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- W3137150206 abstract "The 2020 vancomycin consensus guideline published in AJHP1 was met with excitement from pharmacists looking to improve patient care through implementation of area under the concentration (AUC)–based monitoring.1 Listservers, personal communications, and publications demonstrate pharmacists’ interest in implementing AUC dosing along with their apprehension about how this can be done systematically.2 The guideline is commendable for collating and summarizing decades of data with the goal of optimizing vancomycin exposure while minimizing toxicity, but there is a risk of overcommitting health-system pharmacists to intensive pharmacokinetic monitoring for what we believe to be little appreciable patient care gain. Guideline recommendation 1 advises AUC monitoring for serious methicillin-resistant Staphylococcus aureus (MRSA) infections only; however, it also recommends AUC determination during the empiric therapy period (24-48 hours) and for patients with unstable renal function (recommendations 2 and 4, respectively).1 Hence, there is substantial risk of applying these guidelines to all patients receiving parenteral vancomycin, regardless of whether they have serious MRSA infections. The previous consensus guideline, published in 2009 with similar recommendation caveats, was applied to all patients receiving parenteral vancomycin in many health systems.3 Unfortunately, this led to increased occurrence of acute kidney injury without appreciable efficacy gains.1 This is intuitive. Vancomycin kills bacteria in a concentration-independent manner; this was evidenced in the PROVIDE study, in which higher AUC thresholds led to increased toxicity without increasing efficacy.4" @default.
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- W3137150206 date "2021-03-25" @default.
- W3137150206 modified "2023-10-03" @default.
- W3137150206 title "Pragmatic application of AUC-based monitoring recommendations from the 2020 vancomycin consensus guidelines" @default.
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- W3137150206 doi "https://doi.org/10.1093/ajhp/zxab121" @default.
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