Upon beginning my thirtieth year as a pharmacist, the number of new approaches that continue to be developed for therapeutic drug monitoring impresses me. The second edition of Applied Clinical Pharmacokinetics includes new methods to dose immunosuppressants (2-hour postdose cyclosporine concentrations, area under the curve methods for cyclosporine and tacrolimus), and the elevation of what were new methods of dosing antibiotics to the mainstream (extended interval and area under the curve methods for aminoglycosides, troughonly monitoring for vancomycin). Other additions include more complete coverage of pediatric patients, dosing during hemoperfusion, an overview of methods preceding the initial and dosage adjustment sections, and a dosing strategies section that groups together initial and dosage adjustment techniques into a logical sequence. Of course, relevant sections, examples, problems, and references have been updated as needed for each chapter. However, one thing that remains unchanged is the general organization and philosophy of the book (please see the excerpt from the first edition following this section).
Bernard of Chartres used to say that we are like dwarfs on the shoulders of giants, so that we can see more than they, and things at a greater distance, not by virtue of any sharpness of sight on our part, or any physical distinction, but because we are carried high and raised up by their giant size.—in Metalogicon (1159 A.D.), by John of Salisbury.
Depending on one's point of view, the discipline of therapeutic drug monitoring is entering its fifth decade. Some brilliant scientists and practitioners who have made significant contributions to the area (and whose names are in the reference list or attached to the methods recommended in this text) and changed the lives of countless patients are no longer with us. I extend my humble thanks to all of these exceptional individuals for making things a little bit clearer and a lot easier for the rest of us.
Larry A. Bauer, PharmD