Department of Clinical Pharmacy, Sírio-Libanês Hospital, São Paulo, Brazil; School of Pharmaceutical Sciences, São Paulo University, São Paulo, Brazil.
Faculty of Pharmaceutical Sciences, State University of Campinas, Campinas, Brazil.
Clin Ther. 2022 Sep;44(9):e91-e96. doi: 10.1016/j.clinthera.2022.07.012. Epub 2022 Aug 26.
Recent vancomycin dosing and monitoring guidelines recommend monitoring vancomycin area under the 24-hour time-concentration curve instead of traditional trough-only monitoring. This study aimed to compare the total costs of vancomycin dosing and monitoring between trough-guided and AUC-guided approaches in a quaternary hospital from Brazil.
In this retrospective cohort study, patients were divided into 2 groups according to the monitoring method. Patients with previous renal impairment were excluded. Vancomycin AUC was estimated by using 2 steady-state serum concentrations and first-order kinetics equations. The primary outcome was total cost of vancomycin therapy and monitoring from the hospital perspective, which included costs of cumulative doses, laboratory fees, materials used in blood collection, nursing time for collection, and pharmacist time for result interpretation.
A total of 68 patients were included in the AUC/MIC-guided monitoring group, and 76 patients were included in the trough-guided monitoring group. There were no significant differences between groups regarding baseline serum creatinine level, duration of vancomycin therapy, and cumulative vancomycin dose. The median (interquartile range) total vancomycin drug and monitoring cost was $298.32 ($153.81-$429.85) for the AUC/MIC-guided group compared with $285.59 ($198.81-$435.57) for the trough-guided group (P = 0.9658).
Vancomycin AUC estimation using 2 steady-state serum concentrations and first-order kinetics equations is a feasible alternative for limited-resource institutions that intend to transition from a trough approach to AUC/MIC-guided monitoring.
最近的万古霉素剂量和监测指南建议监测 24 小时时间-浓度曲线下面积（AUC），而不是传统的仅谷值监测。本研究旨在比较巴西一家四级医院中谷值指导和 AUC 指导方法在万古霉素给药和监测方面的总费用。
在这项回顾性队列研究中，根据监测方法将患者分为两组。排除了有先前肾功能损害的患者。采用 2 个稳态血清浓度和一级动力学方程来估算万古霉素 AUC。主要结局是从医院角度评估万古霉素治疗和监测的总费用，包括累积剂量、实验室费用、采血用材料、采血护理时间和药剂师解读结果的时间。
共有 68 例患者纳入 AUC/MIC 监测组，76 例患者纳入谷值监测组。两组在基线血清肌酐水平、万古霉素治疗时间和累积万古霉素剂量方面无显著差异。AUC/MIC 监测组的中位（四分位距）万古霉素药物和监测总成本为 298.32 美元（153.81-429.85 美元），而谷值监测组为 285.59 美元（198.81-435.57 美元）（P=0.9658）。
使用 2 个稳态血清浓度和一级动力学方程估算万古霉素 AUC 是一种可行的替代方法，适用于那些打算从谷值方法过渡到 AUC/MIC 指导监测的资源有限的机构。
