4 种免费在线剂量计算器预测 2 点药代动力学法计算的万古霉素浓度-时间曲线下面积的准确性。

Accuracy of 4 Free Online Dosing Calculators in Predicting the Vancomycin Area Under the Concentration-Time Curve Calculated Using a 2-Point Pharmacokinetic Approach.

机构信息

Children's National Hospital, Washington, DC, USA.

State University of New York Upstate University Hospital, Syracuse, NY, USA.

出版信息

Ann Pharmacother. 2023 Apr;57(4):432-440. doi: 10.1177/10600280221117256. Epub 2022 Aug 18.

DOI:10.1177/10600280221117256

PMID:35979912

Abstract

BACKGROUND

Free online adaptive vancomycin dosing calculators are available to estimate area under the concentration-time curve (AUC), but the accuracy of predicting vancomycin AUC using these calculators compared with using a 2-point pharmacokinetic approach has not been described.

OBJECTIVE

To evaluate the accuracy of calculator-predicted AUC (cpAUC) using 4 free online calculators compared with reference AUC (rAUC), and to assess pharmacists' impressions of the ease of use.

METHODS

Vancomycin AUC was estimated using (1) the reference method via the Sawchuk-Zaske method and linear-logarithmic trapezoidal rule using 2 steady-state postdistributional vancomycin serum concentrations and (2) 4 free online vancomycin dosing calculators including ClinCalc, VancoPK, TDMx, and DMC. Accuracy was calculated by dividing cpAUC by rAUC. Ease of cpAUC estimation was determined by using a 10-point Likert scale.

RESULTS

All 4 calculators had a median cpAUC accuracy ranging from 89% to 110%. Concordance between cpAUC and rAUC determinations of AUC <400 and > 600 mg·h/L occurred 63.3% to 71.4% and 74.5% to 78.6% of the time, respectively. Pharmacist investigators agreed that ClinCalc and VancoPK calculators were easiest to use.

CONCLUSION AND RELEVANCE

cpAUC accuracy varied among the 4 calculators, but all consistently identified patients with an rAUC <400 mg·h/L and an rAUC > 600 mg·h/L at comparable frequencies. All 4 calculators demonstrated some imprecision based on their wide 95% CIs and potential inaccuracies in predicting an rAUC <400 mg·h/L or an rAUC > 600 mg·h/L. Clin Calc and VancoPK were most user friendly based on our pharmacists' impressions.

摘要

背景

目前有许多免费的在线万古霉素剂量计算工具可用于估算药时曲线下面积（AUC），但尚未对这些计算工具预测万古霉素 AUC 的准确性与 2 点药动学方法进行比较。

目的

评估 4 种免费在线计算器预测 AUC（cpAUC）与参考 AUC（rAUC）的准确性，并评估药师对其易用性的印象。

方法

使用 2 种稳态分布后万古霉素血清浓度的 Sawchuk-Zaske 法和线性对数梯形法则（1）通过参考方法估算 AUC，并通过 4 种免费在线万古霉素剂量计算工具包括 ClinCalc、VancoPK、TDMx 和 DMC 估算 AUC（2）。通过将 cpAUC 除以 rAUC 计算准确性。使用 10 分李克特量表确定 cpAUC 估算的难易程度。

结果

所有 4 种计算器的 cpAUC 准确性中位数范围为 89%至 110%。cpAUC 与 AUC<400 和 >600 mg·h/L 的 rAUC 测定的一致性分别为 63.3%至 71.4%和 74.5%至 78.6%。药师调查员认为 ClinCalc 和 VancoPK 计算器最容易使用。

结论和相关性

4 种计算器的 cpAUC 准确性存在差异，但所有计算器均以可比的频率一致地识别出 rAUC<400 mg·h/L 和 rAUC>600 mg·h/L 的患者。所有 4 种计算器均显示出一定的不准确性，其 95%CI 较宽，并且在预测 rAUC<400 mg·h/L 或 rAUC>600 mg·h/L 时可能不准确。根据我们药师的印象，ClinCalc 和 VancoPK 是最方便用户使用的。