HIỆU CHỈNH LIỀU VANCOMYCIN THÔNG QUA GIÁM SÁT NỒNG ĐỘ THUỐC VỚI ĐÍCH AUC DỰA TRÊN ƯỚC ĐOÁN BAYESIAN Ở BỆNH NHÂN HỒI SỨC THẦN KINH: KẾT QUẢ BƯỚC ĐẦU TẠI BỆNH VIỆN HỮU NGHỊ VIỆT ĐỨC

Abstract

Objective: To analyze the impact of therapeutic drug monitoring (TDM) protocol by the area under the concentration-time curve (AUC) Bayesian estimation in optimizing vancomycin dose regimen for neurosurgery patients. Subjects and methods: In a prospective study on 62 patients using vancomycin, data were collected daily through clinical practices of clinical pharmacists, doctors, and nurses at the Department of Neurology and Neuro Intensive Care, Viet Duc University Hospital, from March to December 2022. AUC was estimated based on vancomycin level and patient characteristics in the SmartDose AI software with the Bayesian method. Vancomycin dosage was adjusted to achieve the AUC target range 400 - 600 mg.h/L. Results: The percentage of patients receiving appropriate dose regimens is relatively high (65.8%), but only 25.8% of patients achieved a therapeutic range. After adjusting dose regimens, the rate of target PK/PD attainment increased to 61.3%. While the priori AUC-estimation performance with the population pharmacokinetics model was low (42.7% bias), the posteriori AUC-estimation performance improved significantly (6% bias) with the vancomycin concentrations included. Conclusion: Vancomycin dose optimization using TDM increased the probability of AUC target attainment in neurological patients in the Department of Neurology and Neuro Intensive Care. The estimated AUC by Bayesian method was relatively accurate and convenient for clinical practice. Further pharmacokinetic studies are needed to optimize the maintenance dose to achieve the vancomycin target concentration early.