Development and evaluation of a vancomycin dosing nomogram to achieve the target area under the concentration-time curve. A retrospective study. Issue 5 (May 2020)

• Record Type: Journal Article
• Authors: Oda, Kazutaka; Katanoda, Tomomi; Hashiguchi, Yumi; Kondo, Shoji; Narita, Yuki; Iwamura, Koji; Nosaka, Kisato; Jono, Hirofumi; Saito, Hideyuki
• Is Part Of: Journal of infection and chemotherapy. Volume 26:Issue 5(2020:May)
• Page Start: 444
• Page End: 450
• Publication Date: 2020-05
• Subjects: Vancomycin -- Nomogram -- Area under the concentration-time curve -- Therapeutic drug monitoring -- Pharmacokinetics; AUC0-24 area under the concentration-time curve in a day at steady state -- CL clearance -- CWRES conditional weighted residuals -- eGFR estimated glomerular filtration rate -- K12 transfer rate constant from central to peripheral compartment -- K21 transfer rate constant from peripheral to central compartment -- MAE mean absolute prediction error -- ME mean prediction error -- MRSA methicillin resistant Staphylococcus aureus -- OFV objective function value -- RSE relative standard error -- TDM therapeutic drug monitoring -- Vss Volume of distribution at steady state; Chemotherapy -- Periodicals; Infection -- Periodicals; Communicable diseases -- Chemotherapy -- Periodicals; 615.5805
• DOI: 10.1016/j.jiac.2019.11.009
• Languages: English
• ISSNs: 1341-321X

Abstract

Abstract: Although the superiority of vancomycin dosing based on area under the concentration-time curve (AUC0-24 ) over that based on trough concentration has been reported, a dosing strategy to achieve the target AUC0-24 has yet to be developed. The objective of this study was to develop a convenient useable nomogram for vancomycin dosing to obtain the target AUC0-24 (400 μg h/mL). The nomogram was pharmacokinetically developed in a retrospective manner. The number of enrolled patients and concentrations was 166 and 309 for development of the nomogram, 99 and 181 for evaluation of the nomogram, respectively. The nomogram was developed as doses per personal body weight corresponding to each range of estimated glomerular filtration rate (eGFR), which was identified to be the covariate for vancomycin clearance by non-linear mixed effect modeling. The nomogram described the surrogate trough concentration for the target AUC0-24 was calculatedly different for each eGFR range (9.3–15.0 μg/mL). The rate of attainment of therapeutic range using surrogate trough concentration to obtain the target AUC0-24 was 63.8% in the evaluation period. We have developed and evaluated the first convenient useable nomogram of vancomycin dosing to obtain the target AUC0-24 .