Author(s)

Chelsea A. Schneider^1*, William Rodriguez¹, Jenny Martinez¹, William R. Wolowich²

¹Department of Pharmacy, Mount Sinai Medical Center, Miami Beach, Florida, USA.
²Department of Pharmacy Practice Nova Southeastern University, Fort Lauderdale, Florida, USA.

Background: The 2020 consensus guidelines recommend AUC guided dosing as the preferred monitoring method for vancomycin. AUC based dosing has shown to reduce incidence of acute kidney injury (AKI), utilize lower daily doses in obese patients, and maintain efficacy. Several institutions have adjusted their protocols to utilize AUC guided dosing. However, there are limited studies comparing the clinical outcomes of AUC versus trough monitoring. Methods: This was a retrospective, observational, single centered study. The primary outcome was to evaluate the clinical success of AUC dosing versus trough based dosing of vancomycin for MRSA infections using a composite outcome of afebrile post treatment (<100.4 for ≥48 hour as defined by the Centers for Disease Control and Prevention), decrease in white blood cell counts (WBC) to baseline, and culture clearance (negative cultures post treatment). Secondary outcomes included occurrence of AKI, number of patients that reached therapeutic goal, time to therapeutic goal, average total levels collected per course, and the average number of dose adjustments per course. Results: Forty-seven patients were included in this study, 17 in the AUC group and 30 in the trough group. The primary composite outcome showed a significant benefit of AUC dosing (p = 0.04). The composite component culture clearance showed the largest improvement for the AUC group when compared with the trough group (p = 0.03). More patients achieved therapeutic target attainment and reached the target sooner (3 days versus 4 days, p = 0.2) in the AUC group. Over the study course, 94.1% of patients in the AUC group were considered therapeutic compared to 63.8% in the trough group (p = 0.03). Vancomycin levels were collected less frequently in the AUC group (3 versus 4, p = 0.2). Conclusion: The outcomes of this study may suggest AUC guided dosing as a beneficial alternative to trough based dosing. AUC based dosing may improve clinical success which can be further explored in larger prospective clinical trials.

AUC, MRSA, Pharmacokinetics, Trough Based Dosing, Vancomycin

Schneider, C. , Rodriguez, W. , Martinez, J. and Wolowich, W. (2023) Evaluating Vancomycin Clinical Outcomes Using Area under the Curve versus Trough Based Dosing Strategies. Advances in Infectious Diseases, 13, 442-451. doi: 10.4236/aid.2023.133036.