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Del Valle-Moreno P, Suarez-Casillas P, Mejías-Trueba M, Ciudad-Gutiérrez P, Guisado-Gil AB, Gil-Navarro MV, Herrera-Hidalgo L. Model-Informed Precision Dosing Software Tools for Dosage Regimen Individualization: A Scoping Review. Pharmaceutics 2023; 15:1859. [PMID: 37514045 PMCID: PMC10386689 DOI: 10.3390/pharmaceutics15071859] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Pharmacokinetic nomograms, equations, and software are considered the main tools available for Therapeutic Drug Monitoring (TDM). Model-informed precision dosing (MIPD) is an advanced discipline of TDM that allows dose individualization, and requires a software for knowledge integration and statistical calculations. Due to its precision and extensive applicability, the use of these software is widespread in clinical practice. However, the currently available evidence on these tools remains scarce. OBJECTIVES To review and summarize the available evidence on MIPD software tools to facilitate its identification, evaluation, and selection by users. METHODS An electronic literature search was conducted in MEDLINE, EMBASE, OpenAIRE, and BASE before July 2022. The PRISMA-ScR was applied. The main inclusion criteria were studies focused on developing software for use in clinical practice, research, or modelling. RESULTS Twenty-eight software were classified as MIPD software. Ten are currently unavailable. The remaining 18 software were described in depth. It is noteworthy that all MIPD software used Bayesian statistical methods to estimate drug exposure and all provided a population model by default, except NONMEN. CONCLUSIONS Pharmacokinetic software have become relevant tools for TDM. MIPD software have been compared, facilitating its selection for use in clinical practice. However, it would be interesting to standardize the quality and validate the software tools.
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Affiliation(s)
- Paula Del Valle-Moreno
- Department of Pharmacy, University Hospital Virgen del Rocío, 41013 Seville, Spain; (P.D.V.-M.); (P.S.-C.); (P.C.-G.); (A.B.G.-G.); (M.V.G.-N.); (L.H.-H.)
| | - Paloma Suarez-Casillas
- Department of Pharmacy, University Hospital Virgen del Rocío, 41013 Seville, Spain; (P.D.V.-M.); (P.S.-C.); (P.C.-G.); (A.B.G.-G.); (M.V.G.-N.); (L.H.-H.)
| | - Marta Mejías-Trueba
- Department of Pharmacy, University Hospital Virgen del Rocío, 41013 Seville, Spain; (P.D.V.-M.); (P.S.-C.); (P.C.-G.); (A.B.G.-G.); (M.V.G.-N.); (L.H.-H.)
- Department of Infectious Diseases, Microbiology and Parasitology, Infectious Diseases Research Group, Institute of Biomedicine of Seville, University of Seville/Spanish National Research Council/University Hospital Virgen del Rocio, 41013 Seville, Spain
| | - Pablo Ciudad-Gutiérrez
- Department of Pharmacy, University Hospital Virgen del Rocío, 41013 Seville, Spain; (P.D.V.-M.); (P.S.-C.); (P.C.-G.); (A.B.G.-G.); (M.V.G.-N.); (L.H.-H.)
| | - Ana Belén Guisado-Gil
- Department of Pharmacy, University Hospital Virgen del Rocío, 41013 Seville, Spain; (P.D.V.-M.); (P.S.-C.); (P.C.-G.); (A.B.G.-G.); (M.V.G.-N.); (L.H.-H.)
- Department of Infectious Diseases, Microbiology and Parasitology, Infectious Diseases Research Group, Institute of Biomedicine of Seville, University of Seville/Spanish National Research Council/University Hospital Virgen del Rocio, 41013 Seville, Spain
- Centre for Biomedical Research Network on Infectious Diseases, 28029 Madrid, Spain
| | - María Victoria Gil-Navarro
- Department of Pharmacy, University Hospital Virgen del Rocío, 41013 Seville, Spain; (P.D.V.-M.); (P.S.-C.); (P.C.-G.); (A.B.G.-G.); (M.V.G.-N.); (L.H.-H.)
- Department of Infectious Diseases, Microbiology and Parasitology, Infectious Diseases Research Group, Institute of Biomedicine of Seville, University of Seville/Spanish National Research Council/University Hospital Virgen del Rocio, 41013 Seville, Spain
- Centre for Biomedical Research Network on Infectious Diseases, 28029 Madrid, Spain
| | - Laura Herrera-Hidalgo
- Department of Pharmacy, University Hospital Virgen del Rocío, 41013 Seville, Spain; (P.D.V.-M.); (P.S.-C.); (P.C.-G.); (A.B.G.-G.); (M.V.G.-N.); (L.H.-H.)
- Department of Infectious Diseases, Microbiology and Parasitology, Infectious Diseases Research Group, Institute of Biomedicine of Seville, University of Seville/Spanish National Research Council/University Hospital Virgen del Rocio, 41013 Seville, Spain
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Fonseca Medeiros A, Margotto Bertollo C, Moreira Reis AM, Costa MA, Meireles Leite EM, da Silva Gonçalves S, Nogueira Guimarães de Abreu MH, Pedra de Souza R, Parreiras Martins MA. Building an antimicrobial stewardship program: A narrative of six years under the Donabedian perspective. Front Pharmacol 2023; 14:1074389. [PMID: 37025495 PMCID: PMC10070795 DOI: 10.3389/fphar.2023.1074389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/28/2023] [Indexed: 04/08/2023] Open
Abstract
Introduction: Antimicrobial resistance (AMR) is increasing and represents one of the world's major challenges. AMR increase morbimortality, length of hospital stay and costs. Antimicrobial Stewardship Programs (ASP) are one of the key strategies to promote the rational use of antimicrobials since AMR is mostly driven by antimicrobial consumption. Objective: To describe the ASP implementation in a teaching hospital from the perspective of Donabedian quality assessment and the Brazilian regulatory requirements. Method: This was a descriptive study with secondary data collection, including document review of the ASP. The study setting was a general public 392-bed hospital. The ASP activities were performed by the hospital infection control committee (HICC), hospital pharmacy (HP) and diagnostic support laboratory (DSL). The description of the three services mainly involved in the ASP was based on a quality assessment model involving the dimensions of "structure", "process" and "result" proposed by Donabedian. The distribution among dimensions was guided by the checklist of essential elements of the ASP that compose the Brazilian regulatory requirements. The checklist was applied in July, 2022, and the ASP results described from 2016 to 2021. Results: ASP actions have been gradually implemented since 2008 with the implementation of HICC and improved over the years. Regarding structure, the investments in technology were mapped, quantifying 26 computers and three software programs employed to computerize the ASP processes performed in specific physical areas by HICC, HP and DSL. Institutional guidelines used by HICC, HP and DSL guided clinical practices to operationalize ASP. The evaluation metrics improved for 10 indicators and worsened for four indicators. From the 60 items composing the checklist, the hospital met the requirements in 73.3% of the items (n = 44). Conclusion: This study described the implementation of ASP in a teaching hospital, applying the Donabedian perspective. Although the hospital still does not have a classic ASP model, there were investments to improve structure, processes and results, aiming to comply with international guidelines. A high proportion of key elements of ASP in the hospital were followed according to the Brazilian regulatory requirements. Aspects related to antimicrobial consumption and the emergence of microbial resistance deserve further investigations.
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Affiliation(s)
- Amanda Fonseca Medeiros
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Hospital Risoleta Tolentino Neves, Rua das Gabirobas, Belo Horizonte, Minas Gerais, Brazil
| | - Caryne Margotto Bertollo
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Adriano Max Moreira Reis
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Monica Aparecida Costa
- Hospital Risoleta Tolentino Neves, Rua das Gabirobas, Belo Horizonte, Minas Gerais, Brazil
| | | | | | | | - Renan Pedra de Souza
- Departamento de Genética, Ecologia e Evolução, Instituto de Ciências Biológicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Maria Auxiliadora Parreiras Martins
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Hospital Risoleta Tolentino Neves, Rua das Gabirobas, Belo Horizonte, Minas Gerais, Brazil
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- *Correspondence: Maria Auxiliadora Parreiras Martins,
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Pseudomonas aeruginosa Susceptibility in Spain: Antimicrobial Activity and Resistance Suppression Evaluation by PK/PD Analysis. Pharmaceutics 2021; 13:pharmaceutics13111899. [PMID: 34834314 PMCID: PMC8620410 DOI: 10.3390/pharmaceutics13111899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/29/2021] [Accepted: 11/04/2021] [Indexed: 11/16/2022] Open
Abstract
Pseudomonas aeruginosa remains one of the major causes of healthcare-associated infection in Europe; in 2019, 12.5% of invasive isolates of P. aeruginosa in Spain presented combined resistance to ≥3 antimicrobial groups. The Spanish nationwide survey on P. aeruginosa antimicrobial resistance mechanisms and molecular epidemiology was published in 2019. Based on the information from this survey, the objective of this work was to analyze the overall antimicrobial activity of the antipseudomonal antibiotics considering pharmacokinetic/pharmacodynamic (PK/PD) analysis. The role of PK/PD to prevent or minimize resistance emergence was also evaluated. A 10,000-subject Monte Carlo simulation was executed to calculate the probability of target attainment (PTA) and the cumulative fraction of response (CFR) considering the minimum inhibitory concentration (MIC) distribution of bacteria isolated in ICU or medical wards, and distinguishing between sample types (respiratory and non-respiratory). Ceftazidime/avibactam followed by ceftolozane/tazobactam and colistin, categorized as the Reserve by the Access, Watch, Reserve (AWaRe) classification of the World Health Organization, were the most active antimicrobials, with differences depending on the admission service, sample type, and dose regimen. Discrepancies between EUCAST-susceptibility breakpoints for P. aeruginosa and those estimated by PK/PD analysis were detected. Only standard doses of ceftazidime/avibactam and ceftolozane/tazobactam provided drug concentrations associated with resistance suppression.
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Tabarsi P, Jamaati H, Yousefian S, Marjani M, Moniri A, Langari ZM, Haghgoo R, Eskandari R, Toutkaboni MP, Dastan F. Impact of clinical pharmacist‐led antibiotic stewardship program on clinical outcomes in a tertiary referral hospital. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2021. [DOI: 10.1002/jppr.1731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Payam Tabarsi
- Clinical Tuberculosis and Epidemiology Research Center National Research Institute of Tuberculosis and Lung Diseases (NIRTLD) Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Hamidreza Jamaati
- Chronic Respiratory Diseases Research Center National Research Institute of Tuberculosis and Lung Diseases (NRITLD) Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Sahar Yousefian
- Chronic Respiratory Diseases Research Center National Research Institute of Tuberculosis and Lung Diseases (NRITLD) Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Majid Marjani
- Clinical Tuberculosis and Epidemiology Research Center National Research Institute of Tuberculosis and Lung Diseases (NIRTLD) Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Afshin Moniri
- Clinical Tuberculosis and Epidemiology Research Center National Research Institute of Tuberculosis and Lung Diseases (NIRTLD) Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Zahra Mirshafiei Langari
- Chronic Respiratory Diseases Research Center National Research Institute of Tuberculosis and Lung Diseases (NRITLD) Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Roodabeh Haghgoo
- Chronic Respiratory Diseases Research Center National Research Institute of Tuberculosis and Lung Diseases (NRITLD) Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Raha Eskandari
- Chronic Respiratory Diseases Research Center National Research Institute of Tuberculosis and Lung Diseases (NRITLD) Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Mihan Pourabdollah Toutkaboni
- Chronic Respiratory Diseases Research Center National Research Institute of Tuberculosis and Lung Diseases (NRITLD) Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Farzaneh Dastan
- Chronic Respiratory Diseases Research Center National Research Institute of Tuberculosis and Lung Diseases (NRITLD) Shahid Beheshti University of Medical Sciences Tehran Iran
- Department of Clinical Pharmacy School of Pharmacy Shahid Beheshti University of Medical Sciences Tehran Iran
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The Role of PK/PD Analysis in the Development and Evaluation of Antimicrobials. Pharmaceutics 2021; 13:pharmaceutics13060833. [PMID: 34205113 PMCID: PMC8230268 DOI: 10.3390/pharmaceutics13060833] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 05/27/2021] [Accepted: 05/31/2021] [Indexed: 12/13/2022] Open
Abstract
Pharmacokinetic/pharmacodynamic (PK/PD) analysis has proved to be very useful to establish rational dosage regimens of antimicrobial agents in human and veterinary medicine. Actually, PK/PD studies are included in the European Medicines Agency (EMA) guidelines for the evaluation of medicinal products. The PK/PD approach implies the use of in vitro, ex vivo, and in vivo models, as well as mathematical models to describe the relationship between the kinetics and the dynamic to determine the optimal dosing regimens of antimicrobials, but also to establish susceptibility breakpoints, and prevention of resistance. The final goal is to optimize therapy in order to maximize efficacy and minimize side effects and emergence of resistance. In this review, we revise the PK/PD principles and the models to investigate the relationship between the PK and the PD of antibiotics. Additionally, we highlight the outstanding role of the PK/PD analysis at different levels, from the development and evaluation of new antibiotics to the optimization of the dosage regimens of currently available drugs, both for human and animal use.
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Kiyasseh D, Zhu T, Clifton D. The Promise of Clinical Decision Support Systems Targetting Low-Resource Settings. IEEE Rev Biomed Eng 2020; 15:354-371. [PMID: 32813662 DOI: 10.1109/rbme.2020.3017868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Low-resource clinical settings are plagued by low physician-to-patient ratios and a shortage of high-quality medical expertise and infrastructure. Together, these phenomena lead to over-burdened healthcare systems that under-serve the needs of the community. Alleviating this burden can be undertaken by the introduction of clinical decision support systems (CDSSs); systems that support stakeholders (ranging from physicians to patients) within the clinical setting in their day-to-day activities. Such systems, which have proven to be effective in the developed world, remain to be under-explored in low-resource settings. This review attempts to summarize the research focused on clinical decision support systems that either target stakeholders within low-resource clinical settings or diseases commonly found in such environments. When categorizing our findings according to disease applications, we find that CDSSs are predominantly focused on dealing with bacterial infections and maternal care, do not leverage deep learning, and have not been evaluated prospectively. Together, these highlight the need for increased research in this domain in order to impact a diverse set of medical conditions and ultimately improve patient outcomes.
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Bader JC, Lakota EA, Andes DR, Rubino CM, Ambrose PG, Bhavnani SM. Time for Precision: A World Without Susceptibility Breakpoints. Open Forum Infect Dis 2018; 5:ofy282. [PMID: 30581880 PMCID: PMC6297858 DOI: 10.1093/ofid/ofy282] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 10/29/2018] [Indexed: 12/16/2022] Open
Abstract
Interpretive criteria for in vitro susceptibility testing criteria, "susceptibility breakpoints," underpin the evaluation and selection of antimicrobial regimens. However, despite their strengths, susceptibility breakpoints are a relatively blunt instrument employed to address an extremely complex question-what is the likelihood of treatment success for individual patients? With regard to evaluating patients on a case-by-case basis, breakpoints merely allow us to account for pathogen susceptibility. This approach precludes consideration of drug exposures achieved in patients, thus overlooking half of the equation for predicting treatment success. Herein, we propose the framework for considering both pathogen- and patient-specific information to provide clinicians a means of evaluating antimicrobial regimens for individual patients through tools automating pharmacokinetic-pharmacodynamic target attainment analyses. Implementing these tools along with their acceptance by professional organizations will allow for a shift in the paradigm for how antimicrobials are selected and dosed-toward patient-centered care through precision medicine.
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Affiliation(s)
- Justin C Bader
- Institute for Clinical Pharmacodynamics, Schenectady, New York
| | | | | | | | - Paul G Ambrose
- Institute for Clinical Pharmacodynamics, Schenectady, New York
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