Stoessel Andrew M, Hale Cory M, Seabury Robert W, Miller Christopher D, Steele Jeffrey M
1 Department of Pharmacy, Upstate University Hospital, Syracuse, New York, NY, USA.
2 Department of Pharmacy, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA.
J Pharm Pract. 2019 Aug;32(4):442-446. doi: 10.1177/0897190018764564. Epub 2018 Mar 19.
This study aimed to assess the impact of area under the curve (AUC)-based vancomycin monitoring on pharmacist-initiated dose adjustments after transitioning from a trough-only to an AUC-based monitoring method at our institution.
A retrospective cohort study of patients treated with vancomycin for complicated methicillin-resistant (MRSA) infection between November 2013 and December 2016 was conducted. The frequency of pharmacist-initiated dose adjustments was assessed for patients monitored via trough-only and AUC-based approaches for trough ranges: 10 to 14.9 mg/L and 15 to 20 mg/L.
Fifty patients were included: 36 in the trough-based monitoring and 14 in the AUC-based-monitoring group. The vancomycin dose was increased in 71.4% of patients when troughs were 10 to 14.9 mg/L when a trough-only approach was used and in only 25% of patients when using AUC estimation ( = .048). In the AUC group, the dose was increased only when AUC/minimum inhibitory concentration (MIC) <400; unchanged regimens had an estimated AUC/MIC ≥400. The AUC-based monitoring did not significantly increase the frequency of dose reductions when trough concentrations were 15 to 20 mg/L (AUC: 33.3% vs trough: 4.6%; = .107).
The AUC-based monitoring resulted in fewer patients with dose adjustments when trough levels were 10 to 14.9 mg/L. The AUC-based monitoring has the potential to reduce unnecessary vancomycin exposure and warrants further investigation.
本研究旨在评估在我院从仅监测血药谷浓度过渡到基于曲线下面积（AUC）监测万古霉素后，基于AUC的万古霉素监测对药师发起的剂量调整的影响。
对2013年11月至2016年12月期间接受万古霉素治疗耐甲氧西林金黄色葡萄球菌（MRSA）复杂感染的患者进行回顾性队列研究。评估通过仅监测血药谷浓度和基于AUC的方法监测的患者的药师发起的剂量调整频率，血药谷浓度范围为10至14.9mg/L和15至20mg/L。
纳入50例患者：基于血药谷浓度监测的有36例，基于AUC监测的有14例。当仅采用监测血药谷浓度的方法且血药谷浓度为10至14.9mg/L时，71.4%的患者万古霉素剂量增加；而采用AUC估算时，仅25%的患者剂量增加（P = 0.048）。在AUC组中，仅当AUC/最低抑菌浓度（MIC）<400时剂量才增加；未改变治疗方案的患者估计AUC/MIC≥400。当血药谷浓度为15至20mg/L时，基于AUC的监测未显著增加剂量降低的频率（AUC：33.3% vs血药谷浓度：4.6%；P = 0.107）。
当血药谷浓度为10至14.9mg/L时，基于AUC的监测导致需要调整剂量的患者较少。基于AUC的监测有可能减少不必要的万古霉素暴露，值得进一步研究。
