Should Therapeutic Monitoring of Vancomycin Based on Area under the Curve Become Standard Practice for Patients with Confirmed or Suspected Methicillin-Resistant Staphylococcus aureus Infection?

摘要

The pharmacokinetic-pharmacodynamic parameter best correlated with efficacy of vancomycin in the treatment of infections with methicillin-resistant Staphylococcus aureus (MRSA) is the 24-h ratio of area under the curve (AUC) to minimum inhibitory concentration (MIC).1,2 Given the need for multiple measurements of vancomycin level and complex calculations, the trough level has historically been used as a surrogate marker. In the 2009 guidelines for therapeutic monitoring of vancomycin,3 troughs of 15–20 μg/mL were recommended, on the basis that these levels should correlate with an AUC/MIC of at least 400 mg*h/L, the true efficacy target. Since the implementation of these recommendations, reports of increased toxic effects have raised concerns about overly aggressive dosing, and clinicians have attempted to identify strategies to better balance targeted clinical efficacy with the risk of toxic effects.