Vancomycin Area Under the Curve–Guided Dosing and Monitoring for Adult and Pediatric Patients With Suspected or Documented Serious Methicillin-Resistant Staphylococcus aureus Infections: Putting the Safety of Our Patients First. (19th March 2021)

• Record Type: Journal Article
• Authors: Lodise, Thomas P; Drusano, George
• Is Part Of: Clinical infectious diseases. Volume 72:Number 9(2021)
• Page Start: 1497
• Page End: 1501
• Publication Date: 2021-03-19
• Subjects: vancomycin -- acute kidney injury -- nephrotoxicity -- AUC -- trough; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciaa1744
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: The revised vancomycin consensus guidelines recommended area under the curve (AUC)–guided dosing/monitoring for patients with serious invasive methicillin-resistant Staphylococcus aureus (MRSA) infections as a measure to minimize vancomycin-associated acute kidney injury (VA-AKI) while maintaining similar effectiveness. Data indicate that the intensity of vancomycin exposure drives VA-AKI risk. Troughs of 15–20 mg/L will ensure an AUC ≥400 mg × hr/L but most patients will have daily AUCs >600. VA-AKI increases as a function of AUC, especially when >600. In addition to minimizing VA-AKI risk while maintaining similar efficacy, AUC-guided dosing/monitoring is a more precise way to conduct therapeutic drug monitoring for vancomycin relative to trough-only control. Abstract : Vancomycin Area Under the Curve (AUC)-guided monitoring is now recommended for patients with serious Methicillin-Resistant Staphylococcus aureus infections to minimize vancomycin-associated acute kidney injury (VA-AKI) while maintaining effectiveness. Data indicate that AUC drives VA-AKI, trough is an imprecise measurement of AUC, and AUC monitoring minimizes VA-AKI.