Clinical Feasibility of Nomogram-Based Vancomycin Dosing Strategy: A Retrospective Study

Area of Science:

• Pharmacology
• Clinical Pharmacy
• Infectious Diseases

Background:

• Therapeutic drug monitoring of vancomycin (VCM) is crucial for optimizing efficacy and safety.
• Area under the concentration-time curve (AUC)-guided dosing is recommended but often limited by software availability.
• Alternative dosing strategies are needed for routine clinical practice.

Purpose of the Study:

• To evaluate the utility of an AUC-guided nomogram as an alternative VCM dosing strategy.
• To compare pharmacokinetic target attainment and safety outcomes between nomogram-based, software-based, and non-intervention VCM dosing.
• To assess the impact of VCM dosing strategies on clinical outcomes in patients with Gram-positive bacteremia.

Main Methods:

• Retrospective study of hospitalized patients receiving VCM.
• Patients categorized into software-guided, nomogram-guided, or non-intervention dosing groups.
• Comparison of first-day AUC (AUCf24) attainment, safety outcomes (acute kidney injury), and time to C-reactive protein reduction.

Main Results:

• The nomogram group achieved target AUCf24 attainment (55.4%) significantly more often than the non-intervention group (30.8%) and comparably to the software group (62.0%).
• Non-intervention dosing was associated with failure to achieve target AUCf24 (OR, 2.82).
• No significant difference in acute kidney injury incidence was observed. Patients with Gram-positive bacteremia in the nomogram and software groups showed a faster reduction in C-reactive protein compared to the non-intervention group.

Conclusions:

• A nomogram-based VCM dosing strategy facilitates achievement of therapeutic VCM exposure.
• Nomogram dosing is a feasible and effective alternative to software-based strategies in clinical practice.
• Optimized VCM dosing may improve clinical response in patients with Gram-positive infections.