American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists · 2026
Implementation of vancomycin area under the curve therapeutic drug monitoring: Evaluation of procedural changes at a multihospital community health system.
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Morton Samuel, Cubillos Ashley, Saunders Mary Beth, Chandler Elisabeth
Аннотация
PURPOSE: Therapeutic drug monitoring (TDM) of vancomycin using the ratio of the area under the curve to the minimum inhibitory concentration (AUC/MIC) is recommended but poses practical challenges. Our community health system implemented AUC-based vancomycin monitoring in 2020 and aimed to assess its impact on clinical and operational outcomes.
METHODS: This retrospective, quasi-experimental study included 2 arms: trough-based monitoring and AUC-based monitoring. The primary outcome was the time to attainment of the therapeutic target, defined as attainment of an AUC/MIC ratio of 400 to 600 for the AUC-based monitoring arm or attainment of a trough concentration of 15-20 µg/mL for the trough-based monitoring arm. Additional endpoints included treatment failure, vancomycin dose, dose adjustments, and acute kidney injury (AKI).
RESULTS: A total of 150 patients (75 per arm) were included, with similar characteristics in both groups: 63% male, average age of 60 years, and common indications of bacteremia, pneumonia, and osteomyelitis. The AUC-based monitoring arm had significantly faster therapeutic target attainment (median, 38 hours vs 62 hours; P < 0.01) and a higher rate of target attainment at first steady-state levels (66.7% vs 22.7%, P < 0.01). No significant differences were observed in vancomycin duration, average daily dose, or AKI. AUC-based vancomycin monitoring resulted in more rapid therapeutic target attainment when compared to trough-based monitoring, resulting in fewer dose adjustments (median, 1 [IQR, 0.0-1.0] vs 1 [IQR, 1.0-2.0]; P < 0.01).
CONCLUSION: The implementation of AUC-based vancomycin monitoring in our community health system led to faster attainment of therapeutic targets, with fewer dose adjustments, suggesting potential for improved clinical efficiency. Further studies are needed to directly assess the impact on patient outcomes.
METHODS: This retrospective, quasi-experimental study included 2 arms: trough-based monitoring and AUC-based monitoring. The primary outcome was the time to attainment of the therapeutic target, defined as attainment of an AUC/MIC ratio of 400 to 600 for the AUC-based monitoring arm or attainment of a trough concentration of 15-20 µg/mL for the trough-based monitoring arm. Additional endpoints included treatment failure, vancomycin dose, dose adjustments, and acute kidney injury (AKI).
RESULTS: A total of 150 patients (75 per arm) were included, with similar characteristics in both groups: 63% male, average age of 60 years, and common indications of bacteremia, pneumonia, and osteomyelitis. The AUC-based monitoring arm had significantly faster therapeutic target attainment (median, 38 hours vs 62 hours; P < 0.01) and a higher rate of target attainment at first steady-state levels (66.7% vs 22.7%, P < 0.01). No significant differences were observed in vancomycin duration, average daily dose, or AKI. AUC-based vancomycin monitoring resulted in more rapid therapeutic target attainment when compared to trough-based monitoring, resulting in fewer dose adjustments (median, 1 [IQR, 0.0-1.0] vs 1 [IQR, 1.0-2.0]; P < 0.01).
CONCLUSION: The implementation of AUC-based vancomycin monitoring in our community health system led to faster attainment of therapeutic targets, with fewer dose adjustments, suggesting potential for improved clinical efficiency. Further studies are needed to directly assess the impact on patient outcomes.