMCID: PMC171778  PMID: 2393277

Abstract

A Bayesian method for monitoring vancomycin concentrations and adjusting regimens in patients with unstable renal function by using a two-compartment population model was evaluated with a personal computer. The population model was derived from data from 12 cardiac outpatients who received single doses of vancomycin. The performance of the method was then tested in 27 acutely ill patients who received multiple doses of vancomycin. Significant renal impairment was observed in 15 patients. Renal function changed in 15 patients. The vancomycin concentrations in the patients with changing renal function were not at steady state during the observation times. Two concentrations in serum (peak and then trough, or trough and then peak) were fitted along with the population model to individualize the parameter values for each patient. All the subsequent concentrations in serum for each patient were then predicted by using the parameter values for each patient. Future concentrations of 118 serum samples were predicted. The mean absolute prediction error was 3.6 +/- 4.5 micrograms/ml, and the mean prediction error was -0.7 +/- 5.3 micrograms/ml. These results confirm that a two-compartment pharmacokinetic model can be sufficiently individualized with the knowledge of just two concentrations of drug in patient serum; it is possible to predict closely subsequent concentrations in serum, and dosing regimens for individual patients can be well adjusted to achieve the chosen therapeutic goals.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Baltch A. L., Pressman H. L., Schaffer C., Smith R. P., Hammer M. C., Shayegani M., Michelsen P. Bacteremia in patients undergoing oral procedures. Study following parenteral antimicrobial prophylaxis as recommended by the American Heart Association, 1977. Arch Intern Med. 1988 May;148(5):1084–1088. doi: 10.1001/archinte.148.5.1084. [DOI] [PubMed] [Google Scholar]
  2. Boeckh M., Lode H., Borner K., Höffken G., Wagner J., Koeppe P. Pharmacokinetics and serum bactericidal activity of vancomycin alone and in combination with ceftazidime in healthy volunteers. Antimicrob Agents Chemother. 1988 Jan;32(1):92–95. doi: 10.1128/aac.32.1.92. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Burton M. E., Gentle D. L., Vasko M. R. Evaluation of a Bayesian method for predicting vancomycin dosing. DICP. 1989 Apr;23(4):294–300. doi: 10.1177/106002808902300404. [DOI] [PubMed] [Google Scholar]
  4. Cook F. V., Farrar W. E., Jr Vancomycin revisited. Ann Intern Med. 1978 Jun;88(6):813–818. doi: 10.7326/0003-4819-88-6-813. [DOI] [PubMed] [Google Scholar]
  5. Cunha B. A., Quintiliani R., Deglin J. M., Izard M. W., Nightingale C. H. Pharmacokinetics of vancomycin in anuria. Rev Infect Dis. 1981 Nov-Dec;3 Suppl:S269–S272. [PubMed] [Google Scholar]
  6. D'Argenio D. Z. Optimal sampling times for pharmacokinetic experiments. J Pharmacokinet Biopharm. 1981 Dec;9(6):739–756. doi: 10.1007/BF01070904. [DOI] [PubMed] [Google Scholar]
  7. D'Argenio D. Z., Schumitzky A. A program package for simulation and parameter estimation in pharmacokinetic systems. Comput Programs Biomed. 1979 Mar;9(2):115–134. doi: 10.1016/0010-468x(79)90025-4. [DOI] [PubMed] [Google Scholar]
  8. Drusano G. L., Forrest A., Plaisance K. I., Wade J. C. A prospective evaluation of optimal sampling theory in the determination of the steady-state pharmacokinetics of piperacillin in febrile neutropenic cancer patients. Clin Pharmacol Ther. 1989 Jun;45(6):635–641. doi: 10.1038/clpt.1989.84. [DOI] [PubMed] [Google Scholar]
  9. Drusano G. L., Forrest A., Snyder M. J., Reed M. D., Blumer J. L. An evaluation of optimal sampling strategy and adaptive study design. Clin Pharmacol Ther. 1988 Aug;44(2):232–238. doi: 10.1038/clpt.1988.142. [DOI] [PubMed] [Google Scholar]
  10. Garrelts J. C., Godley P. J., Horton M. W., Karboski J. A. Accuracy of Bayesian, Sawchuk-Zaske, and nomogram dosing methods for vancomycin. Clin Pharm. 1987 Oct;6(10):795–799. [PubMed] [Google Scholar]
  11. Geraci J. E., Wilson W. R. Vancomycin therapy for infective endocarditis. Rev Infect Dis. 1981 Nov-Dec;3 Suppl:S250–S258. [PubMed] [Google Scholar]
  12. Golper T. A., Noonan H. M., Elzinga L., Gilbert D., Brummett R., Anderson J. L., Bennett W. M. Vancomycin pharmacokinetics, renal handling, and nonrenal clearances in normal human subjects. Clin Pharmacol Ther. 1988 May;43(5):565–570. doi: 10.1038/clpt.1988.74. [DOI] [PubMed] [Google Scholar]
  13. Healy D. P., Polk R. E., Garson M. L., Rock D. T., Comstock T. J. Comparison of steady-state pharmacokinetics of two dosage regimens of vancomycin in normal volunteers. Antimicrob Agents Chemother. 1987 Mar;31(3):393–397. doi: 10.1128/aac.31.3.393. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Krogstad D. J., Moellering R. C., Jr, Greenblatt D. J. Single-dose kinetics of intravenous vancomycin. J Clin Pharmacol. 1980 Apr;20(4 Pt 1):197–201. doi: 10.1002/j.1552-4604.1980.tb01696.x. [DOI] [PubMed] [Google Scholar]
  15. Lake K. D., Peterson C. D. Evaluation of a method for initiating vancomycin therapy: experience in 205 patients. Pharmacotherapy. 1988;8(5):284–286. doi: 10.1002/j.1875-9114.1988.tb04084.x. [DOI] [PubMed] [Google Scholar]
  16. Matzke G. R., Kovarik J. M., Rybak M. J., Boike S. C. Evaluation of the vancomycin-clearance:creatinine-clearance relationship for predicting vancomycin dosage. Clin Pharm. 1985 May-Jun;4(3):311–315. [PubMed] [Google Scholar]
  17. Matzke G. R., McGory R. W., Halstenson C. E., Keane W. F. Pharmacokinetics of vancomycin in patients with various degrees of renal function. Antimicrob Agents Chemother. 1984 Apr;25(4):433–437. doi: 10.1128/aac.25.4.433. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Moellering R. C., Jr, Krogstad D. J., Greenblatt D. J. Vancomycin therapy in patients with impaired renal function: a nomogram for dosage. Ann Intern Med. 1981 Mar;94(3):343–346. doi: 10.7326/0003-4819-94-3-343. [DOI] [PubMed] [Google Scholar]
  19. Nielsen H. E., Hansen H. E., Korsager B., Skov P. E. Renal excretion of vancomycinin in kidney disease. Acta Med Scand. 1975 Apr;197(4):261–264. doi: 10.1111/j.0954-6820.1975.tb04914.x. [DOI] [PubMed] [Google Scholar]
  20. Pryka R. D., Rodvold K. A., Garrison M., Rotschafer J. C. Individualizing vancomycin dosage regimens: one- versus two-compartment Bayesian models. Ther Drug Monit. 1989;11(4):450–454. [PubMed] [Google Scholar]
  21. Rodvold K. A., Blum R. A., Fischer J. H., Zokufa H. Z., Rotschafer J. C., Crossley K. B., Riff L. J. Vancomycin pharmacokinetics in patients with various degrees of renal function. Antimicrob Agents Chemother. 1988 Jun;32(6):848–852. doi: 10.1128/aac.32.6.848. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Rodvold K. A., Pryka R. D., Garrison M., Rotschafer J. C. Evaluation of a two-compartment Bayesian forecasting program for predicting vancomycin concentrations. Ther Drug Monit. 1989;11(3):269–275. doi: 10.1097/00007691-198905000-00009. [DOI] [PubMed] [Google Scholar]
  23. Rotschafer J. C., Crossley K., Zaske D. E., Mead K., Sawchuk R. J., Solem L. D. Pharmacokinetics of vancomycin: observations in 28 patients and dosage recommendations. Antimicrob Agents Chemother. 1982 Sep;22(3):391–394. doi: 10.1128/aac.22.3.391. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Sheiner L. B., Beal S. L. Some suggestions for measuring predictive performance. J Pharmacokinet Biopharm. 1981 Aug;9(4):503–512. doi: 10.1007/BF01060893. [DOI] [PubMed] [Google Scholar]
  25. Sheiner L. B., Beal S., Rosenberg B., Marathe V. V. Forecasting individual pharmacokinetics. Clin Pharmacol Ther. 1979 Sep;26(3):294–305. doi: 10.1002/cpt1979263294. [DOI] [PubMed] [Google Scholar]

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