VANCOMY C IN A U C

CU RVE -B A SE D D OSI NG
(AUC) AREA UNDER THE
OBJECTIVE
• Define Vancomycin AUC-guided dosing

• Explain concepts of the Bayesian approach for Vancomycin AUC-

guided dosing

• Compare Vancomycin AUC-guided vs traditional trough-guided dosing

• Recognize when to implement Vancomycin AUC-guided dosing into

your pharmacy practice
WHY IS AUC-GUIDED DOSING IMPORTANT TO ME?
The new IDSA Decreases Decreases
draft guideline Vancomycin
recommends it exposure while patient risk of
for glycopeptides maintaining efficacy nephrotoxicity

Pharmacists Lutheran will have

the software to
are expected guide pharmacist
to use it AUC-based dosing
 BACKGROUND
• Vancomycin: Glycopeptide antibiotic for gram (+) infections

• 2009 Infectious Diseases Society of America (IDSA) guideline:

• Recommends vancomycin for Methicillin-resistance staphylococcus aureus
(MRSA) infections
• Uses steady-state, pre-dose vancomycin trough concentrations (Ctr) for
dosing:
• Target trough 10-15 mg/L: Skin and soft tissue infections (SSTI)
• Target trough 15-20 mg/L: Severe S. aureus infections
Lutheran Hospital MUE: Vancomycin nephrotoxicity
Vancomycin: Known for nephrotoxic adverse (defined as serum creatinine ↑ ≥0.5 mg/dL)
effects
 2014 of 35 patients, 11.4% with nephrotoxicity

 2016 of 41 patients, 14.6% with nephrotoxicity

 2019 of 50 patients, 6% with nephrotoxicity

2019 IDSA Draft update, unpublished.

TERM REVIEW
Pharmacokinetics (PK): Quantifies antibiotic serum level over time
Cmax: Peak serum level
Cmin: Trough level
AUC: Area Under the serum concentration time Curve
“What the BODY does to the
DRUG”

Pharmacodynamics (PD): Relationship between PK and antibiotic effect

“What the DRUG does to the
BODY”

Minimum inhibitory concentration (MIC): Lowest antibiotic concentration that completely

inhibits microorganism growth in vitro

RxKinetics. Accessed December 5, 2019

 PHARMACOKINETICS AND
PHARMACODYNAMICS REVIEW
 PK/PD MODELING COMPARISON
THREE antibiotic pharmacodynamic
properties to describe efficacy:
• Peak/MIC: Higher concentration leads to
faster degree of killing

• T>MIC: Longer duration (≥70%) above MIC

for maximum killing

• AUC/MIC: Maximize amount of drug

received (drug-exposure)
http://rxkinetics.com/antibiotic_pk_pd.html

RxKinetics. Accessed December 5, 2019

PK/PD MODELING
• Vancomycin follows a PD model of 24-
hour AUC to MIC ratio

• Calculated by dividing the AUC by the

MIC
• AUC/MIC ratio ≥ 400 is needed for MRSA
coverage

• Target trough of 15-20 mg/L is thought

to correlate with AUC/MIC ratio ≥ 400

Efficacy
Goal
Correlation

RxKinetics. Accessed December 5, 2019

CHECK POINT #1  Click on the correct response,
 Then click the keyboard arrow to move
on…
What trough range correlates with an AUC:MIC ratio of ≥400 mg*hr/L?
A. 12-16 mg/L Try again
B. 10-15 mg/L Try again
C. 15-20 mg/L YES! This is the correct trough correlation for AUC:MIC 400 mg*hr/L
D. 10-20 mg/L Try again
VANCOMYCIN INDUCED
NEPHROTOXICITY (VIN)
 VANCOMYCIN INDUCED NEPHROTOXICITY (VIN)
Increased VIN risk
Results in acute Typical onset 2-5 days of
glomerular nephritis therapy 1. Patient co-
morbidities

2. Doses >4g/day

3. Initial troughs
Typical peak 5-10 days of 90% cases resolve within >15 mg/L
therapy 19 days
4. AUC levels
600-800
mg*h/L

Estimated 3% cases need

renal replacement Stevens, et al. Pharmacy Times. 2019-04-04
PUBLICATION CHAVADA ET AL: KIDNEY INJURY
Single-center, retrospective observational cohort

• 127 patients with MRSA bacteremia

• Received 14 days of vancomycin
• Primary outcome: Vancomycin exposure with
Bayesian estimation (see therapeutic range)
• Incidence of AKI (defined Scr ≥0.5 mg/L and
50% increase from baseline)

***CONCLUSION:

• Patients with AUC/MIC >563 mg*h/L were more

likely to experience AKI

• AUC measurements were BETTER than trough

measurements when predicting AKI

Chavada et al. 2017; 61(5):1-8. doi: 10.1128/AAC.02535-

PUBLICATION NEELY ET AL: KIDNEY INJURY
AUC/MIC vs. Trough
Neely et al 2017
Design Prospective, 3 year duration
Population 252 adult hospitalized patients
Primary
outcome Proportion of therapeutic trough vs therapeutic AUC
Method • Monitored trough 10-20 mg/L in the first year (year 1)
• Monitored Bayesian AUC ≥ 400-800 mg*hr/L in year 2 and 3
Conclusion Year 1 (trough) Year 2 and 3 (AUC)
• 8% of patients experienced • 0-2% of patients experienced
nephrotoxicity nephrotoxicity
Statistical significance achieved: (P=0.01)
AKI median trough: ~15.7 and AUC ~625
Non AKI median trough: ~8.7 and AUC ~423 Take Home Point:
AUC dosing resulted in less
nephrotoxicity

Neely et al. Antimicrob Agents Chemother. 2018 Jan 25;62(2). pii: e02042-

THERAPEUTIC AUC GOAL

Vancomycin AUC/MIC target for

serious infections:

400-600 mg*h/L
(assumes MIC of MRSA isolate ≤1)

If MIC is 2 mg/L, AUC targets of >800 is

required, which is above safety
threshold

2019 IDSA Draft update, unpublished.

CHECK POINT#2  Click on the correct response,
 Then click the keyboard arrow to move
on…
What is the best definition for AUC-based dosing?
A. Targets the patient’s serum vancomycin peakTry again

B. Targets the vancomycin trough Try again

C. Targets the patients vancomycin exposure above

YES! This is AUC/MIC PD
the minimum inhibitory concentration of a pathogen
CHECK POINT#3  Click on the correct response,
 Then click the keyboard arrow to move
on…
What is the Vancomycin AUC/MIC target for serious infections?
A. 300-500 Try again
mg*hr/L
B. 400-600 YES! This is the target for serious infections using AUC:MIC ratio
mg*hr/L
C. 500-700 Try again
mg*hr/L
D. 600-800 Try again
mg*hr/L
CHECK POINT #4  Click on the correct response,
 Then click the keyboard arrow to move
on…
What is one assumption for using Vancomycin AUC-based dosing?
A. MIC for S. aureus is ≤ YES!
1
B. MIC for S. pyogenes is ≤ Try again
1
C. MIC for S. aureus is ≥ 1Try again
D. MIC for S. aureus is ≥ 2Try again
DOSING METHODS
VANCOMYCIN TROUGH VS AUC
• Look at the graph below, assess the AUCs of two dosing schedules resulting in the
same trough values…
• The Q12h dosing schedule has a much larger
AUC than with the Q6h schedule
Q12h

Q6h
What does this mean?
(Solid line is continuous
• Shows the patient from the graph is experiencing
infusion) MORE vancomycin exposure with less frequent
dosing, despite resulting in the same serum
trough values
Based on 70kg patient with GFR 120 mL/min

Why is this important?

• Demonstrates variability of exposure when
troughs are used as dosing target
• Elevates risk of unnecessary dose increases and
nephrotoxicity
Drennan et al. Int J Antimicrob Agents. 2019; 53: 401-407.
VANCOMYCIN TROUGH VS AUC
Recall:
• AUC: Represents the patient’s total exposure of
vancomycin over a given period of time (usually 24
hours)

• Using AUC/MIC as a dosing target decreases exposure

variability and potential nephrotoxicity

Drennan et al. Int J Antimicrob Agents. 2019; 53: 401-

407.
 2019 IDSA
Guideline:
VANCOMYCIN TROUGH VS AUC HISTORY Bayesian monitoring
software was
AUC/MIC concept created as a
is not new  PRACTICAL means to
calculate and use
Initial in-vitro & AUC values
animal studies Recent
proved it as a PK studies
favorability demonstrat
2009 IDSA e trough
Guideline: values may
Determined NOT be an
Not practical
steady state optimal
to obtain two
troughs were surrogate
lab values
a reliable for AUC
AUC/MIC and calculate
and
target is a by hand
PRACTICAL
proven surrogate for https://upload.wikimedia.org/wikipedia/commons/thumb/6/6
4/Superman_Clipart.svg/939px-Superman_Clipart.svg.png
marker for AUC
vancomyci
n efficacy Rybak et al. Am J Health Syst Pharm. 2009 Jan 1;66(1):82-98.
WHAT IS BAYESIAN-DERIVED AUC MONITORING
• Based on Bayes’ Theorem
• Uses (Bayesian prior) a well-developed vancomycin population PK model
(combines population information) with patient-specific information (Bayesian
posterior) to make dose adjustment predictions

• Then, based on the patient’s exposure profile, the dose optimization software
calculates a patient specific dosing regimen

Software uses
Software uses Software patient info, Software
a PK model determines input by user calculates a
based on patient (serum vancomycin
Bayes’ pharmacokinetic creatinine, regimen with
Theorem parameters drug levels, goal AUC as
(Vd, CrCl, etc.) prior doses, target
demographics
)

2019 IDSA Draft update, unpublished.

WHAT IS BAYESIAN-DERIVED AUC MONITORING
Vancomycin concentrations are collected within first 24-48 hours

Has adaptive feedback control to determine future dosing

Ability to integrate covariates into structural PK model -

Great for critically ill patients (those with “evolving” PK profiles)

2019 IDSA Draft update, unpublished.

WHAT IS BAYESIAN-DERIVED AUC MONITORING

Recap:
1. System uses prior knowledge alongside
current available data

2. Requires single serum level for desired

AUC target in most populations

Two Level (Peak & Trough)

• Obtained ONCE (initially)
• For the obese (BMI >30), critical illness,
unstable renal function
• Then order random levels per protocol

Heil et al. Am J Health-Syst Pharm. 2018; 75(24): 1986-199

 BAYESIAN AND 1ST ORDER KINETIC COMPARISON
The other option to the Bayesian approach is to use 1st order kinetics

1st order kinetics Bayesian approach

Relies on 2 timed steady state serum Can be calculated from single non-steady state
vancomycin concentrations serum vancomycin concentration (1st 24-48 hr)
• Blood draw 1-2 hr after infusion AND trough
for calculating estimated AUC PRO:
• Uses richly sampled vancomycin PK data from 3
studies (population sample)
PRO: • Integrates patient covariates
• Free • It’s adaptive! Uses past data for new dosing
• Relies on fewer assumptions regimens
• Primary literature determines it as accurate and
CON: reliable
• Time-consuming CON:
• Prone to human error • Requires purchasing of dosing software
• Difficult for multiple doses in 24 hours • Needs more data for special populations: Obese,
• Not adaptive (only provides snapshot of AUC, Ex: pediatrics, AKI, RRT
Does not account for changing renal function)

Heil et al. Am J Health-Syst Pharm. 2018; 75(24): 1986-1995

CHECK POINT#5  Click on the correct response,
 Then click the keyboard arrow to move
on…
T or F: The Bayesian approach is a practical means for AUC-guided
dosing that uses population information, WITH patient-specific
information to predict dose adjustments
A. True YES! This is IDSA guideline recommended
B. False Try again
GUIDELINE REVIEW
 EVIDENCED-BASED PRACTICE: GUIDELINES
Recall:
2009 IDSA Vancomycin therapeutic guidelines
• Recommend trough-based dosing as a practical surrogate marker for AUC

2019 Drennan et al
• Demonstrate the variability of drug exposure (AUC) when using trough-based dosing and
associated increased risk of nephrotoxicity

Implement:
2019 IDSA Therapeutic vancomycin monitoring revised consensus guideline
• Recommend Bayesian approach for AUC-based dosing
• Unpublished “draft” guideline available:
https://www.ashp.org/-/media/assets/policy-guidelines/docs/draft-guidelines/draft-guidelines-ASHP-IDSA-PIDS-SIDP-therapeutic-
vancomycin.ashx

2019 IDSA Draft update, unpublished.

PUBLICATION: ANTICIPATED IDSA GUIDELINE
• Troughs will NO LONGER be recommended for serious MRSA infections
• It is recommended to use AUC/MIC targets (assuming ≤MIC of 1)
• It supports the Bayesian approach for AUC-guided dosing
• It provides retrospective studies as evidence for AUC-guided dosing
which provides favorable significant outcomes:
Higher rates of bacterial
Lower rates of AKI eradication

• It advocates a target AUC/MIC ratio of 400-600 for serious MRSA

infections

2019 IDSA Draft update, unpublished.

 PUBLICATION: ANTICIPATED IDSA GUIDELINE
How do you use Bayesian AUC-based dosing per the new guideline recommendation?

 Once weekly monitoring (levels) for hemodynamically stable patients (5-7 days after
initial)
 Bayesian-derived AUC/MIC monitoring (ratio 400-600 with MIC of 1 mg/L) is recommend
for:
Aggressive treatment of MRSA infection

Those with high risk of nephrotoxicity

2019 IDSA Draft update, unpublished.
 PUBLICATION: EXCLUSIONS

1 Acute Kidney
●

Injury
Important Exclusions due to lack of supporting
data:
• “When you should NOT use AUC/MIC-based
dosing”

2 Surgical
●

Prophylaxis
Once renal function stabilizes
from AKI, then AUC-based
strategies should be used

3 Renal Replacement
●

therapy

Heil et al. Am J Health-Syst Pharm. 2018; 75(24): 1986-199

CNS INFECTION…

Currently, the
Lutheran protocol
data is
recommends:
controversial for
AUC 500-600
CNS infection
CHECK POINT#6  Click on the correct response,
 Then click the keyboard arrow to move
on…
According to the updated IDSA draft guideline, what is the preferred
parameter for vancomycin dosing?
A. Trough Try again
B. Peak Try again
C. Duration above Try again
MIC
D. AUC/MIC YES! The IDSA draft guideline supports this recommendation for serious S. aureus
infections
CHECK POINT #7  Click on the correct response,
 Then click the keyboard arrow to move
on…
According to the updated IDSA guideline, what pathogen is the target
for using AUC/MIC-guided vancomycin dosing?
A. S. pyogenes Try again
B. S. epidermidis Try again
C. S. saprophyticus Try again
D. S. aureus YES! Current data supports efficacy of using an AUC/MIC target for eradication
of S. aureus

Fun Fact: If using vancomycin for a different pathogen, it is thought that the AUC/MIC efficacy
range could be lower than 400, but the data is lacking for recommendations at this time
AUC DOSING LIMITATIONS
AND ADVANTAGES
DISADVANTAGES OF AUC-BASED DOSING

The preferred Bayesian

Has only been studied Use is excluded in CNS approach (vs 1st order
for treatment of serious infection, RRT, and AKI kinetics) needs
S. aureus infections purchased software with
staff education

Requires S. aureus MIC ≤

Guideline
1, laboratories vary in
recommendation is based
methods of obtaining an
largely on retrospective
MIC value (must verify!)
studies
 ADVANTAGES OF AUC-GUIDED DOSING

1. Requires single serum level for AUC target in most populations

2. Maintain efficacy while decreasing vancomycin exposure and AKI

risk
3. Shorter duration until therapeutic

4. Lower doses overall than current recommendations

5. Potential hospital cost savings

6. It is best practice for severe S. aureus infections (IDSA draft

guideline)

Neely et al. Antimicrob Agents Chemother. 2018 Jan 25;62(2). pii: e02042-

17
CHECK POINT #8  Click on the correct response,
 Then click the keyboard arrow to move
on…
What is one disadvantage of using the Bayesian approach for
Vancomycin AUC-based dosing?
A. The software is difficult to Try again
learn
B. It requires multiple serum collections Try again
C. Cannot be used during AKI YES! CNS, RRT, surgical prophylaxis, and AKI are excluded
D. It increases patient vancomycin Try again
exposure
CHECK POINT #9  Click on the correct response,
 Then click the keyboard arrow to move
on…
What is one advantage of using the Bayesian approach for Vancomycin
AUC-based dosing?
A. A single patient serum value is needed for YES! (except initially for BMI >30 and
AUC Critically ill)
B. The software is inexpensiveTry again
C. It maximizes vancomycin peakTry again
D. It requires less clinical knowledge Try again
LUTHERAN POLICY UPDATE
 UPDATED VANCOMYCIN DOSING POLICY: GENERAL CONSIDERATIONS

Creatinine Monitoring
Approved at January’s P&T meeting * Advises more monitoring if SCr
for anticipated software increases by ≥0.3
* Notify MD if SCr increases by ≥0.5

Empiric Vancomycin
* MIC assumed to be 1 mg/L
Recommend vancomycin DC at 72
* Lab automatically verifies high MIC
hours if culture data not supporting
(using standard method) with
use
guideline recommended BMD or Etest
 UPDATED VANCOMYCIN DOSING POLICY: GOAL AUC AND TROUGHS
Most Indications Meningitis Targets
(non-CNS) Targets (empiric or definitive)

Use AUC-based dosing

AUC-based dosing: 400-600 AUC-based dosing: 500-600
for:
Trough-based dosing: 10-20 Trough-based dosing: 15- 1. Serious infections
20 2. SSTI

When
? do you use
Use TROUGH-BASED dosing for:
1. All renal replacement therapy
2. Acute AKI
IMPORTANT trough and when
3. High risk for AKI (think whole picture)
do you use the “Dosing by
• concurrent nephrotoxins
Bayesian calculator levels”
• hypotension Or “Renal
for AUC???
• age Replaceme
• hypoperfusion nt dosing”
UPDATED VANCOMYCIN DOSING POLICY: GOAL AUC AND TROUGHS
Set Dosing AUC-Based with NO monitoring
Skin and soft tissue infection with:
Surgical Prophylaxis
(normal renal fxn, no bacteremia, hemodynamically stable)

EXCEPTION for
NO monitoring:

1. Therapy ≥5 days
2. Critically ill
3. Other nephrotoxins
4. Changing renal
function
UPDATED VANCOMYCIN DOSING POLICY: LOADING DOSE
Initiating Bayesian AUC-
based dosing

• Use weight-based load

• May input into calculator

for full regimen before
dose is given

• Can input doses from

other hospitals/providers

• Can input different

scenarios as desired
UPDATED VANCOMYCIN DOSING POLICY: MAINTENANCE DOSING

Obese, critical illness, ●

●
Use Bayesian calculator for “Population Model-Based Dose”
TWO level PK: Initial Peak and trough (enter into calculator)
unstable renal function ●
One level thereafter

Hemodynamically stable, ●

●
Use Bayesian calculator for “Population Model-Based Dose”
Obtain level within 1st 24 hours
stable renal function ●
Random may be in AM (preferably near end of interval)

SSTI (stable patient: no ●

●
Use Bayesian calculator for “Population Model-Based Dose”
One level PK within 1st 24-48 hrs if ≥5 days therapy, critically ill,
monitoring for 5 days) unstable renal function, or other nephrotoxins

Only need to repeat monitoring:

• Every 5-7 days and/or
• If and when renal function changes
GLIMPSE INTO ©

(One option considered and recently

trialed)
Sign in and ADD your patient

24/7 Chat
help
FILL in
Fields…

24/7 Chat
help
Our patient name: TEST, Atest
FIN

24/7 Chat help

 ADD patient doses and
ADD LAB results and times times

CALCULATE DOSE 24/7 Chat help

Default:
uses the Bayesian
Population

24/7 Chat
help
Able to
customize and
try different
dosing plans

Also gives you

timing of next
dose
24/7 Chat
help
 ©
PATIENT CASES:
APPROPRIATE OR INAPPROPRIATE?
 Is Bayesian AUC-based dosing appropriate?
• YES: stable renal function, not on renal replacement

MICHAEL SCOTT How should levels be ordered?

• One-level 24-48 hours after initial dose

Background: Diagnosis: Labs/data:

• 45 year old male • Osteomyelitis • Cultures pending
• BMI 28 • Sepsis work up • WBC 20,000
• Hx: DM type 2, HTN, • Hgb 9.0 mg/dL
dyslipidemia, CKD (Scr Vitals: • Plt 154,000
1.8 baseline), recent toe • 95/46, 102bpm, 22rr, • Scr 1.7
amputation 94% on 2L, 100.5F • BUN 24
• Urine dark yellow 250mL
Chief Complaint: Med info:
• 10/10 pain of amputation • Received vancomycin
site, incisional redness, 1.5g IV x1
fever, chills
 Is Bayesian AUC-based dosing appropriate?
• NO: Looks like AKI

DWIGHT SCHRUTE How should levels be ordered?

• “By levels” until renal function stabilizes

Background: Diagnosis: Labs/data:

• 37 yo male • HAP • Cultures pending
• BMI 29 • WBC 21,000
• Hx of depression, anxiety Vitals: • Hgb 8.7 mg/dL
• 80/46, 115bpm, 30rr, • Plt 200,000
Chief Complaint: 92% on 6L, 101F • Scr 2.5
• S/p MVA, day 5 • BUN 30
• Developed SOB with Med info: • Urine: 15 mL/h
increased O2 demand • Pharmacy to dose (Decreased this AM)
Vancomycin order
• Pharmacy to dose
cefepime order
 Is Bayesian AUC-based dosing appropriate?
• NO: On renal replacement

PAM BEESLY How should levels be ordered?

• Use the renal protocol section of policy (by levels)

Background: Diagnosis: Labs/data:

• 33 yo female • Cellulitis • Cultures pending
• BMI 19 • WBC 14,000
• Hx of anxiety, ESRD, HD Vitals: • Hgb 8.0 mg/dL
MWF • 120/84, 80bpm, 16rr, • Plt 142,000
94% on RA, 98F • Scr 3
Chief Complaint: • BUN 41
• Swollen and reddened Med info: • Urine: anuric
right leg • Pharmacy to dose
Vancomycin order
 Is Bayesian AUC-based dosing appropriate?
• YES: stable renal function, not on renal replacement

KEVIN MALONE How should levels be ordered?

• TWO levels initially d/t obesity, then random 5-7days

Background: Diagnosis: Labs/data:

• 54 yo male • Pneumonia • Cultures pending
• BMI 35 • WBC 21,000
• Hx of HTN, MI 2010, CVA Vitals: • Hgb 10 mg/dL
• Nursing home resident • 140/96, 90bpm, 24rr, • Plt 212,000
93% on 2L, 102F • Scr 1.0
Chief Complaint: • BUN 18
• SOB, cough, chest pain Med info: • Urine: Clear yellow, 200
• Pharmacy to dose mL x1
Vancomycin order
• Pharmacy to dose
cefepime order
AUC/MIC TARGET FOR SERIOUS INFECTIONS

Remember:
Vancomycin AUC/MIC target for
serious infections:

400-600 mg*h/L
(assumes MIC of MRSA isolate ≤1)
CONCLUSION
Use web link below for a brief animated overview (for fun):

https://
www.youtube.com/watch?v=3x35f_msvYE&feature=youtu.be
 KEY SUMMARY POINTS
• The most appropriate pharmacodynamic model for vancomycin is the area under the
concentration-time curve (AUC) to minimum inhibitory concentration (MIC)

• More research, especially prospective studies, are needed to determine efficacy in

unique populations and for other pathogens (S. aureus supported by data)

• The target AUC/MIC for serious infections is 400-600 mg*hr/L

• According to anticipated IDSA guideline, the Bayesian approach is preferred

 ©

KEY SUMMARY POINTS

• Targeting AUC/MIC is effective while deceasing vancomycin-induced toxicity risk

• Serious infections requiring empiric vancomycin assumes a staph aureus MIC of 1

• Consider alternative methods if determined to be >1 by Etest or BMD

• Lutheran will have software for Bayesian AUC-based dosing

• Do NOT use AUC-based dosing for renal replacement therapy, AKI, high risk AKI, or
surgical prophylaxis
• Once AKI stabilizes, transition to AUC-based dosing

• Lutheran’s new protocol has been approved by P&T

 THANK YOU---SURVEY INSTRUCTIONS:
Legal information:

What are my rights as a participant? Your participation in this study is voluntary. You may elect not to participate in the study, and may drop out
of the study at any time without penalty or loss of benefits to which you would be entitled. Your decision not to participate or to withdraw from the
study will not affect the medical care you will receive. If you wish to withdraw your participation, please contact Christina Ford, PharmD, Lutheran
Hospital, 7950 W. Jefferson Boulevard, Fort Wayne, IN 46804 or by phone at 260-433-8909.

• Please take <5 min to take the post education survey evaluating
your confidence of AUC-MIC guided dosing

• Information collected will be anonymous and used for the Great

Lakes Pharmacy Residency Conference

• You may scan this QR code with your mobile device or click on
this link to access the post education survey (or copy and paste
into web-browser)

• https://www.surveymonkey.com/r/7R3DP7Q
REFERENCES
1. Therapeutic monitoring of vancomycin: A revised consensus guideline and review of the American Society of Health-System Pharmacists, the
Infectious Diseases Society of America, the Pediatric Infectious Diseases Society and the Society of Infectious Diseases. Draft update,
unpublished. Accessed November 1, 2019.

2. RxKinetics. A PK/PD Approach to Antibiotic Therapy. http://rxkinetics.com/antibiotic_pk_pd.html. Accessed December 5, 2019.

3. Stevens RW, Carlo F. Use AUC to Optimize Vancomycin Dosing. Pharmacy Times. 2019-04-04.
https://www.pharmacytimes.com/publications/health-system-edition/2019/march2019/use-auc-to-optimize-vancomycin-dosing. Accessed December
7, 2019.

4. Chavada R, Ghosh N, Sandaradura I, Maley M, Van Hal SJ. Establishment of an AUC threshold for nephrotoxicity is a step towards individualized
vancomycin dosing for methicillin-resistant staphylococcus aureus bacteremia. 2017; 61(5):1-8. doi: 10.1128/AAC.02535-16.

5. Neely MN, Kato L, Youn G, et al. Prospective trial on the use of trough concentration versus area under the curve to determine therapeutic
vancomycin dosing. Antimicrob Agents Chemother. 2018 Jan 25;62(2). pii: e02042-17. doi: 10.1128/AAC.02042-17.

6. Drennan PG, Begg EJ, Gardiner SJ, Kirkpatrick CM, Chambers ST. The dosing and monitoring of vancomycin: what is the best way forward?. Int J
Antimicrob Agents. 2019; 53: 401-407. doi.org/10.1016/j.ijantimicag.2018.12.014.

7. Rybak M, Lomaestro B, Rotschafer JC, et al. Therapeutic monitoring of vancomycin in adult patients: a consensus review of the American Society
of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Am J Health Syst
Pharm. 2009 Jan 1;66(1):82-98. doi: 10.2146/ajhp080434.