{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T18:46:49Z","timestamp":1790016409081,"version":"4.0.1"},"reference-count":35,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2023,7,11]],"date-time":"2023-07-11T00:00:00Z","timestamp":1689033600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Vancomycin is commonly used to treat acute pulmonary exacerbations in pediatric patients with cystic fibrosis (CF) and a history of methicillin\u2010resistant\n                      <jats:italic>Staphylococcus aureus<\/jats:italic>\n                      . Optimizing vancomycin exposure during therapy is essential and area under\u2010the\u2010curve (AUC)\u2010guided dosing is now recommended. Model\u2010informed precision dosing (MIPD) utilizing Bayesian forecasting is a powerful approach that can support AUC\u2010guided dose individualization. The objective of the current study was to examine the impact of implementing an AUC\u2010guided dose individualization approach supported via a MIPD clinical decision support (CDS) tool on vancomycin exposure, target attainment rate, and safety in pediatric patients with CF treated with vancomycin during clinical care.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A retrospective chart review was performed in patients with CF at a single children's hospital comparing pre\u2010 and post\u2010implementation of a MIPD approach for vancomycin supported by a cloud\u2010based, CDS tool integrated into the electronic health record (EHR). In the pre\u2010MIPD period, vancomycin starting doses of 60\u2009mg\/kg\/day (&lt;13\u2009years) or 45\u2009mg\/kg\/day (\u226513\u2009years) were used. Dose adjustment was guided by therapeutic drug monitoring (TDM) with a target trough 10\u201320\u2009mg\/L. In the post\u2010MIPD period, starting dose and dose adjustment were based on the MIPD CDS tool predictions with a target 24\u2009h AUC (AUC\n                      <jats:sub>24<\/jats:sub>\n                      ) 400\u2013600\u2009mg*h\/L. Exposure and target achievement rates were retrospectively calculated and compared. Rates of acute kidney injury (AKI) were also compared.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Overall, 23 patient courses were included in the pre\u2010MIPD period and 21 patient courses in the post\u2010MIPD period. In the post\u2010MIPD period, an individualized MIPD starting dose resulted in 71% of patients achieving target AUC\n                      <jats:sub>24<\/jats:sub>\n                      compared to 39% in the pre\u2010MIPD period (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). After the first TDM and dose adjustment, target AUC\n                      <jats:sub>24<\/jats:sub>\n                      achievement was also higher post\u2010MIPD versus pre\u2010MIPD (86% vs. 57%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). AKI rates were low and similar between periods (pre\u2010MIPD 8.7% vs. post\u2010MIPD 9.5%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.9).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>An MIPD approach implemented within a cloud\u2010based, EHR\u2010integrated CDS tool safely supported vancomycin AUC\u2010guided dosing and resulted in high rates of target achievement.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/phar.2845","type":"journal-article","created":{"date-parts":[[2023,7,4]],"date-time":"2023-07-04T02:33:36Z","timestamp":1688438016000},"page":"1007-1014","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Impact of\n                    <scp>model\u2010informed<\/scp>\n                    precision dosing on achievement of vancomycin exposure targets in pediatric patients with cystic fibrosis"],"prefix":"10.1002","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1095-9381","authenticated-orcid":false,"given":"Adam","family":"Frymoyer","sequence":"first","affiliation":[{"name":"Department of Pediatrics Stanford University Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hayden T.","family":"Schwenk","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Stanford University Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jake M.","family":"Brockmeyer","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Lucile Packard Children's Hospital Stanford Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Bio","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Lucile Packard Children's Hospital 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