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ADJUSTING VANCOMYCIN DOSAGE THROUGH MONITORING DRUG CONCENTRATION WITH AUC TARGET BASED ON BAYESIAN ESTIMATION IN SURGICAL INTENSIVE CARE PATIENTS, VIET DUC HOSPITAL
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Abstract
Objective: To analyze the results of implementing vancomycin dose adjustment based on the estimated AUC value by Bayes method according to the vancomycin TDM procedure applied on surgical ICU patients. Method: Prospective study, through the cooperation between clinical pharmacists, ICU doctors and nurses at the Intensive Care Unit 2, Anesthesia and Surgical Intensive Care Center, Viet Duc Hospital from December 2021 to June 2022. Patient information and related parameters are collected daily. Based on the results of the vancomycin concentration in the patient's blood, the AUC value was estimated by Bayesian method on SmartdoseAI software. The vancomycin dose was adjusted to achieve the target AUC 400-600 mg. h/L. Results: When using the recommended regimen with initial maintenance dose (60.3%), only 36.9% of patients had AUC values in the range of 400-600 mg.h/L. After the dose adjustment, the percentage of patients reaching the PK/PD target increased to 62.5%. The ability to estimate AUC values using the initial pharmacokinetic model was relatively low (43.48% deviation) but was significantly improved when Bayesian estimates were applied based on drug concentration data in blood (deviation 7.5%). Conclusions: Using vancomycin TDM has improved the likelihood of achieving AUC target. The Bayesian method has the ability to estimate the AUC value relatively accurately, bringing many conveniences and this is suitable for clinical practice on surgically ICU patients.
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Keywords
AUC, Bayesian, Viet Duc Hospital, intensive care, TDM, vancomycin
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