Therapeutic monitoring of vancomycin in adult patients: A consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists

2009 ◽  
Vol 66 (1) ◽  
pp. 82-98 ◽  
Author(s):  
Michael Rybak ◽  
Ben Lomaestro ◽  
John C. Rotschafer ◽  
Robert Moellering ◽  
William Craig ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Health System ◽  
Adult Patients ◽  
Therapeutic Monitoring ◽  
American Society

scholarly journals Clinical Guideline Highlights for the Hospitalist: Therapeutic Monitoring of Vancomycin

2020 ◽  
Vol 15 (12) ◽  
pp. 740-742
Author(s):  
Mark Murphy ◽  
Sonya Tang Girdwood ◽  
Marc H Scheetz
Keyword(s):  
Staphylococcus Aureus ◽  
Infectious Diseases ◽  
Health System ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Clinical Guideline ◽  
Target Population ◽  
Therapeutic Monitoring ◽  
Release Date ◽  
Methicillin Resistant ◽  
American Society

GUIDELINE TITLE: Therapeutic monitoring of vancomycin for serious methicillin-resistant Staphylococcus aureus infections: A revised consensus guideline and review by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists RELEASE DATE: Online: March 19, 2020 PRIOR VERSION: 2009 DEVELOPERS: American Society of Health-System Pharmacists (ASHP), the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Diseases Society (PIDS), and the Society of Infectious Diseases Pharmacists (SIDP) FUNDING SOURCE: ASHP, IDSA, PIDS, SIDP TARGET POPULATION: Adults, children, and neonates treated for documented or presumed methicillin-resistant Staphylococcus aureus infection

scholarly journals Therapeutic Monitoring of Vancomycin for Serious Methicillin-resistant Staphylococcus aureus Infections: A Revised Consensus Guideline and Review by the American Society of Health-system Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists

2020 ◽  
Vol 71 (6) ◽  
pp. 1361-1364 ◽  
Author(s):  
Michael J Rybak ◽  
Jennifer Le ◽  
Thomas P Lodise ◽  
Donald P Levine ◽  
John S Bradley ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Infectious Diseases ◽  
Health System ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Surrogate Marker ◽  
Therapeutic Monitoring ◽  
Target Area ◽  
Consensus Guidelines ◽  
Methicillin Resistant ◽  
American Society

Abstract Recent clinical data on vancomycin pharmacokinetics and pharmacodynamics suggest a reevaluation of current dosing and monitoring recommendations. The previous 2009 vancomycin consensus guidelines recommend trough monitoring as a surrogate marker for the target area under the curve over 24 hours to minimum inhibitory concentration (AUC/MIC). However, recent data suggest that trough monitoring is associated with higher nephrotoxicity. This document is an executive summary of the new vancomycin consensus guidelines for vancomycin dosing and monitoring. It was developed by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists vancomycin consensus guidelines committee. These consensus guidelines recommend an AUC/MIC ratio of 400–600 mg*hour/L (assuming a broth microdilution MIC of 1 mg/L) to achieve clinical efficacy and ensure safety for patients being treated for serious methicillin-resistant Staphylococcus aureus infections.

scholarly journals Vancomycin Therapeutic Drug Monitoring in Children: New Recommendations, Similar Challenges

2020 ◽  
Vol 25 (6) ◽  
pp. 472-475
Author(s):  
J. Chase McNeil ◽  
Sheldon L. Kaplan
Keyword(s):  
Infectious Diseases ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Kidney Injury ◽  
Therapeutic Monitoring ◽  
Therapeutic Drug ◽  
Therapeutic Success ◽  
Monitoring Strategies ◽  
Vancomycin Trough ◽  
Trough Concentrations ◽  
American Society

The American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists have recently published revised guidelines for the therapeutic monitoring of vancomycin. Previous iterations of the guideline largely focused on targeting vancomycin trough concentrations (VTCs) in the range of 15 to 20 mg/L for therapeutic efficacy. The revised guidelines shift the focus of therapeutic monitoring directly to AUC/MIC-based therapeutic monitoring for children, with a suggestion of a goal AUC/MIC 400 to 800. The primary hesitation in applying these recommendations to children stems from the absence of pediatric clinical data demonstrating correlations with clinical outcomes and either VTC or AUC and no benefit in other secondary outcomes (e.g., recurrence, duration of bacteremia). One can glean indirectly from this that such aggressive dosing and monitoring strategies are unnecessary to achieve therapeutic success in the majority of children with serious methicillin-resistant Staphylococcus aureus infections. Providers should carefully weigh the potential unknown benefits of targeting vancomycin AUC 400 to 800 mg*hr/L in children with the known risks of acute kidney injury associated with increasing the dose of vancomycin as well as the substantial time, effort, and costs of this process.

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