Trough levels don't cut it for vancomycin dosing in seriously ill patients.

Abstract

Pharmacists need to use area under the curve (AUC)–guided monitoring of vancomycin dosing when treating serious infections caused by methicillin-resistant Staphylococcus aureus (MRSA), says Michael J. Rybak, professor of pharmacy and medicine at Wayne State University in Detroit, MI. Michael J. Rybak Rybak, the lead author of consensus guidelines published last year in AJHP, made the case for AUC-guided monitoring over trough level monitoring during the December 8, 2021, Midyear session “Demystifying the Vancomycin Guidelines.” Thomas Lodise For empiric vancomycin dosing in adults and pediatric patients, the guidelines recommend an AUC/minimum inhibitory (MIC) ratio of 400 to 600, using a MIC value of 1 mg/L as determined by broth microdilution. Rybak said the guidelines were developed in response to “indisputable” evidence that overexposure to vancomycin causes acute kidney injury and growing concern that trough levels are “an imprecise measurement of the daily AUC.” He explained that pharmacists who rely on...