Comparison of AUC-Guided Versus Trough-Guided Vancomycin Dosing in Adult Patients
Year: 2016
Type: article
Abstract: Background. IDSA guidelines suggest vancomycin 40–60 mg/kg day and troughs of 10–20 mg/L. We hypothesized that Bayesian-controlled dosing with an AUC target would permit lower doses and troughs. Methods. This was a single center, prospective study of inpatient adults receiving IV vancomycin with ≥1 trough prior to enrollment. Cohorts were as follows. Year 1: Predict vancomycin levels using a non-parametric population model and the BestDose software, with no dose control. Year 2: BestDose control of dosing to achieve AUC:MIC ≥400 (max AUC 800), with unknown MIC set to 1 mg/L. All prior troughs generated each subject's Bayesian posterior model for each dose calculation. Year 3: Use BestDose's MMopt algorithm to obtain individually, optimally timed samples for dosing control. We calculated the prediction bias of each level by excluding it (i.e. using all prior levels in a subject) when generating the Bayesian posterior. Results. In cohorts (years) 1, 2 and 3 there were 83, 90 and 70 evaluable subjects. The median (range) age was 50 (18–93) years, with 62% males. Weight was 76 (15–194) kg. Age (P = 0.10), sex (P = 0.36) and weight (P = 0.63) were similar across years. Planned MMopt sample times in cohort 3 were 10 peaks, 29 troughs, and 30 others. a%bias = (pred-obs)/obs, IQR = interquartile range bBy infection and guidelines cAUC:MIC ≥400 or ≥300 and responding and AUC <800 dCreatinine rise >0.5 mg/dL or >50% from baseline eRelapse in resolved symptoms ≤72 hours after stopping vancomycin Conclusion. Our institution underdoses vancomycin with 70% troughs sub-therapeutic by guidelines. However by AUC, 80% are therapeutic. BestDose Bayesian control nevertheless significantly reduced the number of troughs >20 mg/L and nephrotoxicity. Hospitals with more aggressive dosing would see even greater benefit. Disclosures. All authors: No reported disclosures
Source: Open Forum Infectious Diseases
Language: English
Subfield: Pharmacology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,053
OpenAlex ID: W2561981947