Decreasing Patient Exposure to Vancomycin

Segment Description: Matthew Girgis, PharmD, PGY-2 pharmacy resident at Boston Medical Center, discusses why it's advantageous to decrease patient exposure to vancomycin.

Interview transcript (modified slightly for readability):

Dr. Girgis: "There's many reasons why it would be advantageous for patients to have decreased exposure to vancomycin. I talked a little bit about how all this data is derived from troughs and we realized that, with all this trough data, we're actually overexposing patients. Vancomycin nephrotoxicity is such in that it's exposure-related so we see an increased rate of nephrotoxicity that is directly correlated and related to the amount of exposure that the patient receives, so by decreasing the amount that we administer, we also hope and we find that the rate of nephrotoxicity also decreases. That's been shown in the literature for other institutions that have actually rolled out AUC dosing, as well as when we even look at the original trough literature—even when we go back to the 2009 ASHP vancomycin dosing guidelines—we do find independent associations with nephrotoxicity when the trough is over 15 micrograms per milliliter. Different ranges...it's more of a continuum, but the range is typically above 15 has been associated with acute kidney injury in these patients. That's the main reason to go back to AUC dosing, but there's also other reasons as well. It gets patients on a stable regimen sooner, so if you collect a peak and a trough after the very first dose in the patient's regimen, we're able to achieve a more stable regimen for the patient sooner and it results in less levels that we actually take on these patients long-term in their treatment course so many different reasons why we should switch."

Girgis presented the study, “Hospital Wide Implementation of Vancomycin Area Under the Curve/Minimum Inhibitory Concentration (AUC/MIC) Dosing at a Large Academic Medical Center,” at MAD-ID 2019, held May 8-11, 2019, in Orlando, Florida.