Rodvold K A, Rotschafer J C, Gilliland S S, Guay D R, Vance-Bryan K
Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago 60612.
Ther Drug Monit. 1994 Feb;16(1):37-41. doi: 10.1097/00007691-199402000-00005.
The application of three non-steady-state sampling strategies and the fitting of either three or five pharmacokinetic parameter estimates by a two-compartment Bayesian forecasting program was evaluated retrospectively in 27 adult patients with stable renal function. Sampling strategies included a single midpoint concentration, a set of peak and trough concentrations, and three serial vancomycin concentrations. The most precise and least-bias predictions of steady-state peak vancomycin concentrations were observed by using population-based parameter estimates [mean prediction error (ME) = -0.40 and mean absolute error = 5.77]. The addition of non-steady-state feedback concentration(s) did not provide additional information for predictions of future steady-state peak concentrations. The least-bias prediction of steady-state trough vancomycin concentrations was seen when a single midpoint non-steady-state concentration was used (ME = 0.92 and -0.17 for five and three fitted parameter estimates, respectively). The MEs of serial and peak and trough feedback strategies were similar in magnitude to those obtained using population parameters, but in opposite directions (underprediction vs. overprediction, respectively). The fitting of only three parameters produced results similar to those using five parameters. The results from this study confirm our previous evaluation that non-steady-state concentrations provide very minimal information to Bayesian forecasting of future steady-state concentrations.
对27例肾功能稳定的成年患者进行了回顾性评估，应用了三种非稳态采样策略，并通过二室贝叶斯预测程序对三个或五个药代动力学参数估计值进行拟合。采样策略包括单个中点浓度、一组峰浓度和谷浓度，以及三个连续的万古霉素浓度。通过使用基于群体的参数估计值，观察到对稳态万古霉素峰浓度的预测最为精确且偏差最小[平均预测误差(ME)= -0.40，平均绝对误差= 5.77]。添加非稳态反馈浓度并未为预测未来稳态峰浓度提供额外信息。当使用单个中点非稳态浓度时，观察到对稳态万古霉素谷浓度的偏差最小预测(对于五个和三个拟合参数估计值，ME分别为0.92和-0.17)。连续采样以及峰浓度和谷浓度反馈策略的平均预测误差在大小上与使用群体参数获得的误差相似，但方向相反(分别为预测不足与预测过度)。仅拟合三个参数产生的结果与使用五个参数的结果相似。本研究结果证实了我们之前的评估，即非稳态浓度为未来稳态浓度的贝叶斯预测提供的信息非常少。
