In Outpatients Receiving Parenteral Vancomycin, Dosing Adjustments Produced by Area Under the Curve-Based and Trough-Based Monitoring Differ Only at the Extremes of the Therapeutic Trough Range

Yufei Shi; Bryan T Alexander; Sean Avedissian; Scott J Bergman; Nicolás Cortés-Penfield

doi:10.1093/ofid/ofac696

In Outpatients Receiving Parenteral Vancomycin, Dosing Adjustments Produced by Area Under the Curve-Based and Trough-Based Monitoring Differ Only at the Extremes of the Therapeutic Trough Range

Open Forum Infect Dis. 2023 Jan 7;10(2):ofac696. doi: 10.1093/ofid/ofac696. eCollection 2023 Feb.

Authors

Yufei Shi¹, Bryan T Alexander², Sean Avedissian^{1

3}, Scott J Bergman^{1

2}, Nicolás Cortés-Penfield^{4

5}

Affiliations

¹ University of Nebraska Medical Center, College of Pharmacy, Omaha, Nebraska, USA.
² Department of Pharmacy, Nebraska Medicine, Omaha, Nebraska, USA.
³ Antiviral Pharmacology Laboratory, University of Nebraska Medical Center, Omaha, Nebraska, USA.
⁴ University of Nebraska Medical Center College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA.
⁵ Department Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA.

Abstract

Area under the curve (AUC)-based vancomycin dosing reduces nephrotoxicity but is burdensome. Reviewing 115 adults receiving ≥2 weeks of outpatient vancomycin, we found AUC-based and trough-based dose adjustments discordant only for troughs <12 or >16 mg/L. Selective versus universal outpatient AUC calculation would likely offer similar benefit with reduced workload.

Keywords: OPAT; monitoring; nephrotoxicity; therapeutic dose monitoring; vancomycin.