AUC-based vancomycin dosing tied to reduced AKI incidence in children

Area under the curve (AUC)-guided dosing of vancomycin results in fewer incidences of acute kidney injury (AKI) in paediatric patients without sacrificing efficacy, reports a study.

“Vancomycin therapeutic drug monitoring is essential for optimizing efficacy and minimizing toxicity, particularly in AKI,” the authors said. “However, recent guidelines favour AUC-guided dosing over traditional trough monitoring to improve dosing.”

A total of 288 paediatric patients (2 months to 18 years of age) who underwent vancomycin therapeutic drug monitoring between 2017 and 2019 (trough-based dosing) and 2020 and 2022 (AUC-based dosing) were included in this retrospective cohort study.

The authors used Bayesian software to estimate the pharmacokinetic parameters. They also performed receiver operating characteristics curve analysis to identify the threshold values of AUC and trough concentrations for predicting AKI, which was defined according to the Kidney Disease: Improving Global Outcomes criteria.

Of the patients, 164 were from 2017 to 2019 and 124 from 2020 to 2022. No significant between-group difference was observed in the comparison of the 1-point and 2-point sampling methods for estimating the AUC.

AKI incidence was slightly lower in the 2020‒2022 cohort than in the 2017‒2019 cohort (2.4 percent vs 6.7 percent), but the difference did not reach statistical significance. The AUC threshold for predicting AKI was comparable between 1-point and 2-point sampling methods (688‒621 mg g/L).

“Further studies are warranted to refine the exposure targets for bacteremia resolution,” the authors said.