Monitor VANCOMYCIN with AUC/MIC goals

Infectious Diseases Society of America (IDSA) recommend using AUC/MIC monitoring for most serious MRSA infections and aiming for 400 to 600...
Abdelwahab Ward, BS Pharm, PharmD

As a hospital pharmacist, you will see a shift toward monitoring vancomycin using AUC/MIC calculations instead of trough levels. Clinical pharmacists normally aim for troughs of 15 to 20 mg/L for serious MRSA infections, to increase the likelihood of AUC/MIC over 400. But it turns out these troughs can overshoot AUC/MIC goals and are linked to more nephrotoxicity.

     Now Infectious Diseases Society of America (IDSA) and others recommend using vancomycin AUC/MIC monitoring for most serious MRSA infections, such as bloodstream or pneumonia and aiming for 400 to 600 mg*hr/L (mcg*hr/mL) in adults. This seems to be the sweet spot to maintain efficacy while minimizing acute kidney injury. Many patients can achieve an AUC/MIC in this range even with troughs below 15 mg/L. But it’s too soon to say what the best goal is for CNS infections, coagulase-negative Staph or other non-MRSA organisms or less severe infections, such as a skin abscess.

Expect many hospitals to determine goals in these instances. For example, for less severe infections, some hospitals may use AUC/MIC goals, while others may continue with lower troughs of 10 to 15 mg/L. Don’t be surprised if pharmacists now order two POST-dose levels. They’ll use those levels to calculate an AUC and then determine whether dose adjustments are needed.

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Abdelwahab Ward, BS Pharm, PharmD