Principles of determining vancomycin drug exposure in adults

Measuring the area under the concentration–time curve over a 24-hour period (AUC24) for vancomycin is superior to using a trough plasma concentration to determine drug exposure and is associated with significantly reduced rates of nephrotoxicity (ie acute kidney injury) and consequent mortalityChuma 2022Covvey 2020D'Amico 2022Finch 2017Neely 2018. AUC24 monitoring for vancomycin should be prioritised in certain patient groups – see Adults in whom monitoring the area under the concentration–time curve (AUC) for vancomycin should be prioritised.

Figure 1. Adults in whom monitoring the area under the concentration–time curve (AUC) for vancomycin should be prioritised

Monitoring the area under the concentration–time curve over a 24-hour period (AUC24) for vancomycin should be prioritised for adults who:

  • are critically ill or unstable
  • have severe, necrotising or deep-seated infections
  • have suspected or confirmed Staphylococcus aureus bacteraemia
  • have obesity
  • have augmented renal clearance [NB1]
  • are at high risk of acute kidney injury (eg patients on concomitant nephrotoxins or who have chronic kidney disease).
Note:

NB1: Augmented renal clearance is a term used to describe the enhanced renal function seen in critically ill patients. The use of unadjusted doses of renally eliminated antimicrobials in these patients may result in treatment failureMahmoud 2017.