Pharmacists approve of vancomycin AUC monitoring, cite improved safety outcomes

Pharmacists have seen improvements in safety outcomes following the change to vancomycin area under the curve (AUC) therapeutic drug monitoring, according to a study. Efficacy, on the other hand, appears similar if not increased.

“Evidence suggests the standard vancomycin trough goal of 15 to 20 mg/L for serious Staphylococcus aureus infections is associated with acute kidney injury, whereas appropriate monitoring of 24-hour AUC may decrease nephrotoxicity,” the investigators said.

Because of this, institutions have transitioned to AUC monitoring, the pharmacokinetic/dynamic parameter of vancomycin, to improve safety outcomes. This method, however, requires more pharmacist time and effort.

To know pharmacist perception of the practice change, an electronic survey was disseminated via e-mail 5 months post-AUC implementation. Items of interest were focused on pharmacist perception: quantity of patients monitored using AUC, justification of the practice change, differences in efficacy and safety, and changes in monitoring time requirements.

Of the 196 pharmacists who were electronically surveyed, 84 responded (43-percent response rate). Eighty-one pharmacists had monitored patients using AUC methods. Of these respondents, 69 percent perceived the change to result in improved or slightly better patient safety, 27 percent described no difference, and 4 percent deemed safety to have decreased or slightly decreased.

Forty-percent of respondents believed that the transition led to increased or slightly increased efficacy, but nearly half (48 percent) saw no difference, while 10 percent said that efficacy was reduced or slightly reduced.

“Pharmacists stated the creation of an institutional calculator decreased the time required to calculate AUC,” the investigators noted.