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Published on: September 9, 2015
Therapeutic Drug Monitoring of Vancomycin Based on Ratio of Area under the Curve to Minimum Inhibitory Concentration:
Kaitlin McDougal1, Vanessa Paquette2, Jennifer Kendrick3
1, PharmD, ACPR, is with the Pharmacy Department, Children's and Women's Health Centre of British Columbia, and the Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia.
Background:
Various organizations recommend targeting a calculated ratio of area under the curve to minimum inhibitory concentration (AUC/MIC) of 400-600 for therapeutic drug monitoring (TDM) of vancomycin. Sites that have implemented AUC/MIC-based TDM for vancomycin have shown reduced vancomycin exposure, decreased nephrotoxicity rates, and fewer dosage adjustments relative to the use of trough monitoring.
Objectives:
To implement AUC/MIC-based TDM for vancomycin at a pediatric and obstetric tertiary care site and to assess pharmacists' knowledge and satisfaction before and 1 month after implementation and at 2-year follow-up.
Methods:
This quality improvement project involved the planning, implementation, and evaluation of AUC/MIC-based TDM for vancomycin. Anonymous electronic surveys were distributed to pharmacists before and after implementation and at 2-year follow-up, assessing practices, comfort, knowledge, and satisfaction with AUC/MIC-based TDM.
Results:
Implementation of AUC/MIC-based TDM for vancomycin occurred in April 2021, after 8 months of preparation during which educational sessions, a dosing calculator, guidelines, and written communications were developed and delivered. Surveys were partially or fully completed by 27 pharmacists before implementation, by 24 pharmacists at 1 month after implementation, and by 32 pharmacists at 2-year follow-up. At 1 month and 2 years after implementation, larger proportions of respondents felt knowledgeable (88% [n = 21] and 81% [n = 26], respectively, vs 22% [n = 6] before implementation) and comfortable (88% [n = 21] and 81% [n = 26], respectively, vs 19% [n = 5] before implementation) with AUC/MIC-based TDM. Respondents' satisfaction with implementation of AUC/MIC-based TDM was 88% (n = 21/24) at 1 month after implementation and 94% (n = 29/31) at the 2-year follow-up.
Conclusions:
AUC/MIC-based TDM for vancomycin was implemented with high pharmacist satisfaction. Future studies at this site should investigate clinical outcomes.
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