Abstract：
The 2020 consensus guidelines for vancomycin therapeutic monitoring recommend using Bayesian estimation targeting the ratio of the area under the curve over 24 hours to minimum inhibitory concentration as an optimal approach to individualize therapy in pediatric patients. To support institutional guideline implementation in children, the objective of this study was to comprehensively assess and compare published population-based pharmacokinetic (PK) vancomycin models and available Bayesian estimation tools, specific to neonatal and pediatric patients.
PubMed and Embase databases were searched from January 1994 to December 2020 for studies in which a vancomycin population PK model was developed to determine clearance and volume of distribution in neonatal and pediatric populations. Available Bayesian software programs were identified and assessed from published articles, software program websites, and direct communication with the software company. In the present review, 14 neonatal and 20 pediatric models were included. Six programs (Adult and Pediatric Kinetics, BestDose, DoseMeRx, InsightRx, MwPharm++, and PrecisePK) were evaluated.
Among neonatal models, Frymoyer et al and Capparelli et al used the largest PK samples to generate their models, which were externally validated. Among the pediatric models, Le et al used the largest sample size, with multiple external validations. Of the Bayesian programs, DoseMeRx, InsightRx, and PrecisePK used clinically validated neonatal and pediatric models.
To optimize vancomycin use in neonatal and pediatric patients, clinicians should focus on selecting a model that best fits their patient population and use Bayesian estimation tools for therapeutic area under the -curve-targeted dosing and monitoring.
PubMed and Embase databases were searched from January 1994 to December 2020 for studies in which a vancomycin population PK model was developed to determine clearance and volume of distribution in neonatal and pediatric populations. Available Bayesian software programs were identified and assessed from published articles, software program websites, and direct communication with the software company. In the present review, 14 neonatal and 20 pediatric models were included. Six programs (Adult and Pediatric Kinetics, BestDose, DoseMeRx, InsightRx, MwPharm++, and PrecisePK) were evaluated.
Among neonatal models, Frymoyer et al and Capparelli et al used the largest PK samples to generate their models, which were externally validated. Among the pediatric models, Le et al used the largest sample size, with multiple external validations. Of the Bayesian programs, DoseMeRx, InsightRx, and PrecisePK used clinically validated neonatal and pediatric models.
To optimize vancomycin use in neonatal and pediatric patients, clinicians should focus on selecting a model that best fits their patient population and use Bayesian estimation tools for therapeutic area under the -curve-targeted dosing and monitoring.
摘要：
目的：2020年万古霉素治疗监测共识指南建议使用贝叶斯估计，目标是24小时内曲线下面积（AUC）与最小抑制浓度的比率，作为个体化治疗的最佳方法在儿科患者中。为了支持在儿童中实施机构指南，这项研究的目的是全面评估和比较已发表的基于人群的药代动力学（PK）万古霉素模型和可用的贝叶斯估计工具，特定于新生儿和儿科患者。
方法：从1994年1月至2020年12月，在PubMed和Embase数据库中搜索研究，其中开发了万古霉素人群PK模型以确定新生儿和儿科人群的清除率和分布量。从已发表的文章中确定和评估了可用的贝叶斯软件程序，软件程序网站，并与软件公司直接沟通。在本次审查中，包括14个新生儿模型和20个儿科模型。六个项目(成人和儿科动力学，最佳剂量,DoseMeRx,InsightRx,MwPharm++,和PrecisePK)进行了评估。
结果：在新生儿模型中，Frymoyer等人。和Capparelli等人。使用最大的PK样本来生成他们的模型，经过外部验证。在儿科模型中，Leetal.采用了最大的样本量，具有多个外部验证。在贝叶斯程序中，DoseMeRx,InsightRx,和PrecisePK使用临床验证的新生儿和儿科模型。
结论：为了优化万古霉素在新生儿和儿科患者中的使用，临床医生应重点选择最适合患者人群的模型,并利用贝叶斯估计工具进行治疗性AUC靶向给药和监测.
方法：从1994年1月至2020年12月，在PubMed和Embase数据库中搜索研究，其中开发了万古霉素人群PK模型以确定新生儿和儿科人群的清除率和分布量。从已发表的文章中确定和评估了可用的贝叶斯软件程序，软件程序网站，并与软件公司直接沟通。在本次审查中，包括14个新生儿模型和20个儿科模型。六个项目(成人和儿科动力学，最佳剂量,DoseMeRx,InsightRx,MwPharm++,和PrecisePK)进行了评估。
结果：在新生儿模型中，Frymoyer等人。和Capparelli等人。使用最大的PK样本来生成他们的模型，经过外部验证。在儿科模型中，Leetal.采用了最大的样本量，具有多个外部验证。在贝叶斯程序中，DoseMeRx,InsightRx,和PrecisePK使用临床验证的新生儿和儿科模型。
结论：为了优化万古霉素在新生儿和儿科患者中的使用，临床医生应重点选择最适合患者人群的模型,并利用贝叶斯估计工具进行治疗性AUC靶向给药和监测.
