International Journal of Multidisciplinary Health Sciences and Research

Category: Original Article,      DOI: Recived: 18/05/2024, Accepted: 22/06/2024, Published online: 29/06/2024

Assessment of Therapeutic Drug Monitoring Strategies for Optimizing Vancomycin Dosing in Critically Ill Patients with Augmented Renal Clearance

Vaibhav Srivastava1* , Laxman Verma2

Abstract

Introduction: Augmented renal clearance (ARC) in critically ill patients poses significant challenges for vancomycin dosing. This study aimed to assess and compare the efficacy of different therapeutic drug monitoring (TDM) strategies for optimizing vancomycin dosing in critically ill patients with ARC. Methods: This prospective, observational study included 150 critically ill patients with ARC receiving vancomycin. Patients were managed using either traditional trough-based TDM (n=75) or area under the curve (AUC)-guided TDM (n=75). Primary outcome was achievement of target AUC/MIC ratios. Secondary outcomes included time to target attainment, clinical cure, and nephrotoxicity. Results: AUC-guided TDM resulted in significantly higher achievement of target AUC/MIC ratios compared to traditional TDM (82.7% vs 64%, p=0.008). Time to target attainment was shorter in the AUC-guided group (38.7 vs 52.3 hours, p<0.001). Higher final daily doses were required in the AUC-guided group (42.5 vs 38.7 mg/kg/day, p=0.009). Clinical cure rates were numerically higher in the AUC-guided group (85.3% vs 77.3%, p=0.213), while nephrotoxicity rates were lower (10.7% vs 16%, p=0.338), though not statistically significant. Multivariate analysis identified AUC-guided TDM as a significant predictor of achieving target AUC/MIC ratios (OR 2.68, 95% CI 1.32-5.45, p=0.006). Conclusion: AUC-guided TDM demonstrates superior performance in achieving target vancomycin exposure in critically ill patients with ARC. This approach results in higher target attainment rates and faster time to target achievement. While larger studies are needed to confirm clinical benefits, these findings support the implementation of AUC-guided vancomycin dosing in patients with ARC.