Attainment of Area Under the Curve Targets and Incidence of Nephrotoxicity Utilizing Local Pharmacokinetic Vancomycin Dosing Guidelines
by Alanna Ambrosius, PharmD, Kent Cook, PharmD, Jim Davis, RPh, Justin Guthman, PharmD
"Objective: Current vancomycin monitoring guidelines recognize area under the curve (AUC) to minimum inhibitory concentration (MIC) ratio as the target efficacy parameter for vancomycin. Despite the historical use of trough-only dosing as a surrogate marker for the AUC/MIC ratio, recent studies have challenged this strategy’s efficacy and safety. The objective of this study is to determine the extent to which vancomycin dosing and monitoring achieves target AUC levels and avoids nephrotoxicity. Secondary outcomes include incidence of clinical failure.
Methods: While receiving vancomycin therapy, adult patients were dosed and monitored according to current practice, with one additional vancomycin concentration drawn per dose-adjustment period to calculate the AUC. For the primary outcomes, percent of AUC levels within the established goal range of 400-600 mg h/L was calculated. Percent of patients who developed nephrotoxicity within 21 days of vancomycin initiation, or until the termination of their inpatient stay, was calculated. For the secondary outcomes, escalation to other methicillin-resistant Staphylococcus aureus active agents was measured.
Results: Of 46 AUC values calculated, 39.1% of values were in the target range of 400-600 mg h/L. There were notable variations between trough levels obtained and the calculated AUC. Of 43 patients, 16.3% developed nephrotoxicity. When limited to nephrotoxicity likely attributable to vancomycin, the incidence was lower at 6.98%. One patient required escalation of therapy to an alternate agent.
Conclusion: Trough levels obtained during this study did not accurately predict AUC values calculated, and incidence of nephrotoxicity was confounded by concomitant nephrotoxic agents.”
Keywords: Humans, Adult, Vancomycin, Methicillin-Resistant Staphylococcus aureus, Area Under Curve, Methicillin, Incidence, Goals, Inpatients, Microbial Sensitivity Tests, Renal Insufficiency, Biomarkers
Download PDF
2020 November/December Table of Contents
"Objective: Current vancomycin monitoring guidelines recognize area under the curve (AUC) to minimum inhibitory concentration (MIC) ratio as the target efficacy parameter for vancomycin. Despite the historical use of trough-only dosing as a surrogate marker for the AUC/MIC ratio, recent studies have challenged this strategy’s efficacy and safety. The objective of this study is to determine the extent to which vancomycin dosing and monitoring achieves target AUC levels and avoids nephrotoxicity. Secondary outcomes include incidence of clinical failure.
Methods: While receiving vancomycin therapy, adult patients were dosed and monitored according to current practice, with one additional vancomycin concentration drawn per dose-adjustment period to calculate the AUC. For the primary outcomes, percent of AUC levels within the established goal range of 400-600 mg h/L was calculated. Percent of patients who developed nephrotoxicity within 21 days of vancomycin initiation, or until the termination of their inpatient stay, was calculated. For the secondary outcomes, escalation to other methicillin-resistant Staphylococcus aureus active agents was measured.
Results: Of 46 AUC values calculated, 39.1% of values were in the target range of 400-600 mg h/L. There were notable variations between trough levels obtained and the calculated AUC. Of 43 patients, 16.3% developed nephrotoxicity. When limited to nephrotoxicity likely attributable to vancomycin, the incidence was lower at 6.98%. One patient required escalation of therapy to an alternate agent.
Conclusion: Trough levels obtained during this study did not accurately predict AUC values calculated, and incidence of nephrotoxicity was confounded by concomitant nephrotoxic agents.”
Keywords: Humans, Adult, Vancomycin, Methicillin-Resistant Staphylococcus aureus, Area Under Curve, Methicillin, Incidence, Goals, Inpatients, Microbial Sensitivity Tests, Renal Insufficiency, Biomarkers
Download PDF
2020 November/December Table of Contents