Dosificación de vancomicina guiada por software bayesiano versus dosificación guiada por criterio clínico en pacientes de un Hospital de Tercer Nivel en Costa Rica: un estudio cuasiexperimental

Daniela Matarrita Brenes
Estudiante de Farmacia. Facultad de Farmacia, Universidad de Costa Rica, San José, Costa Rica.

Deborah Rojas Leiva
Estudiante de Farmacia. Facultad de Farmacia, Universidad de Costa Rica, San José, Costa Rica.

José Manuel Fallas Ramírez
Profesor Asociado. Facultad de Farmacia, Universidad de Costa Rica, San José, Costa Rica.

Luis Esteban Hernández Soto
Decano de Farmacia. Facultad de Farmacia, Universidad de Costa Rica, San José, Costa Rica.

Luis David Garro Zamora
Farmacéutico. Servicio de Farmacia, Hospital México, San José, Costa Rica.

Resumen

Se realizó una comparación de la optimización de la dosificación de vancomicina mediante el software de apoyo a la decisión clínica bayesiano (GSB) versus la guiada por criterios clínicos (CC) para determinar si el software bayesiano podría lograr el objetivo farmacocinético y farmacodinámico (FC/ FD) del tratamiento con vancomicina de manera más precisa.

Se trata de un estudio observacional retrospectivo cuasiexperimental de un año, en el que se analizó la optimización simulada de dosis por CC y GSB en una población de pacientes adultos hospitalizados con infección por SARM en el Hospital México, Costa Rica.

Se obtuvieron dos grupos de datos: los modelados según CC y los obtenidos mediante las dosis por GSB. Los niveles mínimos se clasificaron según si estaban dentro o fuera del rango terapéutico objetivo (15-20 mg/L). Se utilizó estadística inferencial y descriptiva.

Un total de 31 pacientes fueron incluidos en el estudio. Los regímenes de dosificación por GSB alcanzaron el objetivo terapéutico en el 100% de las dosis empíricas y ajustadas. En el caso de los regímenes CC después del ajuste de la dosis, el 35,5% de los pacientes fueron expuestos a niveles séricos subterapéuticos y el 35,5% a niveles supraterapéuticos.

El GSB fue más preciso para lograr el objetivo FC/FD tanto para dosis empíricas como ajustadas. Además, la dosificación de CC expuso a un número significativo de pacientes a niveles subterapéuticos y supraterapéuticos que pueden estar asociados con resistencia bacteriana y nefrotoxicidad.

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Palabras claves

Vancomicina, SARM, software bayesiano, farmacocinética, farmacodinámica.

Abstract

A comparison of vancomycin dosing optimization by Bayesian clinical decision support software (CDS) versus that guided by clinical criteria (CC) was performed to determine whether the Bayesian decision support tool could be more accurate in achieving the pharmacokinetic and pharmacodynamic (PK/PD) goal of vancomycin treatment by steadystate trough levels.

A retrospective observational study over a period of one year, in which an analysis of dosing optimization by CC and a CDS using Bayesian software (DoseMeRx®) was performed in a population of hospitalized adult patients with MRSA infection at Hospital Mexico, Costa Rica.

Two groups of data were obtained: those modeled according to the dosage established by CC and those obtained employing the doses suggested by the CDS. The trough levels were classified according to whether they were within or outside the target therapeutic range (15-20 mg/L). Inferential and descriptive statistics were used for the analysis of results.

A total of 31 patients were included in the study. The dosing regimens obtained by CDS reached the therapeutic target of trough levels in 100% of the empirical and adjusted doses. In the case of CC regimens, after dose adjustment, 35.5% of the patients were exposed to subtherapeutic serum levels and 35.5% to supratherapeutic serum levels.

CDS was found to be more accurate in achieving the pharmacokinetic/pharmacodynamic target for both empirical and adjusted doses. In addition, CC dosing exposed a significant number of patients to subtherapeutic and supratherapeutic levels that may be associated with bacterial resistance and nephrotoxicity.

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Keywords

Vancomycin, MRSA, Bayesian software, clinical criteria, pharmacokinetics, pharmacodynamics.

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