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, David E Nix, PharmD, BCPS Department of Pharmacy Practice & Science and Department of Medicine, University of Arizona , Tucson, AZ , USA Address correspondence to Dr. Nix (nix@pharmacy.arizona.edu). Search for other works by this author on: Oxford Academic Lisa E Davis, PharmD, BCPS, BCOP Department of Pharmacy Practice & Science, University of Arizona , Tucson, AZ , USA Search for other works by this author on: Oxford Academic Kathryn R Matthias, PharmD, BCPS, BCIDP Department of Pharmacy Practice & Science, University of Arizona , Tucson, AZ , USA Search for other works by this author on: Oxford Academic
https://orcid.org/0000-0002-9440-465X American Journal of Health-System Pharmacy, Volume 79, Issue 7, 1 April 2022, Pages 534–539, https://doi.org/10.1093/ajhp/zxab457
Published:
27 November 2021
Article history
Published:
27 November 2021
Corrected and typeset:
11 February 2022
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David E Nix, Lisa E Davis, Kathryn R Matthias, The relationship of vancomycin 24-hour AUC and trough concentration, American Journal of Health-System Pharmacy, Volume 79, Issue 7, 1 April 2022, Pages 534–539, https://doi.org/10.1093/ajhp/zxab457
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Abstract
Purpose
Prior to the 2020 release of a joint consensus guideline on monitoring of vancomycin therapy for serious methicillin-resistant Staphylococcus aureus (MRSA) infections, clinicians had escalated vancomycin doses for 2 decades while targeting trough concentrations of 15 to 20 µg/mL, leading to an increased frequency of nephrotoxicity. For MRSA infections, the 2020 guideline recommends adjusting doses to achieve a 24-hour area under the concentration-time curve (AUC) of 400 to 600 µg · h/mL; however, monitoring of trough concentrations has been entrenched for 3 decades. Calculating dose regimens based on AUC will require obtaining an increased number of vancomycin serum concentrations and, possibly, advanced software. The aim of this investigation was to determine the relationship between AUC and trough concentration and the influence of dosing regimen on goal achievement.
Methods
The relationship between trough concentration and AUC was explored through derivation of an equation based on a 1-compartment model and simulations.
Results
24-hour AUC is related to dosing interval divided by half-life in a nonlinear fashion. The target trough concentration can be individualized to achieve a desired AUC range, and limiting use of large doses (>15-20 mg/kg) can protect against excessive 24-hour AUC with trough-only monitoring.
Conclusion
After initially determining pharmaco*kinetic parameters, subsequent monitoring of AUC can be accomplished using trough concentrations only. Trough concentration may be used as a surrogate for AUC, although the acceptable target trough concentration will vary depending on dosing interval and elimination rate constant. This work included development of an AUC-trough equation to establish a patient-specific target for steady-state trough concentration.
AUC, dosing, monitoring, pharmaco*kinetics, trough, vancomycin
© American Society of Health-System Pharmacists 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)
Issue Section:
Therapy Update
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