Practical antimicrobial TDM (PAT) of vancomycin in Japanese emergency and critical care units: Concentration overestimation and correction using scaling factors

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Applying specific scaling factors to predicted population mean serum concentrations improves initial vancomycin dosing accuracy in critically ill patients with trauma or significant changes in creatinine clearance and albumin. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Koki Takeda; Naoki Yoshikawa; Hidehiko Koreeda; Shuhei Urata; Yuki Matsusaki; Tsubasa Yokota; Akira Okada; Ayane Higuchi; Rin Taguchi; Asako Nishimura; Nobuhito Shibata; Ryota Tanaka; Hiroki Itoh; Ryuji Ikeda

doi:10.5414/cp205029

September 3, 2026International Journal of Clinical Pharmacology and Therapeutics

Practical antimicrobial TDM (PAT) of vancomycin in Japanese emergency and critical care units: Concentration overestimation and correction using scaling factors

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Key Points

To identify critically ill patient subgroups whose predicted serum vancomycin concentrations are overestimated by a web-based therapeutic drug monitoring tool and calculate corrective scaling factors.
Simulated serum vancomycin concentrations in 47 patients at a Japanese emergency and critical care center using a population pharmacokinetic model.
Categorized patients by observed-to-predicted concentration ratio (OBS/PRED < 0.67 for low-trough vs. ≥ 0.67 for control).
Calculated scaling factors minimizing mean squared error (MSE) and root mean squared error (RMSE) for identified low-trough subgroups.
Among 47 patients, 23 were assigned to the low-trough group and 24 to the control group.
The low-trough group had a significantly higher prevalence of patients with trauma, changes in creatinine clearance (ΔCCR > 15 mL/min), and changes in albumin (ΔALB < -0.5 g/dL).
Scaling factors for these subgroups ranged from 0.53 to 0.64, with an optimal factor of 0.53 for ΔCCR > 15 mL/min reducing the RMSE from 5.1 to 4.0 μg/mL.

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Implication

Pharmacokinetic study reveals vancomycin concentration overestimation in critical care patients, suggesting scaling factors improve initial dosing accuracy.

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Takeda et al. (2026) studied this question.

synapsesocial.com/papers/6a9bd3f16b95aff0620eb22a https://doi.org/10.5414/cp205029

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Practical antimicrobial TDM (PAT) of vancomycin in Japanese emergency and critical care units: Concentration overestimation and correction using scaling factors

Key Points

No abstract yet

Implication

Discussion

Cite This Study

Practical antimicrobial TDM (PAT) of vancomycin in Japanese emergency and critical care units: Concentration overestimation and correction using scaling factors

Key Points

No abstract yet

Implication

Discussion

Cite This Study

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