Consensus statements recently published in the June 1, 2020, issue of the American Journal of Health-System Pharmacy shed new light on the appropriate dosing and monitoring of vancomycin in adult and pediatric patients with methicillin-resistant Staphylococcus aureus (MRSA). The guideline updates recommendations published in 2009 and are the result of a literature review conducted by member experts from ASHP (American Society of Health-System Pharmacists), the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Diseases Society (PIDS), and SIDP.
The practice of routine monitoring and adjusting of drug dosages based on serum vancomycin concentrations has been the subject of intense debate for over six decades. The authors revisited previous recommendations for the use of trough monitoring as a surrogate marker of area-under-the-curve over 24-hours to minimum inhibitory concentrations (AUC/MIC). The expert panel evaluated contemporary literature for scientific data and reports of increased nephrotoxicity in adult and pediatric patients. Their analysis found that when AUC/MIC monitoring has been employed, there is a significant reduction in vancomycin exposure and kidney injury.
"These recommendations represent a significant shift in the practice of vancomycin monitoring and, for the first time, explore the effects on both adult and pediatric patients," said Michael Rybak, Pharm.D., Ph.D., M.P.H., lead author of the guidelines and Professor of Pharmacy & Medicine at the Eugene Applebaum College of Pharmacy & Health Sciences at Wayne State University in Detroit. “The guidelines also update clinicians on the use of vancomycin loading doses, continuous versus intermittent dosing, and the use in additional special patient populations such as neonates and children, obesity and patients receiving various forms of dialysis.”
SIDP and the partnering organizations plan to develop programming and resources to assist clinicians in implementing the new guidelines.
The sponsoring organizations acknowledge the extensive effort and dedication of the authors to analyze the evidence and formulate the revised recommendations. Participating on the expert panel were:
- Michael J. Rybak, Pharm.D., M.P.H., Ph.D., FCCP, FIDP, FIDSA (Chair)
- Jennifer Le, Pharm.D., M.A.S., BCPS-ID, FCCP, FCSHP, FIDSA
- Thomas P. Lodise, Pharm.D., Ph.D.
- Donald P. Levine, M.D., FACP, FIDSA
- John S. Bradley, M.D., J.S.B., FAAP, FIDSA, FPIDS
- Catherine Liu, M.D., FIDSA
- Bruce A. Mueller, Pharm.D., B.S. Pharm, FASN, FCCP, FNKF
- Manjunath P. Pai, Pharm.D., FCCP
- Annie Wong-Beringer, Pharm.D., FCCP, FIDSA
- John C. Rotschafer, Pharm.D., FCCP
- Keith A. Rodvold, Pharm.D., FCCP, FIDSA
- Holly D. Maples, Pharm.D.
- Benjamin M. Lomaestro, Pharm.D., B.S. Pharm,
The document is available online on ajhp.org.
SIDP is an association of pharmacists and allied healthcare professionals dedicated to promoting the appropriate use of antimicrobial agents. SIDP membership is comprised of 1,500 members in hospital, academic, industry, governmental organizations, and other practice settings across all 50 states and throughout the globe. The mission of SIDP is to advance infectious diseases pharmacy and lead antimicrobial stewardship in order to optimize the care of patients.
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