June 21, 2023
Comparing Different Modalities for AUC Monitoring for Vancomycin DosingBy Daniel Mendoza, MD
Current guidelines recommend using area-under-the-curve (AUC) monitoring for vancomycin dosing as it can be associated with reduced rates of acute kidney injury (AKI). Knight et al. compared the incidence of AKI among three vancomycin dosing modalities: AUC-targeted Bayesian pharmacokinetic software, an AUC-targeted empiric dosing nomogram, and trough-guided dosing using pharmacists’ judgment.
This retrospective study included adults who received ≥1 dose of vancomycin and ≥1 serum vancomycin level documented between Jan. 1, 2018, and Dec. 31, 2019. Patients with baseline serum creatinine ≥2 mg/dL, weighing ≥100 kg, receiving renal replacement therapy, having AKI prior to vancomycin therapy, or who had vancomycin ordered only for surgical prophylaxis were excluded. The primary outcome was incidence of AKI adjusted for baseline serum creatinine, age, and intensive care unit admission. A secondary outcome was adjusted incidence of an abnormal trough value (<10 or >20 μg/mL).
The study included 3,459 encounters. Incidence of AKI was 21% for Bayesian software (n = 659), 22% for the nomogram (n = 303), and 32% for trough-guided dosing (n = 2497). Compared with trough-guided dosing, incidence of AKI was lower in the Bayesian (adjusted odds ratio [OR] = 0.72, 95% confidence interval [CI]: 0.58-0.89) and the nomogram (adjusted OR = 0.71, 95% CI: 0.53-0.95) groups. Compared with trough-guided dosing, abnormal trough values were less common in the Bayesian group (adjusted OR = 0.83, 95% CI: 0.69-0.98) but not significantly different with the nomogram group.
The authors concluded that using AUC-guided Bayesian software could reduce the incidence of AKI and abnormal trough values compared with trough-guided dosing. However, an important limitation of the study is the absence of adjustment in the analysis for comorbidities and medications that could affect kidney function.
(Knight et al. Ann Pharmacother. Published online: May 5, 2023.)
