@misc{10818/59036,
year = {2023},
month = {8},
url = {http://hdl.handle.net/10818/59036},
abstract = {In individualized therapy, the Bayesian approach integrated with population pharmacokinetic
models (PopPK) for predictions together with therapeutic drug monitoring (TDM) to maintain
adequate objectives is useful to maximize the efficacy and minimize the probability of toxicity of vancomycin
in critically ill patients. Although there are limitations to implementation, model-informed
precision dosing (MIPD) is an approach to integrate these elements, which has the potential to
optimize the TDM process and maximize the success of antibacterial therapy. The objective of this
work was to present an app for individualized therapy and perform a validation of the implemented
vancomycin PopPK models. A pragmatic approach was used for selecting the models of Llopis, Goti
and Revilla for developing a Shiny app with R. Through ordinary differential equation (ODE)-based
mixed effects models from the mlxR package, the app simulates the concentrations’ behavior, estimates
whether the model was simulated without variability and predicts whether the model was
simulated with variability. Moreover, we evaluated the predictive performance with retrospective
trough concentration data from patients admitted to the adult critical care unit. Although there were
no significant differences in the performance of the estimates, the Llopis model showed better accuracy
(mean 80.88%; SD 46.5%); however, it had greater bias (mean 􀀀34.47%, SD 63.38%) compared to
the Revilla et al. (mean 10.61%, SD 66.37%) and Goti et al. (mean of 13.54%, SD 64.93%) models. With
respect to the RMSE (root mean square error), the Llopis (mean of 10.69 mg/L, SD 12.23 mg/L) and
Revilla models (mean of 10.65 mg/L, SD 12.81 mg/L) were comparable, and the lowest RMSE was
found in the Goti model (mean 9.06 mg/L, SD 9 mg/L). Regarding the predictions, this behavior did
not change, and the results varied relatively little. Although our results are satisfactory, the predictive
performance in recent studies with vancomycin is heterogeneous, and although these three models
have proven to be useful for clinical application, further research and adaptation of PopPK models is
required, as well as implementation in the clinical practice of MIPD and TDM in real time.},
publisher = {Universidad de La Sabana},
title = {Implementing Vancomycin Population Pharmacokinetic Models: An App for Individualized Antibiotic Therapy in Critically Ill Patients},
doi = {10.3390/antibiotics12020301},
author = {Mena, Manuel and Garcia, Julio Cesar and Bustos, Rosa Helena},
}