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Updated: Oct 26, 2025

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
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Vancomycin in adult prescribing: is it time to move on from trough-based dosing in the UK?

F Heard1, A Sehgal2

  • 1Microbiology Department, Queens Medical Centre, Nottingham University Hospitals Trust, Derby Road, Nottingham NG7 2UH, UK.

The Journal of Antimicrobial Chemotherapy
|July 29, 2021
PubMed

Insights

Vancomycin dosing should shift from trough-based to 24-hour AUC/MIC monitoring for improved efficacy and reduced nephrotoxicity. This change is crucial for safe vancomycin use, especially for MRSA infections.

Area of Science:

  • Pharmacology
  • Infectious Diseases
  • Clinical Pharmacy

Background:

  • Vancomycin is vital for treating Staphylococcus aureus and MRSA infections.
  • Therapeutic drug monitoring (TDM) is essential for vancomycin efficacy and safety.
  • Trough-based dosing, previously standard, faces scrutiny regarding reliability and patient risk.

Purpose of the Study:

  • To advocate for the adoption of 24-hour AUC/MIC-based vancomycin dosing.
  • To highlight the risks associated with continued reliance on trough-based dosing, particularly nephrotoxicity.
  • To align UK vancomycin dosing practices with international guidelines.

Main Methods:

  • Review of current vancomycin dosing guidelines and evidence.
  • Analysis of the risks and benefits of trough-based versus AUC/MIC-based dosing.
  • Comparison of UK practices with international recommendations (e.g., IDSA 2020 guidelines).

Main Results:

  • The 2020 IDSA guidelines recommend 24-hour AUC/MIC dosing over trough-based methods.
  • Evidence indicates trough-based dosing increases the risk of vancomycin-induced nephrotoxicity.
  • The UK has not yet fully implemented AUC/MIC-based dosing, lagging behind evidence-based recommendations.

Conclusions:

  • Transitioning to AUC/MIC-based vancomycin dosing is necessary for patient safety.
  • Implementing AUC/MIC dosing will optimize vancomycin efficacy and minimize toxicity.
  • Adopting AUC/MIC dosing aligns clinical practice with current scientific evidence and guidelines.

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