Analysis of Pharmacokinetics and Comparison Between One-point Versus Two-point Sampling for Therapeutic Drug...

Vancomycin therapeutic drug monitoring (TDM) is essential for optimizing efficacy and minimizing toxicity, particularly in acute kidney injury (AKI). However, recent guidelines favor area under the curve (AUC)-guided dosing over traditional trough monitoring to improve dosing. This study aimed to compare vancomycin TDM strategies in pediatric patients, examine the agreement between 1-point and 2-point sampling methods for AUC estimation, and explore the association between vancomycin exposure and clinical outcomes.

This retrospective cohort study included pediatric patients (2 months to 18 years of age) who underwent vancomycin TDM between 2017 and 2019 (trough-based dosing) and 2020 and 2022 (AUC-based dosing). The pharmacokinetic parameters were estimated using Bayesian software. AKI was defined according to the Kidney Disease: Improving Global Outcomes criteria. Receiver operating characteristic curve analysis was performed to identify the threshold values of AUC and trough concentrations for predicting AKI.

A total of 288 patients were included in the study: 164 were from 2017 to 2019 and 124 were from 2020 to 2022, respectively. A comparison of the 1-point and 2-point sampling methods for estimating the AUC showed no significant differences. The incidence of AKI was slightly lower in the 2020-2022 cohort (2.4%) than in the 2017-2019 cohort (6.7%), though the difference was not statistically significant. The AUC threshold for predicting AKI was similar between 1-point and 2-point sampling methods (588-621 mg h/L).

AUC-based vancomycin dosing was associated with a reduced incidence of AKI in pediatric patients, without compromising efficacy. Further studies are warranted to refine the exposure targets for bacteremia resolution.