Improving Drug Dosing in Hospitalized Patients: Automated Modeling of Pharmacokinetics for Individualization of Drug Dosage Regimens

摘要

Many clinically useful drugs have a narrow range of blood concentrations which are both safe and efficacious. Inter-individual and intra-individual variation in drug disposition are important factors causing blood concentrations of drug to fall outside of the therapeutic range. Modeling of the pharmacokinetics of the individual offers an effective approach to this problem. Previous approaches for the modeling of individual pharmacokinetics have required either extensive computations or access to computer software and hardware in the clinical environment, and special expertise to interpret the results. As part of the MENTOR therapeutic monitoring system, we have developed software which can, in an automated fashion, monitor drug dosing and recommend changes which may be needed to obtain blood concentrations in the therapeutic range. The software can also detect changes in drug disposition in particular patients which will lead to concentrations outside of the therapeutic range, identify potentially erroneous drug concentration measurements, and assess the need for further measurements. The recommendations of the program are delivered to physicians in a timely fashion through issuance of MENTOR advisories. A prototype version of this program has been implemented for aminoglycoside antibiotics. Expansion to other drugs is planned.