Deng Yutao, Rebollido Zachary W, Pettengill Matthew A, Stickle Douglas F
Jefferson University Hospital, Philadelphia, PA, USA.
Pract Lab Med. 2023 Jan 28;34:e00310. doi: 10.1016/j.plabm.2023.e00310. eCollection 2023 Mar.
Current pharmacy practice guidelines recommend 24-h area-under-curve (AUC) targets for use of vancomycin against methicillin-resistant Staphylococcus aureus (MRSA). AUC protocol-specific vancomycin orders were begun recently (2022) at our institution. We reviewed initial AUC protocol-associated data and calculations.
AUC calculations are derived from timed, paired measurements of vancomycin (V1,V2). We retrieved paired (V1,V2) measurements for a 90-day interval. Calculations to obtain AUC were performed according to two accepted methods (A, B) that assume first-order kinetics for vancomycin elimination between V1 and V2.
44 (V1,V2) measurement pairs were from among 27 patients. Dosing intervals were 8, 12, or 24 h. The first-order rate constant was normally distributed ( = 0.096 ± 0.046 1/h); t ranged from 3 to 30 h. For target AUC = 400-600 h × μg/mL, 55% of calculated AUC results were within target. Imprecision for calculated was predicted to be least when V2 is a trough level. Method B results were greater than Method A results by a factor of 1.07.
45% of AUC results indicated need for change in dosage. Recommendations are that average results from A and B methods of calculation should be used, and that V1 and V2 should be as widely separated as possible.
当前的药学实践指南推荐了万古霉素针对耐甲氧西林金黄色葡萄球菌（MRSA）使用时的24小时曲线下面积（AUC）目标。我院近期（2022年）开始了基于AUC方案的万古霉素医嘱。我们回顾了最初与AUC方案相关的数据及计算结果。
AUC计算源自万古霉素的定时配对测量值（V1、V2）。我们检索了90天期间的配对（V1、V2）测量值。根据两种公认的方法（方法A、方法B）进行AUC计算，这两种方法假定V1和V2之间万古霉素消除呈一级动力学。
44对（V1、V2）测量值来自27例患者。给药间隔为8、12或24小时。一级速率常数呈正态分布（=0.096±0.046 1/小时）；t范围为3至30小时。对于目标AUC = 400 - 600小时×μg/mL，55%的计算AUC结果在目标范围内。当V2为谷浓度时，预计计算的不精密度最小。方法B的结果比方法A的结果大1.07倍。
45%的AUC结果表明需要调整剂量。建议采用方法A和方法B计算的平均结果，并使V1和V2尽可能分开。
