An AUC Target Simulation for Vancomycin in Patients With Class III Obesity. (August 2021)

• Record Type: Journal Article
• Authors: Langton, Meagan M.; Ahern, John W.; MacDougall, Julie
• Is Part Of: Journal of pharmacy practice. Volume 34:Number 4(2021)
• Page Start: 577
• Page End: 580
• Publication Date: 2021-08
• Subjects: vancomycin -- AUC -- simulation -- obesity -- pharmacokinetics; Pharmacy -- Periodicals; Pharmacology -- Periodicals; 615.1
• DOI: 10.1177/0897190019885241
• Languages: English
• ISSNs: 0897-1900

Abstract

Objective: The objective of this simulation is to compare 24-hour vancomycin (Vanc24 ) dosage requirements between a target area under the curve (AUC) versus a target trough approach in patients with class III obesity. Methods: Adult patients were included if they received vancomycin in accordance with the University of Vermont Medical Center's class III obesity dosage protocol from June 2016 through December 2018. Patient-specific pharmacokinetic parameters were calculated for each patient using the Sawchuck-Zaske method. For this simulation, Vanc24 dosages were calculated to achieve an AUC of 400 mg/L h and a trough concentration of 15 mg/L. Results: Sixty-three patients had Vanc24 dosage requirements calculated. The median age was 59 years (interquartile range [IQR]: 51.5-68), body mass index (BMI): 45.7 kg/m 2 (IQR: 42.4-51.5), and 50.7% were male. The mean Vanc24 dosage requirements were 3995 mg (standard deviation [SD] ±1673) in the target trough approach versus 2783 mg (SD ±1149) in the target AUC approach ( P < .0001). Conclusion: A target AUC approach required less vancomycin over a 24-hour time period relative to a target trough approach. Vancomycin therapeutic drug monitoring that explicitly targets AUC may reduce vancomycin exposure and potentially decrease the risk of nephrotoxicity in patients with class III obesity.