Maximizing Vancomycin Efficacy Through Optimal Dosing Strategy: A Comparison of Trough Concentration and Area Under the Curve-based Strategies for Achieving Therapeutic Levels

Abstract

Introduction: The transition from trough-guided dosing to an area under the concentration-time curve (AUC)-guided dosing strategy was implemented to enhance treatment response and minimize unnecessary vancomycin exposure. This study compared the achievement of therapeutic targets, total daily dose of vancomycin required to reach the target, and the incidence of vancomycin-associated nephrotoxicity between the two dosing strategies. Materials and methods: This prospective cohort study involved 40 adult patients with methicillin-resistant Staphylococcus aureus infection who received intermittent intravenous vancomycin using an AUC-guided dosing strategy. The retrospective comparison group consisted of 65 patients who received vancomycin with a trough-guided dosing approach. Daily AUC was calculated using two-point serum vancomycin concentrations and first-order pharmacokinetic equations. Results: In the trough-guided dosing group, only 13 (20%) of 65 initial trough levels were therapeutic, compared to 17 (42.5%) of 40 initial AUC values in the AUC-guided dosing group (p= 0.013). The AUC-guided dosing group required a significantly lower mean daily vancomycin dose (2085.94 ± 958.01 mg) to achieve therapeutic goals compared to the trough-guided dosing group (2669.05 ± 1034.58 mg, p= 0.016). Nephrotoxicity occurred in 16.9% of trough-guided patients and 5% of AUC-guided patients (p= 0.072). Conclusion: Compared to trough-guided dosing, AUC-guided dosing with two-point sampling improved therapeutic target attainment and resulted in lower mean daily vancomycin doses. Although the reduction in nephrotoxicity incidence was not statistically significant, this study provides valuable evidence supporting the transition to AUC-guided dosing for optimizing vancomycin dosage.