Precision dosing of vancomycin: in defence of AUC-guided therapy in children.

TitlePrecision dosing of vancomycin: in defence of AUC-guided therapy in children.
Publication TypeJournal Article
Year of Publication2021
AuthorsMurphy ME, Girdwood STang, Goldman JL, Scheetz MH, Downes KJ
JournalJ Antimicrob Chemother
Date Published2021 Jun 07
ISSN1460-2091
Abstract

In 2020, new vancomycin guidelines were released, recommending the transition from trough-based to AUC24 monitoring for adult and paediatric patients. Given the resources required to achieve this transition, there has been debate about the costs and benefits of AUC24-based monitoring. A recent narrative review of vancomycin therapeutic drug monitoring in paediatrics claims to have uncovered the methodological weaknesses of the data that informed the guidelines and advises against premature adoption of AUC24-guided monitoring. In this article, we present supporting arguments for AUC24-guided monitoring in children, which include that: (i) troughs alone are inadequate surrogates for AUC24; (ii) vancomycin-associated nephrotoxicity has significant consequences that warrant optimization of dosing; (iii) a substantial portion of children receiving vancomycin are at high risk for poor outcomes and deserve targeted monitoring; and (iv) limited efficacy data in support of AUC24 is not a justification to revert to a less supported monitoring approach.

DOI10.1093/jac/dkab194
Alternate JournalJ Antimicrob Chemother
PubMed ID34096598