Advancing Precision Dosing and Pharmacogenetics in Hospitalized Children
The Tang Girdwood Lab seeks to optimize medication use in hospitalized children and young adults to maximize efficacy and minimize toxicity. The lab utilizes pharmacometrics, pharmacogenetics, and model-informed precision dosing to achieve its goals. We specialize in partnering with multiple clinical divisions in the institution, including Critical Care Medicine, Nephrology and Hypertension, the Cancer and Blood Diseases Institute, and Pathology and Laboratory Medicine, to obtain patient samples for drug concentration and biomarker measurements for research so that we can understand drug disposition.
Despite the passage of several acts, many medications are approved without having been studied rigorously in children. In addition, the most vulnerable pediatric populations like critically ill children or children with medical complexity are often excluded from trials. Our research program focuses on characterizing the pharmacokinetics, pharmacodynamics, and pharmacogenetics of various medications in these populations, and we derive dosing recommendations that enhance target attainment and patient care.
We leverage the use of scavenged opportunistic sampling, where leftover blood from clinically-obtained samples are collected, and timed blood sampling to measure drug concentrations and build complex mathematical models to describe drug distribution, metabolism, and elimination. In partnership with the clinical laboratory, we have the capability to measure multiple beta-lactam antibiotics, including ceftriaxone, cefepime, piperacillin, and meropenem.
As the director of the Genetic Pharmacology Service, which provides pharmacogenetic testing throughout the institution, Dr. Tang Girdwood also oversees pharmacogenetics research at Cincinnati Children's. She is specifically interested in the implementation of pharmacogenetic testing in children with medical complexity and investigating the outcomes of pharmacogenetic testing on outcomes.
Based on our research, we recently launched a pharmacokinetic consult service to provide personalized dosing recommendations for patients on beta-lactam antibiotics using an approach called model-informed precision dosing (MIPD). This is one of the first pharmacokinetic consultation services for beta-lactam antibiotics for children, improving antibiotic exposure even for highly complex patients requiring extracorporeal devices.
