Department of Pharmacy, Radboud University Medical Centre and Radboud Institute for Health Sciences, Nijmegen, the Netherlands.
Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; Pharmacy Department, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
Clin Microbiol Infect. 2022 Sep;28(9):1211-1224. doi: 10.1016/j.cmi.2022.03.041. Epub 2022 Apr 14.
Precision dosing programs are promising tools for optimising antimicrobial dosing. Selecting the ideal program for local application may be challenging due to the large variety of available programs with differing characteristics.
The objectives of this study were to systematically identify available precision dosing software programs to optimize antimicrobial dosing and describe the characteristics of each program. Details on the ability of programs to provide beta-lactam dosing support was also gathered.
A systematic review search strategy was used to identify candidate software programs described in the literature in Embase and PubMed. A detailed survey was then developed to identify characteristics of programs, including details on the underlying methodology driving dosing software recommendations, interface characteristics, costs and regulatory affairs. Software developers from all identified programs were invited to participate in the survey.
The systematic search results identified 18 programs. Fifteen developers responded to the survey (83%) and 11 programs provide dosing support for at least one beta-lactam. Fourteen programs can utilize measured drug concentrations to generate dosing recommendations, with 13 able to generate empiric dosing recommendations. Six programs integrate with local electronic health records and four are registered with at least one regulatory agency. Pharmacokinetic models in combination with Bayesian statistics is the most common methodology used to generate dosing recommendations, with 14 programs utilizing this method.
There was significant variability in the available antimicrobial profiles and characteristics among dosing software programs. As healthcare providers will differ in their requirements within their local settings, clinicians should use these findings to identify potential candidate programs and, if feasible, trial these to ensure they meet their specific requirements.
精准剂量方案是优化抗菌药物剂量的有前途的工具。由于可用方案种类繁多，具有不同的特点，因此选择适合本地应用的理想方案可能具有挑战性。
本研究旨在系统地确定可用的精准剂量软件程序，以优化抗菌药物剂量，并描述每个程序的特点。还收集了有关程序提供β-内酰胺剂量支持能力的详细信息。
使用系统评价搜索策略在 Embase 和 PubMed 中识别文献中描述的候选软件程序。然后开发了详细的调查来确定程序的特征，包括程序驱动剂量软件建议的基本方法、界面特征、成本和监管事务的详细信息。邀请所有确定的程序的软件开发商参与调查。
系统搜索结果确定了 18 个程序。15 位开发者对调查做出了回应（83%），其中 11 个程序至少为一种β-内酰胺提供剂量支持。14 个程序可以利用测量的药物浓度来生成剂量建议，其中 13 个能够生成经验性剂量建议。6 个程序与本地电子健康记录集成，4 个程序至少在一个监管机构注册。药代动力学模型结合贝叶斯统计是生成剂量建议最常用的方法，有 14 个程序使用这种方法。
可用的抗菌药物特征和剂量软件程序之间存在显著的差异。由于医疗保健提供者在其本地环境中的需求会有所不同，因此临床医生应利用这些发现来确定潜在的候选程序，如果可行，试用这些程序以确保它们符合其特定需求。
