Michael J Rybak1,2,3, Jennifer Le4, Thomas P Lodise5,6, Donald P Levine2,3, John S Bradley7,8, Catherine Liu9,10, Bruce A Mueller11, Manjunath P Pai11, Annie Wong-Beringer12, John C Rotschafer13, Keith A Rodvold14, Holly D Maples15, Benjamin M Lomaestro6. 1. Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy & Health Sciences, Wayne State University, Detroit, Michigan. 2. School of Medicine, Wayne State University, Detroit, Michigan, United States. 3. Detroit Receiving Hospital, Detroit, Michigan. 4. Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, California. 5. Albany College of Pharmacy and Health Sciences, Albany, New York, United States. 6. Albany Medical Center Hospital, Albany, New York. 7. Division of Infectious Diseases, Department of Pediatrics, University of California at San Diego, La Jolla, California. 8. Rady Children's Hospital San Diego, San Diego, California. 9. Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington. 10. Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington. 11. University of Michigan College of Pharmacy, Ann Arbor, Michigan. 12. University of Southern California School of Pharmacy, Los Angeles, California. 13. University of Minnesota College of Pharmacy, Minneapolis, Minnesota. 14. University of Illinois College of Pharmacy, Chicago, Illinois. 15. College of Pharmacy & Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Abstract
BACKGROUND: Recent vancomycin PK/PD and toxicodynamic studies enable a reassessment of the current dosing and monitoring guideline in an attempt to further optimize the efficacy and safety of vancomycin therapy. The area-under-the-curve to minimum inhibitory concentration (AUC/MIC) has been identified as the most appropriate pharmacokinetic/pharmacodynamic (PK/PD) target for vancomycin. The 2009 vancomycin consenus guidelines recommended specific trough concentrations as a surrogate marker for AUC/MIC. However, more recent toxicodynamic studies have reported an increase in nephrotoxicity associated with trough monitoring. METHODS AND RESULTS: This is the executive summary of the new vancomycin consensus guidelines for dosing and monitoring vancomycin therapy and was developed by the American Society of Health-Systems Pharmacists, Infectious Diseases Society of America, Pediatric Infectious Diseases Society and the Society of Infectious Diseases Pharmacists vancomycin consensus guidelines committee. CONCLUSIONS: The recommendations provided in this document are intended to assist the clinician in optimizing vancomycin for the treatment of invasive MRSA infections in adult and pediatric patients. An AUC/MIC by broth microdilution (BMD) ratio of 400 to 600 (assuming MICBMD of 1 mg/L) should be advocated as the target to achieve clinical efficacy while improving patient safety for patients with serious MRSA infections. In such cases, AUC-guided dosing and monitoring is the most accurate and optimal way to manage vancomycin therapy.
BACKGROUND: Recent vancomycin PK/PD and toxicodynamic studies enable a reassessment of the current dosing and monitoring guideline in an attempt to further optimize the efficacy and safety of vancomycin therapy. The area-under-the-curve to minimum inhibitory concentration (AUC/MIC) has been identified as the most appropriate pharmacokinetic/pharmacodynamic (PK/PD) target for vancomycin. The 2009 vancomycin consenus guidelines recommended specific trough concentrations as a surrogate marker for AUC/MIC. However, more recent toxicodynamic studies have reported an increase in nephrotoxicity associated with trough monitoring. METHODS AND RESULTS: This is the executive summary of the new vancomycin consensus guidelines for dosing and monitoring vancomycin therapy and was developed by the American Society of Health-Systems Pharmacists, Infectious Diseases Society of America, Pediatric Infectious Diseases Society and the Society of Infectious Diseases Pharmacists vancomycin consensus guidelines committee. CONCLUSIONS: The recommendations provided in this document are intended to assist the clinician in optimizing vancomycin for the treatment of invasive MRSA infections in adult and pediatric patients. An AUC/MIC by broth microdilution (BMD) ratio of 400 to 600 (assuming MICBMD of 1 mg/L) should be advocated as the target to achieve clinical efficacy while improving patient safety for patients with serious MRSA infections. In such cases, AUC-guided dosing and monitoring is the most accurate and optimal way to manage vancomycin therapy.
Authors: Carolina Hikari Yamada; João Paulo Telles; Dayana Dos Santos Oliveira; Juliette Cieslinski; Victoria Stadler Tasca Ribeiro; Juliano Gasparetto; Felipe Francisco Tuon Journal: Braz J Infect Dis Date: 2020-08-05 Impact factor: 3.257