Pharmacokinetic Variability in Pediatrics and Intensive Care: Toward a Personalized Dosing Approach

Abstract

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Providing a safe and efficacious drug therapy for large and often heterogeneous populations is a challenging objective in clinical drug development and routine clinical practice. It has been known for years that the optimum dose required for many therapeutic agents among individuals is quite variable. A wide interindividual pharmacokinetic variability was described in clinically relevant populations such as pediatrics and critically ill patients. The aim of this article was to present the main individual factors influencing variability in these two populations and their applications. Growth and development are two specific features of children that are not observed in adults. And critically ill patients have a much higher level of sickness severity that is associated with profound pathophysiological changes. These particular features could lead to difficulties to attain therapeutic targets. Nonlinear mixed effects modeling is a common approach to identify unexplained population variability. This approach is often applied to evaluate and optimize drug therapy in particular populations. Numerous studies have been conducted in these two specific populations to characterize pharmacokinetic parameters and to identify individual factors influencing variability. Size, age and organ function appeared to be the main factors influencing pharmacokinetics in pediatrics. Factors influencing pharmacokinetics in critically ill patients were mainly cardiovascular system, organ dysfunction and organ support. Dosage individualization seems to be a key issue to optimize drug treatment in these specific populations. Clinically utility and safety of a model-based personalized drug therapy has been demonstrated for vancomycin in pediatrics. Many programs were available to optimize drug regimens, especially for antibiotic drugs in critically ill patients. This innovative personalized dosing approach is a promising way to optimize drug therapy in clinically relevant populations, such as pediatrics and critically ill patients.