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Precision dosing of vancomycin: in defence of AUC-guided therapy in children

Mark E Murphy1,2, Sonya Tang Girdwood2,3,4, Jennifer L Goldman5,6,7

  • 1Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

The Journal of Antimicrobial Chemotherapy
|June 7, 2021
PubMed

Insights

New guidelines recommend AUC24 monitoring for vancomycin in children, moving beyond trough levels. This approach optimizes dosing to reduce vancomycin-associated nephrotoxicity and improve outcomes in high-risk pediatric patients.

Area of Science:

  • Pharmacology
  • Pediatric Infectious Diseases
  • Clinical Pharmacy

Background:

  • Vancomycin dosing guidelines shifted in 2020 to AUC24 monitoring.
  • Debate exists regarding the resources and benefits of AUC24 monitoring versus traditional trough monitoring.
  • A recent review questioned the data supporting AUC24 monitoring in pediatrics.

Purpose of the Study:

  • To provide supporting arguments for AUC24-guided vancomycin monitoring in pediatric patients.
  • To address concerns about the transition to AUC24 monitoring.
  • To advocate for optimized vancomycin therapy in children.

Main Methods:

  • This article presents a supportive argument based on existing literature and clinical reasoning.
  • It critically evaluates the limitations of trough-based monitoring.
  • It highlights the clinical implications of vancomycin dosing in pediatric populations.

Main Results:

  • Trough vancomycin levels are insufficient surrogates for AUC24.
  • Vancomycin-associated nephrotoxicity has serious consequences necessitating optimized dosing.
  • A significant number of children are at high risk for adverse outcomes with vancomycin therapy.
  • Limited efficacy data for AUC24 does not justify reverting to less supported methods.

Conclusions:

  • AUC24 monitoring is superior to trough monitoring for vancomycin in children.
  • Optimizing vancomycin dosing through AUC24 monitoring is crucial for mitigating nephrotoxicity and improving outcomes.
  • Continued adoption of AUC24-guided monitoring in pediatric patients is warranted.

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