Readiness to implement vancomycin monitoring based on area under the concentration–time curve: A cross-sectional survey of a national health consortium

Kufel, Wesley D; Seabury, Robert W.; Mogle, Bryan T.; Beccari, Mario V.; Probst, Luke A.; Steele, Jeffrey

doi:10.1093/ajhp/zxz070

Cited by 48 publications

(64 citation statements)

References 21 publications

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“…Maintenance doses were administered once daily and C min was simulated by day 5 (96 h). practice (Kufel et al, 2019). Considerable extra costs for the levels monitoring using AUC is another dilemma (Meng et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

Population Pharmacokinetics and Model-Based Dosing Optimization of Teicoplanin in Pediatric Patients

et al. 2020

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Objectives: The pharmacokinetics (PK) of teicoplanin differs in children compared with adults. Our aim was to determine the PK of teicoplanin in an Asian pediatric population and to optimize dosage regimens.Methods: This was a retrospective PK study and all the data were collected from hospitalized children. We developed a population PK model using sparse data, and Monte Carlo simulation was used to assess the ability of standard teicoplanin regimen and other different dosage regimens. The optimal dosing regimens were defined as achieving the target trough concentration (Cmin) of 10 mg/L and pharmacokinetic/pharmacodynamic (PK/PD, [AUC24/MIC]) of 125 for moderate infection. For severe infection, the optimal dosing regimens were defined as achieving the target 15 mg/L and AUC24/MIC of 345.Results: 159 children were included and 1.5 samples/children on average were provided. Estimated clearance of teicoplanin was 0.694 L/h (0.784/L/h/70 kg) and volume of distribution was 1.39 L. Teicoplanin standard loading dose was adequate for moderate infection, while 13 mg/kg was needed for severer infection. With standard maintenance doses, both patients with moderate and severe infection failed to achieve the target Cmin. 12 and 16 mg/kg/day were required to achieve a Cmin ≥ 10 and 15 mg/L, respectively. However, standard maintenance dose was adequate to achieve AUC24/MIC ≥ 125 for moderate infection, and 12 mg/kg/day was needed to achieve AUC24/MIC ≥ 345 for severe infection. Lower weight and serum creatinine were associated with higher dose.Conclusion: Optimal doses based on the target Cmin were higher than that based on the PK/PD target. To achieve the Cmin and PK/PD targets simultaneously, a standard loading dose was adequate for moderate infection based on simulation, while dosing higher than standard doses were required in other situation. Further clinical studies with rich sampling from children is required to confirm our findings.

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Section: Discussionmentioning

confidence: 99%

Population Pharmacokinetics and Model-Based Dosing Optimization of Teicoplanin in Pediatric Patients

et al. 2020

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“…They also proposed body surface area as an alternative to body weight. Implementing these options may not be feasible in resource‐constrained institutions that cannot offer AUC‐based vancomycin monitoring services (39).…”

Section: Findings and Discussion By Therapeutic Categorymentioning

confidence: 99%

Dosing Common Medications in Hospitalized Pediatric Patients with Obesity: A Review

Ameer

Weintraub

2020

Obesity

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Medication management in children and adolescents with obesity is challenging because both developmental and pathophysiological changes may impact drug disposition and response. Evidence to date indicates an effect of obesity on drug disposition for certain drugs used in this population. This work identified published studies evaluating drug dosing, pharmacokinetics (PK), and effect in pediatric patients with obesity, focusing on 70 common medications used in a pediatric network of 42 US medical centers. A PubMed search revealed 33 studies providing PK and/or effectiveness data for 23% (16 of 70) of medications, 44% of which have just one study and can be considered exploratory. This work appraising 4 decades of literature shows several promising approaches: greater use of PK models applied to prospective clinical studies, dosing recommendations derived from both PK and safety, and multiyear effectiveness data on drugs for chronic conditions (e.g., asthma). Most studies make dose recommendations but are weakened by retrospective study design, small study populations, and no controls or historic controls. Dosing decisions continue to rely on extrapolating knowledge, including targeting systemic drug exposure typically achieved in adults. Optimal weight‐based dosing strategies vary by drug and warrant prospective, controlled studies incorporating PK and modeling and simulation to complement clinical assessment.

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“…A recent survey of academic medical centers reported that the majority (88%) of all respondents who did not currently utilize AUC 24 monitoring did not plan on making this immediate transition, largely citing unfamiliarity and training requirements. 20 It is conceivable that the transition to AUC monitoring in smaller facilities may have fewer barriers than those seen in tertiary care centers. There are fewer health care providers and pharmacists to educate with the primary responsibilities falling on relatively few clinicians.…”

Section: Discussionmentioning

confidence: 99%

Gap Analysis for the Conversion to Area Under the Curve Vancomycin Monitoring in a Small Rural Hospital

Cole¹

2020

Federal Practitioner

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Consensus guidelines for vancomycin monitoring now recommend area under the curve (AUC) calculations for optimal vancomycin efficacy and safety. This will be a major practice change for many facilities. Implementation guidance is available but has not been reported in smaller, primary care hospitals. The objective of this study was to measure the uptake of AUC monitoring implementation in a rural facility. Methods: This is a gap analysis evaluating the appropriateness of vancomycin levels tests after the April 1, 2019 transition. All vancomycin levels between April 2019 and June 2019 after the go-live date were included with no exclusions in a retrospective chart review. The primary outcome was the proportion of levels in the appropriate time frame: peaks 1 to 2 hours after infusion with troughs at least 1 half-life after initial dose and prior to the next dose. Secondary outcomes included reasons identified for inappropriate levels and the proportion of AUC 24 calculations within therapeutic range (400-600 mg.h/L). Descriptive statistics were used to measure the scope and outcomes of this transition. Results: The transition was effective with 97% of cases utilizing AUC-based methods. There were 65 vancomycin levels in the 3-month study period with 86% deemed appropriate. Of the 9 inappropriate levels, 4 had to be repeated for accurate monitoring. There were 28 two-level couplets used for AUC 24 calculations, 17 (61%) fell within therapeutic range. Conclusion: Implementation strategies for the AUC transition described in tertiary medical centers can be successfully utilized in primary facilities.

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Readiness to implement vancomycin monitoring based on area under the concentration–time curve: A cross-sectional survey of a national health consortium

Cited by 48 publications

References 21 publications

Population Pharmacokinetics and Model-Based Dosing Optimization of Teicoplanin in Pediatric Patients

Population Pharmacokinetics and Model-Based Dosing Optimization of Teicoplanin in Pediatric Patients

Dosing Common Medications in Hospitalized Pediatric Patients with Obesity: A Review

Gap Analysis for the Conversion to Area Under the Curve Vancomycin Monitoring in a Small Rural Hospital

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