Outpatient Vancomycin Therapy: Acute Kidney Injury in Individualized AUC Based Goal Trough Ranges vs. Traditional Trough Dosing

Abstract Background Recent changes to vancomycin Guidelines recommend AUC monitoring in most patients, due to similar effectiveness and reduced rates of acute kidney injury (AKI). Objective The purpose of this study was to assess the incidence of AKI in patients receiving vancomycin dosed by AUC based goal troughs and vancomycin dosed by traditional trough goals (15 – 20 mcg/mL) in the outpatient setting. Methods Patients were included if they received vancomycin outpatient for at least 1 week. The primary objective was incidence of AKI in patients receiving vancomycin outpatient with trough goals derived from patient specific AUC calculations determined as an inpatient compared to patients receiving vancomycin by traditional goal troughs. Secondary objectives included rate of treatment failure, AUC estimated trough range, and number of regimen changes required. Results There were 65 patients in the traditional trough dosing group and 53 patients in the AUC trough dosing group. The incidence of AKI was lower in the AUC trough group (5.7% vs 23.1%; P = 0.01). There were no differences in incidence of treatment failure. The median AUC estimated trough range was 11.4 – 17.1 mcg/mL. There were significantly less average regimen changes required in the AUC dosing group (1.13 vs 1.64; P = 0.006). Conclusion There was a significantly lower incidence of AKI in patients receiving vancomycin dosed by individualized AUC based trough ranges compared to traditional trough dosing. Developing a process for individualized AUC based trough ranges can facilitate a convenient monitoring method to utilize the benefits of vancomycin AUC dosing as an outpatient.