Effectiveness of a vancomycin dosing protocol guided by area under the concentration-time curve to minimal inhibitory concentration (AUC/MIC) with multidisciplinary team support to improve hospital-wide adherence to a vancomycin dosing protocol: A pilot study

Abstract

Background: Limited data are available on the implementation of an area under the concentration-time curve (AUC)–based dosing protocol with multidisciplinary team (MT) support to improve adherence with vancomycin dosing protocol. Objective: To evaluate the effectiveness of an AUC-based dosing protocol with MT support intervention with adherence to a hospital-wide vancomycin dosing protocol at Thammasat University Hospital. Method: We conducted a quasi-experimental study in patients who were prescribed intravenous vancomycin. The study was divided into 2 periods; (1) the preintervention period when the vancomycin dosing protocol was already applied in routine practice and (2) the post-intervention period when the implementation of an AUC-based dosing protocol with MT support was added to the existing vancomycin dosing protocol. The primary outcome was the rate of adherence, and the secondary outcomes included acute kidney injury events, vancomycin-related adverse events, and 30-day mortality rate. Results: In total, 240 patients were enrolled. The most common infections were skin and soft-tissue infections (24.6%) and bacteremia (24.6%). The most common pathogens were coagulase-negative staphylococci (19.6%) and Enterococcus spp (15.4%). Adherence with the vancomycin dosing protocol was significantly higher in the postintervention period (90.8% vs 55%; P ≤ .001). By multivariate analysis, an AUC-based dosing protocol with MT support was the sole predictor for adherence with the vancomycin dosing protocol (adjusted odds ratio, 10.31; 95% confidence interval, 4.54–23.45; P ≤ .001). The 30-day mortality rate was significantly lower during the postintervention period (8.3% vs 20%; P = .015). Conclusions: AUC-based dosing protocol with MT support significantly improved adherence with vancomycin dosing protocol and was associated with a lower 30-day mortality rate.

Comparison of the mathematical equation and trapezoidal approach for 24 h area under the plasma concentration‐time curve calculation in patients who received intravenous vancomycin in an acute care setting

“…Additionally, the AUC‐based dosing protocol with multidisciplinary team (MT) supports significantly improved adherence with the protocol, associated with a lower 30‐day mortality rate and a trend toward reduction in nephrotoxicity. 18 We suggested calculating AUC from peak and trough vancomycin concentrations obtained during the elimination phase of vancomycin ( C P is 0.5 or 1 h at the end of 2‐h infusion and C T is 1 h before the next dose) that showed the best correlation with the AUC trapezoidal method. Our study supports current recommendations of the AUC‐based monitoring to the target values of 400–600 mg·h/L using two‐point pharmacokinetics calculation.…”

“…To the best of our knowledge, monitoring the AUC of vancomycin to keep the target at 400 to 600 mg/L is by far the better approach for maximizing efficacy and minimizing nephrotoxicity. Additionally, the AUC‐based dosing protocol with multidisciplinary team (MT) supports significantly improved adherence with the protocol, associated with a lower 30‐day mortality rate and a trend toward reduction in nephrotoxicity 18 . We suggested calculating AUC from peak and trough vancomycin concentrations obtained during the elimination phase of vancomycin ( C P is 0.5 or 1 h at the end of 2‐h infusion and C T is 1 h before the next dose) that showed the best correlation with the AUC trapezoidal method.…”

The role of the clinical pharmacist in antimicrobial stewardship in Asia: A review

“…27 Finally, clinical pharmacist involvement in the multidisciplinary team support improved adherence to a vancomycin dosing protocol (90.8% vs 55%; P < .001), and the clinical pharmacist can help the ASP team implement antibiotic heterogeneity through periodic antibiotic monitoring and supervision strategy in both medicine and surgical departments in Japan and Thailand. 28,29 In China, a multicenter study conducted in 8 intensive care units (ICUs) at 4 university hospitals resulted in a lower all-cause hospital mortality in 4 ICUs where clinical pharmacists were involved (19.3% vs 29%; P = .007). 30 But this study had limitations including a short study period, potential selection bias of the clinical cohort, and a small sample size.…”