A recent study by University Hospitals of Leicester NHS Trust, published in the British Journal of Pharmacology (BJCP), found DoseMeRx (a bed-side Bayesian dosing software) increased the number of vancomycin patients achieving two clinically important targets – Area Under the Curve (AUC24) and Time in Target Therapeutic Range (TTR). They also found significantly fewer missed vancomycin doses in the DoseMeRx group – an important consideration for patients who are receiving vancomycin for serious infections.
A preliminary version of the 2019 draft of the 2020 vancomycin dosing guidelines, which recommended a to shift from trough-based dosing to area under the curve (AUC) based dosing formed the basis for the study.
The observational cohort study evaluated the benefit of using DoseMeRx (Bayesian-guided dosing) in all patients admitted to the University Hospitals of Leicester vascular surgery unit prescribed intravenous (IV) vancomycin over a nine-month period. The researchers compared key clinical therapeutic targets between the Bayesian-guided vancomycin dosing in the DoseMeRx group and a retrospective control group of patients admitted to the same vascular surgery unit treated with vancomycin IV.
The researchers found:
- A significantly higher proportion of patients achieved mean AUC24 values in the acceptable range
- Less interpatient variability and better control of target AUC24 values in the DoseMeRx cohort
- Improvement in median %TTR (AUC24 350-450 mg/L*h) in the DoseMeRx group
- DoseMeRx reduced the burden of blood sampling and allowed for much more flexible sampling times, as vancomycin concentrations were measured at the same time as the patient’s routine blood tests
- DoseMeRx was easy to implement and use in the clinical setting with appropriate training and pharmacy support
“This study further highlights how DoseMeRx improves the care of vancomycin patients, aligning with the recent 2020 vancomycin dosing guidelines recommendations,” stated Kristi Kuper, PharmD, BCPS, Director of Clinical Pharmacy for DoseMeRx.
“Using DoseMeRx accomplishes one of the main goals of dosing antibiotics such as vancomycin in infectious diseases, which is to achieve a therapeutic dose as quickly and safely as possible.”
One of the other benefits highlighted in the study is a reduction in missed vancomycin doses, where the difference was quite substantial. Kuper emphasized, “As the authors highlight, there were less doses missed in the DoseMeRx group partially because the software is able to utilize a blood concentration level drawn at almost anytime during the dosing interval. This allows clinicians to continue therapy as scheduled, without having to wait until a specific time to draw an interpretable vancomycin level. It also lessens the risk missing a dose of vancomycin, which could lead to therapeutic failure.”
Further details on the study methodology and results can be found in the published paper.
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