{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T07:17:00Z","timestamp":1791357420881,"version":"4.3.1"},"reference-count":19,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2019,3,18]],"date-time":"2019-03-18T00:00:00Z","timestamp":1552867200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:sec><jats:title>Study Objective<\/jats:title><jats:p>The optimal pharmacodynamic parameter for the prediction of efficacy of vancomycin is the area under the concentration\u2013time curve (AUC), and current published data indicate that dosing based on vancomycin trough concentrations is an inaccurate substitute. In this study, our objective was to compare the achievement of therapeutic target attainment after switching from a trough\u2010based to an AUC\u2010based dosing strategy as a part of our institution's vancomycin\u2010per\u2010pharmacy protocol.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Prospective observational quality assurance study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Academic medical center.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients<\/jats:title><jats:p>A total of 296 hospitalized adults who received vancomycin and monitoring under our institution's vancomycin\u2010per\u2010pharmacy protocol were included in the analysis. The preimplementation retrospective comparison group consisted of 179 patients in whom vancomycin was initiated using a trough\u2010based dosing strategy between November 22, 2017, and January 22, 2018. The postimplementation group included 117 patients in whom vancomycin was initiated using an AUC\u2010based dosing strategy using two\u2010point sampling between June 19, 2018, and July 19, 2018, after hospital\u2010wide implementation of this protocol on June 19, 2018.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements and Main Results<\/jats:title><jats:p>AUC values were calculated from two vancomycin concentrations (peak and trough). The primary outcome was achievement of therapeutic AUC values (400\u2013800\u00a0mg\u00b7hr\/L) in the postimplementation group or therapeutic trough level values (10\u201320\u00a0mg\/L) in the preimplementation group. Only 98 (55%) of 179 initial trough values were therapeutic in the preimplementation group (trough\u2010only dosing method) versus 86 (73.5%) of 117 initial AUC values in the postimplementation group (AUC\u2010based dosing method) (p=0.0014). A lower proportion of supratherapeutic AUC values was observed in the postimplementation group compared with supratherapeutic trough concentrations in the preimplementation group (1.7% vs 18%, p&lt;0.0001). Overall, 62% of patients with initially therapeutic AUC values had subsequent trough value increases of 25% or greater, occurring at a median of 6\u00a0days of vancomycin therapy. Nephrotoxicity occurred in 11% of patients in the preimplementation versus 9.4% in the postimplementation group (p=0.70).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Compared with a trough concentration\u2013based dosing strategy, AUC\u2010based dosing using two\u2010point sampling improved therapeutic target attainment. Implementation is feasible at any hospital that performs vancomycin peak concentration testing and is a workable alternative to using Bayesian software for estimating AUC. This approach should also be directly compared with AUC\u2010based dosing using Bayesian software.<\/jats:p><\/jats:sec>","DOI":"10.1002\/phar.2234","type":"journal-article","created":{"date-parts":[[2019,2,10]],"date-time":"2019-02-10T04:29:53Z","timestamp":1549772993000},"page":"433-442","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":92,"title":["Conversion from Vancomycin Trough Concentration\u2013Guided Dosing to Area Under the Curve\u2013Guided Dosing Using Two Sample Measurements in Adults: Implementation at an Academic Medical Center"],"prefix":"10.1002","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6874-7798","authenticated-orcid":false,"given":"Lina","family":"Meng","sequence":"first","affiliation":[{"name":"Department of Pharmacy Stanford Health Care Stanford California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiffany","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Stanford Health Care Stanford California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Stanford Health Care Stanford California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Mui","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Stanford Health Care Stanford California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinhkhoa","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Information Technology Services Stanford Health Care Stanford California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriela","family":"Espinosa","sequence":"additional","affiliation":[{"name":"Department of Information Technology\u2013Clinical and Business Analytics Stanford Health Care Stanford California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janjri","family":"Desai","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Stanford Health Care Stanford California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marisa","family":"Holubar","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Geographic Medicine Stanford University School of Medicine Stanford California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stan","family":"Deresinski","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Geographic Medicine Stanford University School of Medicine Stanford California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,3,18]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.2146\/ajhp080434"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01653-13"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01293-17"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.02042-17"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.02478-16"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.addr.2014.05.016"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.2146\/ajhp180034"},{"key":"e_1_2_6_9_1","unstructured":"Stanford Antimicrobial Safety and Sustainability Program. 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