Vancomycin area under the curves estimated with pharmacokinetic equations using trough‐only data

Fewel, Nathan

doi:10.1111/jcpt.13474

Cited by 9 publications

(9 citation statements)

References 20 publications

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“…We also observed that the AUC 24 estimates from the VancoPK single‐concentration calculator had less bias and lower imprecision when compared to the ClinCalc single‐concentration calculator. Fewel performed a retrospective study assessing the accuracy and precision of AUC 24 estimates from the VancoPK single‐concentration vancomycin calculator versus the 2PK reference method 8 . This study found a mean AUC 24 difference of 1.6 mg*h/L between the 2PK reference method and the VancoPK single‐concentration vancomycin calculator.…”

Section: Resultsmentioning

confidence: 99%

“…ClinCalc utilizes Bayesian modelling to estimate vancomycin clearance (CL v ) and volume of distribution ( V d ) 6 . VancoPK calculates patient‐specific V d , elimination rate ( K e ), CL v , and AUC from the data utilizing first‐order, intermittent IV infusion equations 7,8 . Although these online calculators are likely easier to utilize in comparison to the guideline‐recommended methods, their accuracy for estimating AUC 24 is uncertain.…”

Section: What Is Known and Objectivementioning

confidence: 99%

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Comparison of vancomycin area under the concentration‐time curve ( AUC ) using two‐point pharmacokinetics versus two open‐access online single‐concentration vancomycin calculators

Ondrush

Ademovic

Seabury

et al. 2022

Clinical Pharmacy Therapeu

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What Is Known and Objective Current vancomycin monitoring guidelines recommend the use of area under the concentration‐time curve (AUC24) monitoring in patients with serious Methicillin‐Resistant Staphylococcus aureus (MRSA) infections by utilizing either a Bayesian approach or first‐order analytic equations. Several open‐access websites exist that allow estimation of vancomycin AUC24 with the use of a single steady‐state concentration. It is uncertain how these open‐access calculators perform against guideline‐recommended methods. The objective was to compare AUC24 estimates from two online, open‐access, single‐concentration vancomycin calculators compared with the two‐point pharmacokinetic (2PK) method. Methods AUC24 estimates were made using the 2PK reference method and the single‐concentration vancomycin calculators, ClinCalc and VancoPK. The AUC24 estimates from the 2PK reference method were compared to the online calculators by assessing bias (median AUC24 difference) and precision (AUC24 difference ± 100 mg*h/L). Clinical precision was also assessed by characterizing the frequency that the 2PK reference method and the online calculators showed clinical disagreement based on the following AUC24 categories: (1) AUC24 < 400 mg*h/L; (2) AUC24 400–600 mg*h/L and (3) AUC24 > 600 mg*h/L. Results and Discussion A total of 253 patients were included in the study. The AUC24 estimates from the ClinCalc and VancoPK single‐concentration vancomycin calculators showed some bias and imprecision, though VancoPK appeared to have less. Clinical disagreement versus the 2PK reference method occurred in 31.2% and 19.4% of AUC24 estimates from the ClinCalc and VancoPK single‐concentration vancomycin calculators, suggesting clinical imprecision. What Is New and Conclusion The AUC24 estimates from single‐concentration, online vancomycin calculators showed some bias and imprecision in comparison to the 2PK method. Institutions should validate these online, trough‐only calculators relative to a 2PK method in their patient populations prior to adoption as standard‐of‐care.

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Section: Resultsmentioning

confidence: 99%

Section: What Is Known and Objectivementioning

confidence: 99%

Comparison of vancomycin area under the concentration‐time curve ( AUC ) using two‐point pharmacokinetics versus two open‐access online single‐concentration vancomycin calculators

Ondrush

Ademovic

Seabury

et al. 2022

Clinical Pharmacy Therapeu

View full text Add to dashboard Cite

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Section: Methodsmentioning

confidence: 99%

“…Using an internally validated online calculator called vancopk.com, patient age, height, weight, serum creatinine and sex were used to initially predict each patient's population-based PK data and associated vancomycin dosing regimens. 12 The initial dosing calculator uses creatinine clearance to estimate vancomycin clearance and uses other population-based equations to estimate various PK parameters, such as Ke. 12 Predictions were made based on the following calculator settings: infusion rate of 1000 mg/h, goal trough range of 10-15 mg/L and vancomycin MIC of 1 mg/L against S. aureus.…”

Section: Pharmacokinetic Datamentioning

confidence: 99%

“…12 The initial dosing calculator uses creatinine clearance to estimate vancomycin clearance and uses other population-based equations to estimate various PK parameters, such as Ke. 12 Predictions were made based on the following calculator settings: infusion rate of 1000 mg/h, goal trough range of 10-15 mg/L and vancomycin MIC of 1 mg/L against S. aureus.…”

Section: Pharmacokinetic Datamentioning

confidence: 99%

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Assessment of an online calculator’s vancomycin dosing and exposure appropriateness in persons who inject drugs with methicillin‐resistant Staphylococcus aureus bloodstream infections

Opitz

Housman

et al. 2022

Clinical Pharmacy Therapeu

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What is known and objective While the gold standard for calculating AUC involves two steady‐state concentrations, online calculators can empirically estimate AUC and other pharmacokinetic (PK) parameters. In patients with potentially altered PK, such as persons who inject drugs (PWID), the reliability of these predictions is unclear. Our objectives were to characterize the PK of vancomycin in PWID with methicillin‐resistant Staphylococcus aureus (MRSA) bloodstream infections (BSI) and to assess the impact of these PK parameters on dosing regimens when compared to regimens generated by an online calculator. Methods This descriptive pilot study included a retrospective chart review of 48 inpatient PWID with MRSA BSI from 30 April 2018 through 31 August 2020. Demographic and clinical data along with vancomycin dosing and serum concentrations were collected. Patient‐specific PK parameters were used to calculate the AUC of each empiric regimen compared with the originally predicted AUC. Results and discussion The study population had a median volume of distribution of 0.74 L/kg, clearance of 0.081 L/kg/h, elimination rate constant of 0.110/h and half‐life of 6.3 h. The online calculator empirically predicted 6 subtherapeutic and 42 appropriate AUC values with its recommended empiric dosing regimens. Using the actual patient‐specific PK parameters, the empiric vancomycin regimens actually resulted in 21 (43.75%) underexposures, 24 (50%) appropriate exposures and 3 (6.25%) overexposures. What is new and conclusions In PWID, empiric vancomycin dosing strategies suggested by an online calculator frequently resulted in lower‐than‐predicted vancomycin exposures. These findings suggest that PWID with MRSA BSI may require higher and/or more frequent vancomycin doses than those empirically recommended by the population‐based methods of an online calculator.

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Vancomycin dosing in high‐intensity continuous renal replacement therapy: A retrospective cohort study

et al. 2023

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IntroductionAn inverse relationship exists between vancomycin serum concentrations and the intensity of continuous renal replacement therapy (CRRT), reflected through the dialysate flow rate (DFR). There remains a lack of evidence to guide initial vancomycin dosing in the setting of high‐intensity CRRT (i.e., DFR >30 mL/kg/h). Additionally, recommendations for pharmacokinetic monitoring of vancomycin have transitioned from a trough‐based to area under the curve (AUC)‐based dosing strategy to optimize efficacy and safety. Therefore, an improved understanding of the impact of CRRT intensity on AUC/MIC (minimum inhibitory concentration) has the potential to enhance vancomycin dosing in this patient population.ObjectivesThe goal of this study is to evaluate current vancomycin dosing strategies and achievement of pharmacokinetic targets in patients on high‐intensity CRRT.MethodsThis was a single‐center, retrospective cohort study of adult critically ill patients admitted to Houston Methodist Hospital between May 2019 and October 2021 and received vancomycin therapy while on high‐intensity CRRT. High‐intensity CRRT was defined by a DFR that was both ≥3 L/h and >30 mL/kg/h. Depending on the initial vancomycin dosing strategy, patients were stratified into either the traditional (15 mg/kg/day) or enhanced (≥15 mg/kg/day) dosing group. The primary outcome was the percent of patients who attained steady‐state AUC24/MIC ≥400 mg*h/L at the first obtained vancomycin level in the enhanced group compared with the traditional group.ResultsA total of 125 patients were included in the final analysis, 56 in the traditional and 69 in the enhanced dosing group. The primary end point occurred in 74% and 54% of patients in the enhanced and traditional dosing groups, respectively (p = 0.029). Therapeutic vancomycin trough levels (10–20 μg/mL) were more commonly achieved in the enhanced dosing group compared with the traditional dosing group (66.7% vs. 45%, p = 0.013). As DFR rose, increasingly higher doses of vancomycin, up to 27 mg/kg/day, were required to achieve the therapeutic targets.ConclusionThis is the first study to evaluate the influence of variable CRRT intensities on vancomycin AUC/MIC. Our findings suggest that vancomycin doses of ≥15 mg/kg/day are needed to achieve early therapeutic targets in patients on high‐intensity CRRT.

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Vancomycin area under the curves estimated with pharmacokinetic equations using trough‐only data

Abstract: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cited by 9 publications

References 20 publications

Comparison of vancomycin area under the concentration‐time curve ( AUC ) using two‐point pharmacokinetics versus two open‐access online single‐concentration vancomycin calculators

Comparison of vancomycin area under the concentration‐time curve ( AUC ) using two‐point pharmacokinetics versus two open‐access online single‐concentration vancomycin calculators

Assessment of an online calculator’s vancomycin dosing and exposure appropriateness in persons who inject drugs with methicillin‐resistant Staphylococcus aureus bloodstream infections

Vancomycin dosing in high‐intensity continuous renal replacement therapy: A retrospective cohort study

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