Application of Machine Learning Classification to Improve the Performance of Vancomycin Therapeutic Drug Monitoring.

Bayesian therapeutic drug monitoring (TDM) software uses a reported pharmacokinetic (PK) model as prior information. Since its estimation is based on the Bayesian method, the estimation performance of TDM software can be improved using a PK model with characteristics similar to those of a patient. Therefore, we aimed to develop a classifier using machine learning (ML) to select a more suitable vancomycin PK model for TDM in a patient. In our study, nine vancomycin PK studies were selected, and a classifier was created to choose suitable models among them for patients. The classifier was trained using 900,000 virtual patients, and its performance was evaluated using 9000 and 4000 virtual patients for internal and external validation, respectively. The accuracy of the classifier ranged from 20.8% to 71.6% in the simulation scenarios. TDM using the ML classifier showed stable results compared with that using single models without the ML classifier. Based on these results, we have discussed further development of TDM using ML. In conclusion, we developed and evaluated a new method for selecting a PK model for TDM using ML. With more information, such as on additional PK model reporting and ML model improvement, this method can be further enhanced.