| DOI: DOI:10.29090/psa.2024.04.24.AP0574 | Pharm Sci Asia 2024; 51(4), 349-359 |
Evaluation on therapeutic monitoring of vancomycin using the 2020 consensus guideline at one teaching hospital at Ho Chi Minh CityAnh Thi Kim Nguyen1, Khue Nguyen Y Ha1, Trang Nguyen Doan Dang1,2,*
1 Department of Clinical Pharmacy, Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
2
Department of Pharmacy, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
According to the 2020 vancomycin updated consensus guideline, the ratio of 24-hour area under the concentration-time curve to minimum inhibitory concentration (AUC24/MIC) was considered a better surrogate marker of efficacy than trough concentration (Ctrough) in serious MRSA infections. This study aimed to investigate the implementation of vancomycin therapeutic drug monitoring following the updated guideline and determine the association between different ranges of Ctrough and the attainment of AUC24/MIC target among patients treated at University Medical Center Ho Chi Minh City (UMC HCMC). A cross-sectional study was conducted among hospitalized adult patients receiving intravenous vancomycin for severe infections at UMC HCMC from May 2020 to Aril 2021. AUC24 was estimated using first-order pharmacokinetic equation with Sawchuk-Zaske model. Linear regression analysis was used to estimate Ctrough and AUC24 correlation. Ninety-five patients, including 27 patients in ICU group and 68 patients in non-ICU group, were enrolled in the study. The volume of distribution in ICU and non-ICU groups were 1.08 ± 0.36 L/kg and 0.95 ± 0.36 L/kg, respectively. Vancomycin clearance in ICU was lower than that in non-ICU (3.56 (IQR 1.38; 19.8) L/h vs. 6.07 (IQR 2.30; 13.3) L/h, p < 0.001). The mean Ctrough was 10.9 ± 5.4 mg/L and the mean AUC24/MIC was 412.3 ± 176.2. The proportions of patients achieving an AUC24 within the targeted range in the Ctrough <15 mg/L group and Ctrough 15 – 20 mg/L group were 35.1% and 70.0%, respectively. Nephrotoxicity occurred in 10.5% of patients. Logistic regression analyses suggested the association between CrCL < 50 mg/L and the possibility of achieving AUC24/MIC target (OR = 2.712; 95% CI 1.093 – 6.726; p = 0.031). Our findings indicate that an AUC24/MIC-based dosing strategy may help limit unnecessary vancomycin exposure, providing valuable data to inform updates to the current vancomycin therapeutic drug monitoring guideline at UMC HCMC.
Keyword:
vancomycin, pharmacokinetics, therapeutic drug monitoring, pharmacodynamics, infectious diseases
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