NONPHARMACOKINETIC CLINICAL FACTORS AFFECTING AMINOGLYCOSIDE THERAPEUTIC PRECISION - A SIMULATION STUDY

A Monte Carlo simulation study evaluated the effects of a simulated 'good' or 'poor' ward care setting, pharmacy, laboratory and phlebotomy service on the resulting precision of control of serum tobramycin concentrations in a representative (theoretical) patient receiving the drug. The ward care (precise dose administration and recording of times given) and the pharmacy (precise dosage preparation) played significant roles in achieving precise serum concentrations whereas laboratory (assay precision) and the phlebotomy service (precise labelling of blood specimen times) were considerably less important. However, use of a simulated 'smart' infusion pump contributed most to therapeutic precision. These results suggest that therapeutic precision can be increased, and costs reduced, by manufacturing total daily drug doses in reproducible concentrations in conveniently sized bags and tubin, minimising preparation of individual doses (saving labour costs), and administering each individual dose from the bag precisely, either with conventional accurately set infusion pumps or with 'smart' infusion apparatus.