Vancomycin AUC Monitoring and Its Role in Home Infusion
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In the mid- to late-1990s, interest in appropriate dosing of vancomycin increased due to a number of factors, including: 1) dramatic rise in rates of methicillin-resistant Staphylococcus aureus (MRSA) throughout United States hospitals, 2) reported strains of MRSA intermediate and resistant to VAN, 3) development of new gram-positive agents, and 4) increased clinical failure with VAN and minimum inhibitory concentration (MIC) creep among MRSA isolates. Recently, several researchers have determined that the preferred pharmacodynamic parameter to decrease bacterial burden is actually a ratio of 24-hour area under the curve to minimum inhibitory cncetration (MIC), or AUC24/MIC. This article explores important aspects of AUC dosing, including methods to measure AUC, and AUC in home infusion. It includes case studies for further elaboration.
Learning Objectives:
- Review the history of vancomycin AUC/MIC pharmacokinetic and pharmacodynamics concepts along with current guidelines for use.
- Describe the relationship between vancomycin trough levels, AUC/MIC ratio and vancomycin-associated nephrotoxicity.
- Review the different methods used to calculate vancomycin AUC/MIC.
- Discuss the role and application of AUC/MIC monitoring in home infusion along with the transition from the inpatient setting.
Anne R Daniels, PharmD, BCPS, AAHIVP
Froedtert Hospital
Anne R Daniels, PharmD, BCPS, AAHIVP graduated from the University of Minnesota School of Pharmacy, and then completed her pharmacy residency at Froedtert Hospital. She has practiced in critical care, internal medicine, and infectious diseases over the last 20 years. She currently provides care for patients in the Froedtert Infectious Diseases clinic and is a member of the Froedtert Antimicrobial Stewardship Program. She has served as a mentor and preceptor for numerous pharmacy students and residents. Her practice interests include treatment and adherence opportunities for people living with HIV, HIV Pre-Exposure Prophylaxis, outpatient parenteral antimicrobial therapy, and immunizations.
No Disclosures to Report
Diane M Marks, BCPharm, BCPS
Pharmacist
Froedtert Hospital
Diane M. Marks, BSPharm BCPS, graduated from the University of Wisconsin-Madison School of pharmacy then completed her residency at Doyne Hospital, now Froedtert Hospital. Most of her career has been spent working inpatient hospital pharmacy with focus on critical care, emergency medicine, cardiology, surgery, and medicine. She also has experience in retail pharmacy, anticoagulation clinic and transitions of care. Throughout this time, she had the opportunity to precept and mentor pharmacy students and residents. Four years ago, she made a career change and began working home infusion; a new service line within the Froedtert health system. She is now the Home Infusion Coordinator in this rapidly growing department and a Clinical Affiliate Instructor for the Medical College of Wisconsin School of Pharmacy.
No Disclosures to Report
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