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GuidelineTherapeutic monitoring of vancomycin for serious MRSA infections: a revised consensus guidelineRybak MJ et al. · 2020

GuidelineSurviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021Evans L et al. · 2021

GuidelineTRIPOD+AI statement: updated guidance for reporting clinical prediction modelsCollins GS et al. · 2024

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Therapeutic monitoring of vancomycin for serious MRSA infections

Revised consensus guideline

Rybak MJ et al. · Am J Health Syst Pharm · 2020

Abstract

This revision updates vancomycin dosing and monitoring for serious MRSA infections. An individualized AUC target of 400–600 mg·h/L (MIC 1 mg/L) is advised. Trough-only monitoring at 15–20 mg/L is no longer recommended, as it adds kidney injury risk. Bayesian AUC estimation is the preferred method.

This revision updates vancomycin dosing and monitoring for serious MRSA infections. An individualized AUC target of 400–600 mg·h/L (MIC 1 mg/L) is advised. Trough-only monitoring at 15–20 mg/L is no longer recommended, as it adds kidney injury risk. Bayesian AUC estimation is the preferred method.

This revision updates vancomycin dosing and monitoring for serious MRSA infections. An individualized AUC target of 400–600 mg·h/L (MIC 1 mg/L) is advised. Trough-only monitoring at 15–20 mg/L is no longer recommended, as it adds kidney injury risk. Bayesian AUC estimation is the preferred method.

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Why AUC instead of trough?

The revision favors AUC-guided dosing over trough targets.

Target AUC 400–600 (MIC 1)1

Trough-only 15–20 is no longer advised due to kidney risk2

Bayesian AUC estimation is preferred

Evidence 2Rybak 2020

Ask about this paperWhy AUC instead of trough?Source: This paper

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P&T committee

Only me · Today

Adopt AUC-based vancomycin TDM

24 h stop compliance for prophylaxis

Posting schedule for the revision

Decisions

Post the revision as required reading

To-dos

Review a TDM calculator

Schedule surgical team training

AE reporting SOP

TRIPOD+AI

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Ask Alphadoc, or type @ to add a sourceAntibiotic guideline revisionPut the changes in a tableSourcesSources: Internal board

Antibiotic guideline revisionPut the changes in a table

What changed

The revision aligns prophylaxis timing and duration with international guidelines. Board

TimingWithin 60 minGuideline

DurationStop within 24 hGuideline

VancomycinAUC 400–600Paper

Sources 3BoardGuidelinePaper

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