Computerised advice on drug dosage of some benefit

Clinical question: 
How beneficial is computerised advice on drug dosage?
Bottom line: 
Compared with routine care, computerised advice on drug dosage increased the serum concentrations for aminoglycoside antibiotics, and improved the proportion of time for which the plasma drug was within the therapeutic range for aminoglycoside antibiotics and theophylline. It led to a physiological parameter more often within the desired range for oral anticoagulants and insulin. It decreased the time to achieve stabilisation for oral anticoagulants and reduced thromboembolism, reduced the length of hospital stay and tended to decrease unwanted effects of antirejection drugs and aminoglycoside antibiotics. It also significantly decreased unwanted effects for anticoagulants. In most trials, the computer-assisted dosage had lower or equivalent costs than manual dosage.
The results are based on studies mainly of low quality, concerning a small number of drugs. The advice was system-initiated or user-initiated, and comprised a recommendation on specific drug dosage calculated by the computer. No conclusion could be drawn concerning the logistics of the computerised support and organisation of care aspects. It was not certain these benefits could be achieved with different computer systems in different clinical situations.
Maintaining therapeutic concentrations of drugs with a narrow therapeutic window is a complex task. Several computer systems have been designed to help doctors determine optimum drug dosage. Significant improvements in healthcare could be achieved if computer advice improved health outcomes and could be implemented in routine practice in a cost-effective fashion.
Review CD#: 
February, 2014
Authored by: 
Brian R McAvoy