Publications by authors named "Jonathan Faldasz"
Article Synopsis
- - The study assesses the performance of various vancomycin pharmacokinetic (PK) models tailored to different age and BMI groups, aiming to enhance model-informed precision dosing (MIPD) for better drug optimization.
- - Using a large database of 384,876 treatment courses from 155 U.S. health systems, the research evaluates the accuracy of eleven different models, finding that performance varies significantly by age and BMI, with older adults generally having more accurate predictions.
- - The findings indicate that specific models, like the Colin model for younger adults and the Goti/Tong model for older, non-obese adults, outperform others, suggesting a need for tailored approaches in MIPD to achieve optimal vancomycin dosing.
Background And Objective: Infants and neonates present a clinical challenge for dosing drugs with high interindividual variability due to these patients' rapid growth and the interplay between maturation and organ function. Model-informed precision dosing (MIPD), which can account for interindividual variability via patient characteristics and Bayesian forecasting, promises to improve individualized dosing strategies in this complex population. Here, we assess the predictive performance of published population pharmacokinetic models describing vancomycin in neonates and infants, and analyze the robustness of these models in the face of clinical uncertainty surrounding covariate values.
View Article and Find Full Text PDFModel-informed precision dosing (MIPD) leverages pharmacokinetic (PK) models to tailor dosing to an individual patient's needs, improving attainment of therapeutic drug exposure targets and thus potentially improving drug efficacy or reducing adverse events. However, selection of an appropriate model for supporting clinical decision making is not trivial. Error or bias in dose selection may arise if the selected model was developed in a population not fully representative of the intended MIPD population.
View Article and Find Full Text PDFBackground: Gentamicin therapy in neonates is optimized through achieving specific peak and trough concentrations. The objective of this study was to compare the ability a Bayesian clinical decision support system (CDSS) with standard of care (SOC) in determining personalized gentamicin therapies for neonates, at regimen initiation and in response to measured drug concentrations.
Methods: This retrospective review and simulation compared target attainment among 4 arms: historical dosing according to SOC, via nomogram for initial dosing (SOC-initial) and via clinician judgment in response to measured concentrations (SOC-adjusted), and simulated dosing using the CDSS, incorporating a neonatal pharmacokinetic model for initial dosing (CDSS-initial) and incorporating maximum a posteriori-Bayesian analysis in response to measured concentrations (CDSS-adjusted).
Objectives: To compare a Bayesian clinical decision support (CDS) dose-optimizing software program with clinician judgement in individualizing vancomycin dosing regimens to achieve vancomycin pharmacokinetic (PK)/pharmacodynamic (PD) targets in a paediatric population.
Methods: A retrospective review combined with a model-based simulation of vancomycin dosing was performed on children aged 1 year to 18 years at the University of California, San Francisco Benioff Children's Hospital Mission Bay. Dosing regimens recommended by the clinical pharmacists, 'clinician-guided', were compared with alternative 'CDS-guided' dosing regimens.
Objective: Identify drug information (DI) resources used in neonatal practice guidelines in low- and middle-income countries.
Methods: Individuals with knowledge of national neonatal guideline development completed a descriptive, cross-sectional survey.
Key Findings: Eighty-five per cent (33/39) of respondents fully completed the survey.