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Evaluation of traditional initial vancomycin dosing versus utilizing an electronic AUC/MIC dosing program.

Kerri A Mcgrady¹, Makenzie Benton², Serina Tart³

¹PharmD. College of Pharmacy and Health Sciences, Campbell University. Buies Creek, NC (United States). kamcgrady1006@email.campbell.edu.

Pharmacy Practice

|October 2, 2020

Summary

New vancomycin dosing guidelines recommend targeting area under the curve to minimum inhibitory concentration (AUC/MIC) over trough concentrations. This study found that using an AUC/MIC dosing program resulted in significantly lower first-day vancomycin doses, potentially improving safety.

Keywords:

Acute Kidney Injury Area Under Curve Drug Monitoring Inpatients Microbial Sensitivity Tests Retrospective Studies Software United States Vancomycin

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Area of Science:

Pharmacokinetics and Pharmacodynamics
Infectious Diseases
Nephrology

Background:

The 2020 vancomycin guidelines recommend area under the curve to minimum inhibitory concentration (AUC/MIC) for optimized dosing.
Traditional trough-based vancomycin dosing is an insufficient surrogate for AUC/MIC targets and may lead to adverse events like acute kidney injury.
Higher trough levels do not consistently correlate with desired AUC/MIC ratios and increase nephrotoxicity risk.

Purpose of the Study:

To compare the mean total first-day vancomycin dose administered using traditional trough-based dosing versus an AUC/MIC dosing program.
To evaluate the impact of AUC/MIC-guided vancomycin dosing on initial daily dosage requirements.
To assess the difference in vancomycin doses prescribed by electronic AUC/MIC calculators versus standard practice.

Main Methods:

A single-center, retrospective cohort study included adult inpatients receiving at least 24 hours of IV vancomycin.
The primary endpoint was the difference in the mean total first-day vancomycin dose (mg) between actual trough-based dosing and AUC/MIC calculator recommendations.
Patients served as their own controls, comparing actual doses received with electronically recommended doses. Adverse events were also compared.

Main Results:

The study included 264 patients.
Initial 24-hour vancomycin exposure was significantly lower with the AUC/MIC recommended dose (2380.7 mg) compared to the dose actually received (2649.6 mg).
The difference in mean total first-day dose was statistically significant (p=0.0007).

Conclusions:

Implementing an electronic AUC/MIC vancomycin dosing calculator leads to reduced total first-day vancomycin doses.
AUC/MIC-guided dosing represents a more accurate approach to vancomycin administration compared to traditional trough monitoring.
This shift in dosing strategy may mitigate risks associated with excessive vancomycin exposure.