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Murphy ME, Tang Girdwood S, Goldman JL, Scheetz MH, Downes KJ. Precision dosing of vancomycin: in defence of AUC-guided therapy in children. J Antimicrob Chemother 2021; 76:2494-2497. [PMID: 34096598 PMCID: PMC8633448 DOI: 10.1093/jac/dkab194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In 2020, new vancomycin guidelines were released, recommending the transition from trough-based to AUC24 monitoring for adult and paediatric patients. Given the resources required to achieve this transition, there has been debate about the costs and benefits of AUC24-based monitoring. A recent narrative review of vancomycin therapeutic drug monitoring in paediatrics claims to have uncovered the methodological weaknesses of the data that informed the guidelines and advises against premature adoption of AUC24-guided monitoring. In this article, we present supporting arguments for AUC24-guided monitoring in children, which include that: (i) troughs alone are inadequate surrogates for AUC24; (ii) vancomycin-associated nephrotoxicity has significant consequences that warrant optimization of dosing; (iii) a substantial portion of children receiving vancomycin are at high risk for poor outcomes and deserve targeted monitoring; and (iv) limited efficacy data in support of AUC24 is not a justification to revert to a less supported monitoring approach.
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Affiliation(s)
- Mark E Murphy
- Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Division of Clinical Pharmacology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Sonya Tang Girdwood
- Division of Clinical Pharmacology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jennifer L Goldman
- Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children’s Mercy Kansas City, Kansas City, MO, USA
- Division of Infectious Diseases, Children’s Mercy Kansas City, Kansas City, MO, USA
- Department of Pediatrics, University of Missouri—Kansas City, Kansas City, MO, USA
| | - Marc H Scheetz
- Pharmacometrics Center of Excellence, Department of Pharmacy Practice, College of Pharmacy, Chicago, IL, USA
- Department of Pharmacology, College of Graduate Studies, Midwestern University, Chicago, IL, USA
- Department of Pharmacy, Northwestern Medicine, Chicago, IL, USA
| | - Kevin J Downes
- The Center for Clinical Pharmacology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- The Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
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Leroux S, van den Anker JN, Smits A, Pfister M, Allegaert K. Maturational changes in vancomycin protein binding affect vancomycin dosing in neonates. Br J Clin Pharmacol 2019; 85:865-867. [PMID: 30834552 PMCID: PMC6475736 DOI: 10.1111/bcp.13899] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 02/04/2019] [Accepted: 02/07/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- Stéphanie Leroux
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital BaselUniversity of BaselBaselSwitzerland
- Neonatal Intensive Care UnitUniversity Hospital RennesRennesFrance
| | - Johannes N. van den Anker
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital BaselUniversity of BaselBaselSwitzerland
- Division of Clinical PharmacologyChildren's National Health SystemWashingtonDCUSA
| | - Anne Smits
- Neonatal Intensive Care UnitUniversity Hospitals LeuvenLeuvenBelgium
- Department of Development and RegenerationKU LeuvenLeuvenBelgium
| | - Marc Pfister
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital BaselUniversity of BaselBaselSwitzerland
- Certara LPPrincetonNJUSA
| | - Karel Allegaert
- Department of Development and RegenerationKU LeuvenLeuvenBelgium
- Department of Pediatrics, Division of Neonatology, Erasmus MC Sophia Children's HospitalUniversity Medical Center RotterdamRotterdamThe Netherlands
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