PharmaAgent: a real-world evaluation of high- and low-autonomy agentic systems for inpatient vancomycin dosing

Vancomycin has a narrow therapeutic window requiring individualized dosing and repeated monitoring, a process health systems delegate from physicians to pharmacists for consistency. We silently deployed PharmaAgent, LLM-based vancomycin dosing agentic systems, at Stanford Hospital for two months and compared high- and low-autonomy configurations, each with and without institutional guidelines. Across 403 dosing events in 316 patients, mean absolute percentage error against the treating pharmacist's order was 21.8% with high autonomy versus 37.8% with low autonomy, and recommendations were with

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