Use of AUC Versus Trough for Vancomycin TDM – Which Fares Better?

Vancomycin is commonly used for the treatment of infections caused by resistant gram-positive pathogens, notably , methicillin-resistant Staphylococcus aureus (MRSA). Studies have shown that the ratio of area under the curve to minimum inhibitory concentration (AUC/MIC) of ≥400 is the primary pharmacokinetic/pharmacodynamic predictor of vancomycin activity. Conventionally, a trough-targeted dosing approach has been used for therapeutic drug monitoring (TDM). With the publication of new data and the advent of advanced pharmacokinetics software, the consensus guideline released in 2020 recommended the use of the AUC-guided dosing to optimise exposure and minimise nephrotoxicity. Despite this paradigm shift, questions on the implementation of AUC-guided dosing remain: Should we use AUC-guided dosing for all patients? Are the costs of implementation worth it? Does the trough-guided approach remain relevant due to its practicality?

Join this debate session and explore the evidence behind this new TDM recommendation and find out which approach fares better.