SCCM Resource Library-How to Get the Best Curves: Dosing Vancomycin Using Area Under the Curve Monitoring

Video Transcription

Video Summary

In this video, pharmacist Xiuyan Amy Yeung discusses the topic of optimizing vancomycin dosing using area under the curve (AUC) monitoring. AUC is a better predictor of efficacy and has been associated with less neurotoxicity compared to trough-based dosing. The updated guidelines recommend a loading dose of 20-35 mg/kg with a dose cap of 3 grams for obese patients, and a target AUC-to-MIC ratio between 400 to 600 for MRSA infections. Two approaches are recommended for achieving these targets: first-order kinetic and Bayesian modeling. The first-order kinetic approach involves calculating initial dosing based on population kinetic estimates and adjusting based on patient-specific parameters. Bayesian modeling uses an empiric dose calculated from a large bank of pharmacokinetic data and incorporates patient characteristics to estimate the dosing regimen. Studies have shown that using two levels in Bayesian modeling improves accuracy. Implementing AUC-guided dosing requires defining patient populations, selecting the appropriate dosing method, considering costs and workflow integration, and training staff. Education is crucial for pharmacists, prescribers, and nurses to understand correct interpretation of levels and timing of measurements. Evaluation of the implementation should include target attainment and renal outcomes. Resources like the Society of Infectious Disease Pharmacists Vancomycin AUC Toolkit and MedID website provide valuable information for this process. It is also important to consider the appropriateness of vancomycin treatment for each patient.

Asset Subtitle

Pharmacology, 2022

Asset Caption

Guidelines for vancomycin area under the curve (AUC)/minimum inhibitory concentration (MIC) monitoring were published by the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists in March 2020. Many institutions are developing new protocols for monitoring vancomycin, including the updated recommendation from the guidelines to use AUC/MIC monitoring in place of traditional trough monitoring. In addition, recent literature has promoted the use of continuous infusion beta-lactam dosing. In this flipped classroom session, attendees will bring local protocols and dosing schemes to launch a comparison with the newly published guidance and compare strategies by using audience polling. This session will also review the advantages and disadvantages of 2 level AUC pharmacokinetics and more advanced Bayesian AUC pharmacokinetics in an interactive session using simulated patient data, including initial dosing schemes and dosage revisions. A similar approach will be taken to determine time > MIC dosing for beta-lactam antibiotics using therapeutic drug monitoring techniques and extended/continuous infusion dosing approaches.

Meta Tag

Content Type Presentation

Knowledge Area Pharmacology

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Tag Antibiotics

Tag Pharmacokinetics Pharmacodynamics

Year 2022

Keywords

vancomycin dosing

area under the curve

AUC monitoring

neurotoxicity

loading dose

MRSA infections

Bayesian modeling

	Society of Critical Care Medicine 500 Midway Drive Mount Prospect, IL 60056 USA Phone: +1 847 827-6888 Fax: +1 847 439-7226 Email: support@sccm.org	Contact Us About SCCM Newsroom Advertising & Sponsorship DONATE	MySCCM LearnICU Patients & Families Surviving Sepsis Campaign Critical Care Societies Collaborative	GET OUR NEWSLETTER
© Society of Critical Care Medicine. All rights reserved. \| Privacy Statement \| Terms & Conditions The Society of Critical Care Medicine, SCCM, and Critical Care Congress are registered trademarks of the Society of Critical Care Medicine.