Lab Med Online.  2022 Oct;12(4):285-291. 10.47429/lmo.2022.12.4.285.

Comparison of Trough-Based and Area Under the Curve-Based Therapeutic Drug Monitoring of Vancomycin: An In Silico Study

• Yoon E
• Lee HS
• Park HD
• Lee SY

• KMID: 2538616
• DOI: http://doi.org/10.47429/lmo.2022.12.4.285

Abstract

Background
Recent American guideline published in 2020 recommend using 24-h area under the curve (AUC)/minimum inhibitory concentration instead of vancomycin serum concentration (C_trough) for vancomycin therapeutic drug monitoring (TDM). However, C_trough-based TDM is widely used in clinical practice. Thus, this retrospective study aimed to compare C_trough-based and AUC-based TDM.
Methods
We evaluated patients’ TDM data with at least one vancomycin trough measurement. Patients younger than 18 years, admitted to an intensive care unit, or on renal replacement therapy were excluded. The variables of C_trough-based and AUC-based TDM were simulated using MwPharm++ (Mediware, Czech Republic) with vancomycin two-compartment model. The therapeutic range was 400-600 mg*h/L and 15-20 mg/L for AUC and C_trough, respectively. We evaluated the correlation between C_trough and AUC, the attainment rate of AUC target range, and changes in vancomycin dose and C_trough when AUC-based TDM is applied.
Results
One hundred and four patients were enrolled. C_trough and AUC correlated moderately (R=0.707, P<0.001). Among 31 patients with C_trough of 15-20 mg/L, the AUC of only 18 patients was within the target range (18/31, 58.1%). In addition, most patients with C_trough of 10-15 mg/L had the AUC within the target range (57/66, 86.4%). The respective vancomycin dose and C_trough were expected to be significantly lower in AUC-based TDM simulation than those in C_trough-based TDM simulation
Conclusions
C_trough of 15-20 mg/L for vancomycin monitoring is not appropriate for attaining AUC target range. Targeting either AUC or lower C_trough is recommended for vancomycin TDM.

Keyword

Vancomycin; Vancomycin; Therapeutic drug monitoring; Therapeutic drug monitoring; Trough concentration; Trough concentration; Area under the curve; Area under the curve

Figure

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  Fig. 1 Correlation between estimated Ctrough and AUC (N=104). Regression line with 95% CI is shown. Abbreviations: Ctrough, serum vancomycin trough concentration; AUC, area under the curve for 24 h; CI, confidence interval.

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  Fig. 2 Comparison of (A) vancomycin dosage per kg and (B) serum vancomycin trough concentration by monitoring target (N=28). The monitoring target is defined as follows: Ctrough, serum vancomycin trough concentration of 15-20 mg/L; AUC400, AUC/MIC 400; AUC500, AUC/MIC 500; and AUC600, AUC/MIC 600, with MIC assumed to be 1 mg/L. Abbreviations: AUC, area under the curve for 24 h; MIC, minimum inhibitory concentration; Ctrough, serum vancomycin trough concentration.

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