The DOI matches its Crossref record; 22 of the 22 references it cites were found in a registry or an index.
Prospective Trial on the Use of Trough Concentration versus Area under the Curve To Determine Therapeutic Vancomycin Dosing
Open accessAbstract
We hypothesized that dosing vancomycin to achieve trough concentrations of >15 mg/liter overdoses many adults compared to area under the concentration-time curve (AUC)-guided dosing. We conducted a 3-year, prospective study of vancomycin dosing, plasma concentrations, and outcomes. In year 1, nonstudy clinicians targeted trough concentrations of 10 to 20 mg/liter (infection dependent) and controlled dosing. In years 2 and 3, the study team controlled vancomycin dosing with BestDose Bayesian software to achieve a daily, steady-state AUC/MIC ratio of ≥400, with a maximum AUC value of 800 mg · h/liter, regardless of trough concentration. For Bayesian estimation of AUCs, we used trough samples in years 1 and 2 and optimally timed samples in year 3. We enrolled 252 adults who were ≥18 years old with ≥1 available vancomycin concentration. Only 19% of all trough concentrations were therapeutic versus 70% of AUCs ( P < 0.0001). After enrollment, median trough concentrations by year were 14.4, 9.7, and 10.9 mg/liter ( P = 0.005), with 36%, 7%, and 6% over 15 mg/liter ( P < 0.0001). Bayesian AUC-guided dosing in years 2 and 3 was associated with fewer additional blood samples per subject (3.6, 2.0, and 2.4; P = 0.003), shorter therapy durations (8.2, 5.4, and 4.7 days; P = 0.03), and reduced nephrotoxicity (8%, 0%, and 2%; P = 0.01). The median inpatient stay was 20 days among nephrotoxic patients versus 6 days ( P = 0.002). There was no difference in efficacy by year, with 42% of patients having microbiologically proven infections. Compared to trough concentration targets, AUC-guided, Bayesian estimation-assisted vancomycin dosing was associated with decreased nephrotoxicity, reduced per-patient blood sampling, and shorter length of therapy, without compromising efficacy. These benefits have the potential for substantial cost savings. (This study has been registered at ClinicalTrials.gov under registration no. NCT01932034.)
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Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2008.08.010 · Cited by 51,384
Rybak, M., Lomaestro, B., Rotschafer, J. C., Moellering, R., Craig, W., Billeter, M., Dalovisio, J. R., & Levine, D. P. (2009) · American Journal of Health-System Pharmacy · doi:10.2146/ajhp080434 · Cited by 1,795
The Pharmacokinetic and Pharmacodynamic Properties of Vancomycin
Rybak, M. J. (2006) · Clinical Infectious Diseases · doi:10.1086/491712 · Cited by 774
Moise-Broder, P. A., Forrest, A., Birmingham, M. C., & Schentag, J. J. (2004) · Clinical Pharmacokinetics · doi:10.2165/00003088-200443130-00005 · Cited by 757
van Hal, S. J., Paterson, D. L., & Lodise, T. P. (2013) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.01568-12 · Cited by 639
Are Vancomycin Trough Concentrations Adequate for Optimal Dosing?
Neely, M. N., Youn, G., Jones, B., Jelliffe, R. W., Drusano, G. L., Rodvold, K. A., & Lodise, T. P. (2014) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.01653-13 · Cited by 392
Self-citationInnovative approaches to optimizing the delivery of vancomycin in individual patients
Pai, M. P., Neely, M., Rodvold, K. A., & Lodise, T. P. (2014) · Advanced Drug Delivery Reviews · doi:10.1016/j.addr.2014.05.016 · Cited by 292
Self-citationFinch, N. A., Zasowski, E. J., Murray, K. P., Mynatt, R. P., Zhao, J. J., Yost, R., Pogue, J. M., & Rybak, M. J. (2017) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.01293-17 · Cited by 241
Cataldo, M. A., Tacconelli, E., Grilli, E., Pea, F., & Petrosillo, N. (2012) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dkr442 · Cited by 204
Lodise, T. P., Drusano, G. L., Zasowski, E., Dihmess, A., Lazariu, V., Cosler, L., & McNutt, L.-A. (2014) · Clinical Infectious Diseases · doi:10.1093/cid/ciu398 · Cited by 167
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Tong, S. Y. C., Lye, D. C., Yahav, D., Sud, A., Robinson, J. O., Nelson, J., Archuleta, S., Roberts, M. A., Cass, A., Paterson, D. L., et al. (2020) · JAMA · doi:10.1001/jama.2020.0103 · Cited by 279
He, N., Su, S., Ye, Z., Du, G., He, B., Li, D., Liu, Y., Yang, K., Zhang, X., Zhang, Y., et al. (2020) · Clinical Infectious Diseases · doi:10.1093/cid/ciaa1536 · Cited by 155
Turner, R. B., Kojiro, K., Shephard, E. A., Won, R., Chang, E., Chan, D., & Elbarbry, F. (2018) · Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy · doi:10.1002/phar.2191 · Cited by 135
Metadata
- Authors
- Neely, M. N., Kato, L., Youn, G., Kraler, L., Bayard, D., van Guilder, M., Schumitzky, A., Yamada, W., Jones, B., & Minejima, E.
- Venue
- Antimicrobial Agents and Chemotherapy
- Publisher
- American Society for Microbiology
- Published
- 2018-02
- Volume
- 62
- Issue
- 2
- ISSN
- 0066-4804 (ISSN-L)
- 1098-6596
- OpenAlex
- W2774974184
- Cited by
- 359
- References
- 22
- FWCI
- 16.84
- Type
- journal article
- Language
- en
- Open access
- green
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- Neely, M. N., Kato, L., Youn, G., Kraler, L., Bayard, D., van Guilder, M., Schumitzky, A., Yamada, W., Jones, B., & Minejima, E. (2018). Prospective Trial on the Use of Trough Concentration versus Area under the Curve To Determine Therapeutic Vancomycin Dosing. Antimicrobial Agents and Chemotherapy. https://doi.org/10.1128/aac.02042-17
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