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.
Bottom Line
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.
96.4%
ICU vancomycin patients TDM-eligible
5.41x
odds of tacrolimus target attainment
NNT 2.38
DRP resolution, in-range tacrolimus
26.8%
pediatric models externally validated
State of Play
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.
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Full Analysis: Subscribers Only
The complete evidence synthesis, practice recommendations, and open questions.
What Changed
How It Fits the Guidelines
Effect chart & evidence comparison
Evidence at a Glance
Practice Considerations
Open Questions
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Not medical advice. PharmD Signal provides educational synthesis of published pharmacy and medical literature for practicing pharmacists. It is not a treatment recommendation for any individual patient; clinical decisions remain the responsibility of the treating clinician exercising independent professional judgment.