Ariane Du Sault1, Marc Parent2, Chantale Simard3. 1. , PharmD, was, at the time of writing, a Pharmacy Practice Resident at CHU de Québec-Université Laval - Hôpital Saint-François d'Assise, Université Laval, Québec, Quebec. She is now a Pharmacist with the Department of Pharmacy, Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec - Centre hospitalier affilié universitaire régional, Trois-Rivières, Quebec. 2. , BPharm, DPH, MSc, is a Pharmacist with the Department of Pharmacy, CHU de Québec-Université Laval - Hôpital Saint-François d'Assise, and the Faculty of Pharmacy, Université Laval, Québec, Quebec. 3. , BPharm, MSc, PhD, is a Full Professor with the Faculty of Pharmacy, Université Laval, and an Investigator with the Research Centre of the Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Université Laval, Québec, Quebec.
Abstract
Background: The most recent vancomycin monitoring guideline recommends targeting a value for area under the curve (AUC) of 400 to 600 mg*h/L, with an assumed minimum inhibitory concentration (MIC) of 1 mg/L. Few studies have investigated the effect of this method on vancomycin dosing regimens, relative to a target trough concentration of 15 to 20 mg/L. Objective: To compare vancomycin dosing regimens generated with the 2 monitoring methods. Methods: This retrospective chart review included hospitalized patients who received vancomycin between May 2019 and April 2020. The dosing regimens were compared, with the paired Student t test, in terms of unit dose, daily dose, and dosing interval. Variables of interest were collected from electronic medical charts. A pharmacy resident used first-order pharmacokinetic equations to determine dosing regimens based on AUC monitoring. Local pharmacists retrospectively determined dosing regimens for trough-based monitoring. Results: Of 100 courses of treatment initially identified, 66 were included in the analysis. The unit dose was similar with the 2 methods (1086 mg with AUC-based monitoring versus 1100 mg with trough-based monitoring; p = 0.62). AUC monitoring was associated with a 12.8% lower daily dose (2294 mg versus 2630 mg; p < 0.001) and a 13.5% longer dosing interval (13.24 h versus 11.67 h; p < 0.001) relative to trough-based monitoring. AUC monitoring also generated a lower extrapolated trough concentration (12.90 mg/L versus 16.22 mg/L; p < 0.001). Conclusions: A target trough concentration of 15 to 20 mg/L was confirmed as being unnecessarily high. AUC monitoring could allow a reduction in daily vancomycin dose and an extension of the dosing interval relative to trough-based monitoring. 2022 Canadian Society of Hospital Pharmacists. All content in the Canadian Journal of Hospital Pharmacy is copyrighted by the Canadian Society of Hospital Pharmacy. In submitting their manuscripts, the authors transfer, assign, and otherwise convey all copyright ownership to CSHP.
Background: The most recent vancomycin monitoring guideline recommends targeting a value for area under the curve (AUC) of 400 to 600 mg*h/L, with an assumed minimum inhibitory concentration (MIC) of 1 mg/L. Few studies have investigated the effect of this method on vancomycin dosing regimens, relative to a target trough concentration of 15 to 20 mg/L. Objective: To compare vancomycin dosing regimens generated with the 2 monitoring methods. Methods: This retrospective chart review included hospitalized patients who received vancomycin between May 2019 and April 2020. The dosing regimens were compared, with the paired Student t test, in terms of unit dose, daily dose, and dosing interval. Variables of interest were collected from electronic medical charts. A pharmacy resident used first-order pharmacokinetic equations to determine dosing regimens based on AUC monitoring. Local pharmacists retrospectively determined dosing regimens for trough-based monitoring. Results: Of 100 courses of treatment initially identified, 66 were included in the analysis. The unit dose was similar with the 2 methods (1086 mg with AUC-based monitoring versus 1100 mg with trough-based monitoring; p = 0.62). AUC monitoring was associated with a 12.8% lower daily dose (2294 mg versus 2630 mg; p < 0.001) and a 13.5% longer dosing interval (13.24 h versus 11.67 h; p < 0.001) relative to trough-based monitoring. AUC monitoring also generated a lower extrapolated trough concentration (12.90 mg/L versus 16.22 mg/L; p < 0.001). Conclusions: A target trough concentration of 15 to 20 mg/L was confirmed as being unnecessarily high. AUC monitoring could allow a reduction in daily vancomycin dose and an extension of the dosing interval relative to trough-based monitoring. 2022 Canadian Society of Hospital Pharmacists. All content in the Canadian Journal of Hospital Pharmacy is copyrighted by the Canadian Society of Hospital Pharmacy. In submitting their manuscripts, the authors transfer, assign, and otherwise convey all copyright ownership to CSHP.
Entities:
Keywords:
area under the curve; drug regimen; pharmacocinétique; pharmacodynamic; pharmacodynamique; pharmacokinetics; schéma thérapeutique; suivi thérapeutique médicamenteux; surface sous la courbe; therapeutic drug monitoring; vancomycin; vancomycine
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