This review helps pharmacists see where model-informed therapeutic drug monitoring (TDM) is warranted, how to choose defensible dosing tools, and why human factors often decide target attainment.
Across ICU vancomycin, pediatric vancomycin population pharmacokinetic (popPK) modeling, and pediatric tacrolimus, target attainment depends as much on monitoring infrastructure, model selection, and human-factor interventions as on the drug concentration itself.
Model-informed precision dosing has matured from concept to operational tool, yet real-world uptake lags the eligible population, especially in the intensive care unit (ICU). The evidence base spans three complementary layers: quantifying who needs monitoring, selecting the pharmacokinetic model that drives the software, and delivering the human-facing interventions that translate a good target into an in-range concentration.
The 2020 revised consensus guideline from the American Society of Health-System Pharmacists (ASHP), Infectious Diseases Society of America (IDSA), Pediatric Infectious Diseases Society (PIDS), and Society of Infectious Diseases Pharmacists (SIDP) shifted vancomycin from trough-based to area under the curve (AUC)-guided monitoring, and newer work now operationalizes that shift. A BMC Anesthesiology cohort showed 96.4% of ICU vancomycin patients meet a guideline TDM indication, while a British Journal of Clinical Pharmacology synthesis built a structured scoring tool to rank pediatric popPK models, and a Frontiers in Medicine study quantified how pharmacist-led education raises tacrolimus target attainment.
All three studies extend rather than contradict the 2020 AUC-guided vancomycin consensus and standard tacrolimus TDM practice, filling operational gaps the guidelines leave open. The vancomycin guideline recommends AUC/minimum inhibitory concentration (MIC) targeting but does not specify which popPK model to embed, a gap the pediatric scoring tool addresses; likewise, tacrolimus guidance sets a trough target without prescribing the caregiver and nurse education that the transplant study shows drives attainment.
| Source | Key finding | Grade / Verdict |
|---|---|---|
|
Nearly All ICU Vancomycin Patients Qualify for Missing TDM
Study · BMC anesthesiology
monitoring-need quantification Establishes that nearly the entire ICU vancomycin population qualifies for TDM under the 2020 consensus guideline, framing precision monitoring as a resource-planning and safety imperative.
|
96.4% (319 of 331) of ICU vancomycin patients met at least one guideline TDM indication | Grade: Low Hypothesis-generating |
|
Structured Scoring Tool Ranks Pediatric Vancomycin PK Models for Precision Dosing
Study · British journal of clinical pharmacology
model-selection methodology Provides a reproducible scoring instrument to choose defensible pediatric vancomycin popPK models, favoring maturation and renal-function covariates and external validation.
|
Renal-function equations (creatinine clearance or estimated glomerular filtration rate) were retained in 55.8% of models versus serum creatinine in 23.3% | Grade: Moderate Confirmatory |
|
Pharmacist Education Triples In-Range Tacrolimus in Pediatric Transplant
Study · Frontiers in medicine
human-factor intervention evidence Shows that pharmacist-led caregiver and nurse education plus DRP resolution substantially raises in-range tacrolimus attainment beyond what routine labs predict.
|
Post-education status conferred a 5.41-fold increase in odds of reaching target tacrolimus range (95% CI 2.59–11.30) | Grade: Low Hypothesis-generating |
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