Therapeutic drug monitoring for everolimus in kidney transplantation using 12-month exposure, efficacy, and safety data

Daptomycin is a candidate for therapeutic drug monitoring (TDM). The objectives of this work were to implement and compare two pharmacometric tools for daptomycin TDM and precision dosing. A nonparametric population PK model developed from patients with bone and joint infection was implemented into the BestDose software. A published parametric model was imported into Tucuxi. We compared the performance of the two models in a validation dataset based on mean error (ME) and mean absolute percent error (MAPE) of individual predictions, estimated exposure and predicted doses necessary to achieve daptomycin efficacy and safety PK/PD targets. The BestDose model described the data very well in the learning dataset. In the validation dataset (94 patients, 264 concentrations), 21.3% of patients were underexposed (AUC24h < 666 mg.h/L) and 31.9% of patients were overexposed (Cmin > 24.3 mg/L) on the first TDM occasion. The BestDose model performed slightly better than the model in Tucuxi (ME = −0.13 ± 5.16 vs. −1.90 ± 6.99 mg/L, p < 0.001), but overall results were in agreement between the two models. A significant proportion of patients exhibited underexposure or overexposure to daptomycin after the initial dosage, which supports TDM. The two models may be useful for model-informed precision dosing.

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The Scottish model of vancomycin dosing and therapeutic drug monitoring improves both efficacy and safety of vancomycin therapy

Vnitřní lékařství ◽

10.36290/vnl.2018.098 ◽

2018 ◽

Vol 64 (7-8) ◽

pp. 717-724

Author(s):

Kristýna Zahálková ◽

Aleš Chrdle ◽

Olga Dvořáčková ◽

Marie Kašparová ◽

Magdalena Horníková ◽

...

Keyword(s):

Therapeutic Drug Monitoring ◽

Drug Monitoring ◽

Therapeutic Drug ◽

Efficacy And Safety ◽

Vancomycin Therapy

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A Moving Target—Vancomycin Therapeutic Monitoring

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piaa078 ◽

2020 ◽

Vol 9 (4) ◽

pp. 474-478

Author(s):

Alaina N Burns ◽

Jennifer L Goldman

Keyword(s):

Clinical Practice ◽

Therapeutic Drug Monitoring ◽

Drug Monitoring ◽

Clinical Care ◽

Area Under The Curve ◽

Therapeutic Monitoring ◽

Therapeutic Drug ◽

Moving Target ◽

Efficacy And Safety ◽

Vancomycin Trough

Abstract Therapeutic drug monitoring (TDM) has been a common practice to optimize efficacy and safety of vancomycin. While vancomycin trough-only TDM has widely been integrated into pediatric clinical practice since 2009, recently updated vancomycin TDM guidelines published in March 2020 recommend area under the curve (AUC) based TDM for vancomycin instead of trough-only TDM. In this review, we discuss the rationale behind the change in TDM recommendations, describe two approaches for calculating vancomycin AUC in clinical practice, and address considerations for integrating vancomycin AUC TDM into pediatric clinical practice. Our primary goal is to provide pediatric clinicians with a resource for implementing vancomycin AUC monitoring into clinical care.

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