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
concentrations, area under the curve methods for cyclosporine
), and the elevation of what were new methods of dosing
antibiotics to the mainstream (extended interval and area under the curve
methods for aminoglycosides, trough-only 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