Comparative performance of different stochastic methods to simulate drug exposure and variability in a population

Monte Carlo simulations (MCSs) are increasingly being used to predict the pharmacokinetic variability of antimicrobials in a population. However, various MCS approaches may differ in the accuracy of the predictions. We compared the performance of 3 different MCS approaches using a data set with known parameter values and dispersion. Ten concentration-time profiles were randomly generated and used to determine the best-fit parameter estimates. Three MCS methods were subsequently used to simulate the AUC0-∞ of the population, using the central tendency and dispersion of the following in the subject sample: 1) K and V; 2) clearance and V; 3) AUC0-∞. In each scenario, 10 000 subject simulations were performed. Compared to true AUC0-∞ of the population, mean biases by various methods were 1) 58.4, 2) 380.7, and 3) 12.5 mg h L−1, respectively. Our results suggest that the most realistic MCS approach appeared to be based on the variability of AUC0-∞ in the subject sample.