Underestimation of the Calculated Area Under the Concentration-Time Curve Based on Serum Creatinine for Vancomycin Dosing
نویسندگان
چکیده
BACKGROUND The ratio of the steady-state 24-hour area under the concentration-time curve (ssAUC24) to the MIC (AUC24/MIC) for vancomycin has been recommended as the preferred pharmacodynamic index. The aim of this study was to assess whether the calculated AUC24 (cAUC24) using the creatinine clearance (CLcr) differs from the ssAUC24 based on the individual pharmacokinetic data estimated by a commercial software. MATERIALS AND METHODS The cAUC24 was compared with the ssAUC24 with respect to age, body mass index, and trough concentration of vancomycin and the results were expressed as median and interquartile ranges. A correlation between the cAUC24 and ssAUC24 and the trough concentration of vancomycin was evaluated. The probability of reaching an AUC24/MIC of 400 or higher was compared between the cAUC24 and ssAUC24 for different MICs of vancomycin and different daily doses by simulation in a subgroup with a trough concentration of 10 mg/L and higher. RESULTS The cAUC24 was significantly lower than the ssAUC24 (392.38 vs. 418.32 mg·hr/L, P < 0.0001) and correlated weakly with the trough concentration (r = 0.649 vs. r = 0.964). Assuming a MIC of 1.0 mg/L, the probability of reaching the value of 400 or higher was 77.5% for the cAUC24/MIC and 100% for the ssAUC24/MIC in patients with a trough concentration of 10 mg/L and higher. If the MIC increased to 2.0 mg/L, the probability was 57.7% for the cAUC24/MIC and 71.8% for the ssAUC24/MIC at a daily vancomycin dose of 4,000 mg. CONCLUSIONS The cAUC24 using the calculated CLcr is usually underestimated compared with the ssAUC24 based on individual pharmacokinetic data. Therefore, to obtain a more accurate AUC24, therapeutic monitoring of vancomycin rather than a simple calculation based on the CLcr should be performed, and a more accurate biomarker for renal function is needed.
منابع مشابه
Association between vancomycin trough concentration and area under the concentration-time curve in neonates.
National treatment guidelines for invasive methicillin-resistant Staphylococcus aureus (MRSA) infections recommend targeting a vancomycin 24-h area under the concentration-time curve (AUC0-24)-to-MIC ratio of >400. The range of vancomycin trough concentrations that best predicts an AUC0-24 of >400 in neonates is not known. This understanding would help clarify target trough concentrations in ne...
متن کاملEvaluation of Vancomycin Dosing and Corresponding Drug Concentrations in Pediatric Patients
ABBREVIATIONS AUC: area under the curve IDSA: Infectious Diseases Society of America MIC: minimum inhibitory concentration MRSA: methicillin-resistant Staphylococcus aureus SCr: serum creatinine VIN: vancomycin-induced nephrotoxicity Dr Geerlof wrote the fi rst draft of the manuscript and made substantive contributions to the study; Dr Boucher made substantive contributions to the study; and bo...
متن کاملEvaluation of Vancomycin Dosing and Corresponding Drug Concentrations in Pediatric Patients
ABBREVIATIONS AUC: area under the curve IDSA: Infectious Diseases Society of America MIC: minimum inhibitory concentration MRSA: methicillin-resistant Staphylococcus aureus SCr: serum creatinine VIN: vancomycin-induced nephrotoxicity Dr Geerlof wrote the fi rst draft of the manuscript and made substantive contributions to the study; Dr Boucher made substantive contributions to the study; and bo...
متن کاملA Prospective Study to Assess Vancomycin Serum Concentrations in Pediatric Patients with Current Dosing Guidelines
Concerns about increasing bacterial resistance to vancomycin, have caused the adult treatment guidelines to recommend higher trough concentrations based on the type and location of infectious disease. Although these recommendations are not specific to children, the values can be extrapolated. This prospective study was designed to evaluate efficacy of current vancomycin dosing recommendations t...
متن کاملA Prospective Study to Assess Vancomycin Serum Concentrations in Pediatric Patients with Current Dosing Guidelines
Concerns about increasing bacterial resistance to vancomycin, have caused the adult treatment guidelines to recommend higher trough concentrations based on the type and location of infectious disease. Although these recommendations are not specific to children, the values can be extrapolated. This prospective study was designed to evaluate efficacy of current vancomycin dosing recommendations t...
متن کامل